The Importance of Prostate Cancer Screenings

with Alex Zacharias, M.D., Urologist, Advanced Healthcare

Posted: Sept. 1, 2004

For men, the greatest risk of cancer statistically throughout life comes from a walnut-sized gland called the prostate that sits just below the bladder. For reasons not fully understood, as men age the prostate becomes increasingly susceptible to cancer. It is the most commonly diagnosed cancer in men, and according to the American Cancer Society, it will put one in six men at risk at some point in their life. Behind lung cancer, prostate cancer is the leading cause of cancer death among men.

But the good news is that prostate cancer is also one of the most treatable forms of cancer, according to Alex Zacharias, M.D., a urologist with Advanced Healthcare. “Caught early, the survival rate for prostate cancer is nearly 100%. However, because symptoms are often nonexistent, many men never find out they have the disease until it’s too late. That’s why early detection is key and regular screenings are important.”

Alex Zacharias, M.D., Urologist, Advanced Healthcare "Regular screenings play a vital role in catching prostate cancer early, when it’s most treatable."

Digital Rectal Exam (DRE)
A DRE is one of two basic tests used by physicians to screen for prostate cancer. The other is the prostate-specific antigen test, or PSA. While debate exists surrounding routine PSA testing, there is little debate on the value of the DRE.

“All men should be get an annual DRE starting at age 50,” explains Dr. Zacharias. “And they should start at age 40 if they are at increased risk for the disease.”

During a DRE, the physician inserts a gloved, lubricated finger into the rectum to assess the texture, size and shape of the prostate gland. The exam is simple and painless.
PSA

The prostate-specific antigen test, or PSA, is another important screening tool physicians like Dr. Zacharias use to help detect prostate cancer. PSA is an enzyme made by the prostate that helps liquefy semen. Testing the amount of PSA circulating in the bloodstream can identify prostate cancer while still confined to the gland.

It's normal for a small amount of PSA to be found in the blood, and as men age the normal level of PSA may increase slightly, which is why physicians now use an age-adjusted scale in PSA testing.

“PSA is a tumor marker, but it’s not perfect because it can be elevated for more than one reason,” says Dr. Zacharias. “In addition to advancing age, enlargement of the prostate, inflammation and even something as simple as a bladder infection can cause elevation.”

If a PSA is elevated, a physician may recommend a transrectal ultrasound and biopsy of the prostate to rule out cancer.

Dr. Zacharias agrees with the American Cancer Society recommendations that men have annual PSA testing starting at age 50, and that African American men, who as a group are at an increased risk of prostate cancer, along with men who have a family history of the disease (father, brother, uncle on father’s side), be screened starting at age 40.

However, statistics show older men may have less benefit from regular PSA testing. In men over 80 years of age, or those with a life expectancy of less than 10 years, screening may identify slow growing cancer that may not produce any symptoms, and may unlikely be the ultimate cause of death. Treatment of these cancers could result in little benefit, but rather result in significant side effects, including impotence and incontinence.

Dr. Zacharias says in the end the decision to pursue regular screening should be up to the patient who has all the necessary information.

“If a man has 10 to 15 years life expectancy, and he’s going to have prostate cancer, it makes sense to diagnose early. Life expectancy is the critical factor in how we evaluate and treat. In men with less than 10 years of life ahead, I do not recommend screening. However, under normal circumstances, the most important thing is to find prostate cancer early and treat it. That is what we strive to do.”

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