What is prostate cancer screening ?
Screening
Organized screening for prostate cancer would involve systematically searching for the disease in an asymptomatic population.
This screening has been the subject of much debate since 1994, when the US regulatory authorities (Food and Drug Administration or FDA) approved the use of PSA testing in conjunction with digital rectal examination as an aid in detecting prostate cancer in men aged 50 and older.
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PSA, which stands for Prostate Specific Antigen , is a protein secreted into the blood by normal or tumor prostate cells.
The PSA level is measured in the bloodstream after a simple blood test and is expressed in nanograms per milliliter (ng/ml). For men under 70 years old, a PSA level below 3 ng/ml is considered normal.
PSA levels typically increase slightly with age, so beyond the age of 70, a level up to 6.5 ng/ml is generally reassuring (source: arcagy.org). Besides elevations due to prostate cancer, PSA blood levels can increase under various circumstances . For instance, physical exercise, especially cycling, prostate infection (prostatitis), or benign prostatic hyperplasia (enlargement of the prostate due to a benign tumor), can all cause PSA levels to rise.
Therefore, PSA is not solely indicative of cancer , although its measurement can contribute to the detection of certain prostate cancers. Interpreting PSA levels can be nuanced and should be done by a physician who monitors changes in PSA levels over time.
PSA testing, what are the benefits ?
Currently, the benefit of PSA testing for the entire male population has not been definitively proven. Therefore, screening for prostate cancer using PSA testing is not recommended on a population-wide scale.
However, early detection of prostate cancer using PSA testing and digital rectal examination may be offered on an individual basis by a physician, especially for those at risk.
PSA testing should only be conducted after a thorough discussion between the patient and their doctor. The doctor will explain what PSA is, the uncertainties associated with its results, and the possibility of detecting prostate cancer through this test.
The issue of early detection
The doctor will outline the risks associated with early detection. These risks include complications from diagnostic procedures following early detection, such as the need for biopsies.
They may also be related to the complications of chosen management strategies or the psychological and social consequences of a cancer diagnosis. The doctor will present the main characteristics of prostate cancer, the different treatment options, and their potential side effects. They will ensure that the approach to early detection and its potential consequences align with the patient's expectations.
In general, this comprehensive discussion between the doctor and patient typically occurs between ages 50 and 75. If there are risk factors present, this dialogue may begin earlier, between ages 40 and 45. It is recommended to revisit this discussion every two to four years based on the patient's risk profile (2022 Recommendations from the French Urology Association or AFU).
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Article updated on Nov 21, 2024
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