When Should Men Start Screening For Prostate Cancer?

Hey there Guys,

Today I wanted to cover an important topic for all men. Prostate Cancer.

In Australia there has been a number of screening campaigns encouraging men to be checked for prostate cancers with some men confused and worried about when they should have their first test.

Today I wanted to help clarify this.

First it’s important to understand exactly who is more likely to have the risk of prostate cancer.

Prostate cancer is most common in men aged over 50 with 80% of new prostate cancer found in men over the age of 60.

Men who have a father or brother who has had prostate cancer are at a higher risk of also developing prostate cancer. There is emerging evidence if you have a mother or sister who has had breast or ovarian cancer there can be increased risk of prostate cancer in their immediate male relatives.

Majority of prostate cancers found grow very slowly without requiring treatment or surgery. There are some forms of prostate cancer that can grow and spread quickly. These are frequently found in younger men and there does seem to be a connection between the genes associated breast and ovarian cancer and this type of prostate cancer.

How do we test for prostate cancer?

Currently the first port of call for testing for prostate cancer is “digital rectal exam” or DRE AKA, “the finger up the bum”. This is combined with a blood test that checks for prostate specific antigen also called PSA testing

In 80% of prostate cancers there will be a raise in PSA but there is 20% of cancers that will not cause a rise in PSA. Because of the position of the prostate, examination with the finger is not able to feel all the prostate, if the cancer is small or out of reach it can be missed.

If either of these tests come back abnormal the next step is to have an ultrasound of the prostate and in some cases biopsies to examine for cancer cells.

Who should be tested for prostate cancer?

Current recommendations are that men aged 55 to 70 should consider testing if worried or have symptoms. If you are young and concerned or have a brother or father who has had prostate cancer it is suggested to have a single PSA test done at the age of 40 to help predict your potential risk of developing prostate cancer over then next 25 years.

Currently it is recommended to only do PSA testing on men who have symptoms of prostate problems. These include:

  • needing to pass urine on a frequent basis
  • difficulty starting or stopping the urine stream
  • poor urine stream and bladder emptying
  • post urination dribbling
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If you do not have any of the symptoms mentioned then the current guideline suggest only getting testing done if you are particularly concerned. This is because the risk of harm from testing, ultrasounds and biopsy is high compared to the benefit of early cancer detection.

Of course if you have concerns your family doctor will be able to help answer your questions.

In summary the current guidelines suggest waiting till you are 55 before considering prostate cancer screening and even then if you don’t have symptoms it’s unlikely you are at immediate risk. Again, be sure to talk to your doctor if you have worries.

Yours in good health.

Dr George

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