30 August 2022

When men should consider prostate cancer screening

30 August 2022

When men should consider prostate cancer screening

Understanding prostate health and disease, risk factors, screening & diagnosis

The prostate is a gland which is part of the male exocrine system. It helps make semen and is positioned just below the urinary bladder. In healthy men, the prostate is around the size of an egg and weighs 20-30 grams.

The prostate gland is sensitive to androgenic hormones and can become affected by a range of conditions which become more prevalent in older men.

Common disorders affecting the prostate include benign prostatic hyperplasia (BHP), prostatitis and prostate cancer. Conditions that affect the prostate are generally characterised by inflammation or enlargement of the gland.

Men suffering from prostate disorders frequently experience a range of symptoms which can include problems urinating including poor stream, urine retention and urinary incontinence, and increased frequency of urination which can disrupt sleep.

Statistics and outcomes

According to the Australian Government, prostate cancer was the most diagnosed cancer in males and the second most diagnosed cancer overall in 2021.

There were an estimated 18,110 new cases of prostate cancer diagnosed in 2021, accounting for 23% of all new male cancer diagnoses.

There were an estimated 3,323 deaths from prostate cancer in Australia in 2021, which accounted for 12% of all male deaths from cancer during the year.

While these statistics may sound grim, they underline the importance of screening and early detection. The good news is the same statistics show a 96% chance of survival for at least five years for all males diagnosed with prostate cancer from 2013-2017. 

Risk factors

The most significant risk factor for developing prostate cancer is age, which is why it’s important for older men to schedule regular prostate screening exams. The risk of developing prostate cancer increases significantly after the age of 50.

Family history also plays a role. Having a father or brother develop prostate cancer before the age of 60 increases one’s risk - as does any family history of prostate, breast or ovarian cancer, especially BRCA1 and BRCA2 gene mutations.

There is additionally an association between high testosterone hormone levels and the development of prostate cancer.

Advanced prostate cancer symptoms can include frequent urination, pain while urinating or blood in the urine, a weak stream, pain in the pelvis area or lower back and weakness in the legs or feet. 

What tests are available?

There are several tests which can help doctors diagnose or rule out prostate cancer and other prostate conditions. 

PSA Blood Test: This the current gold standard screening test. A prostate specific antigen (PSA) test is a blood test that measures levels of proteins made by both normal and cancerous prostate cells. PSA levels can be variable, and it is not a definitive test in and of itself. Doctors may schedule regular PSA tests to gauge results over time in order to determine a patient’s level of risk. 

Digital Rectal Examination: A manual examination that is generally recommended for prostate cancer for men who are exhibiting symptoms of the condition, however, is sometimes performed as part of screening. 

Diagnostic imaging: In some instances, where cancer is suspected, further tests including an MRI of the prostate and PSMA PET scans may be scheduled to determine whether the cancer is contained in the prostate.

When to consider screening/testing

It is a good idea to start a conversation with your doctor about it when you are 50.

This may start earlier if you experience symptoms such as difficulty urinating or blood in the urine or semen or have a family history of prostate cancer. 

The discussion about screening should take place at: 

  • Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years. 
  • Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65). 
  • Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age). 

After this discussion, men who want to be screened should get the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.

What is a prostate MRI?

A magnetic resonance imaging (MRI) scanner uses strong magnetic fields to create an image of the prostate and surrounding tissues.

A doctor may request this test to find evidence of cancer in the prostate gland if you have a high or rising prostate specific antigen (PSA) level. PSA is usually raised when you have prostate cancer but can also be raised for other reasons; for example, if you have an infection of the prostate gland (prostatitis).

A prostate MRI is used to show the presence of high-grade prostate cancer, to more clearly show the extent of known prostate cancer (specifically to see if it is contained within the prostate gland or if it has spread outside the gland) and can help in planning surgery and radiotherapy treatment for prostate cancer.

A prostate MRI scan must be requested by a specialist doctor and must meet specific criteria to meet Medicare eligibility. Find out more here

What is a PSMA PET scan?

PET stands for ‘positron emission tomography’ and is a nuclear imaging test used to diagnose a range of cancers, heart disease and other conditions.

Prostate specific membrane antigen (PSMA) PET scans are an extremely accurate tool used to diagnose the existence of and spread of prostate cancer.

When conducting a PSMA PET scan, a clinician injects a tiny radio tracer into the patient’s vein which binds with the cancer cells. The patient goes into a PET scanner where images are then taken of the entire body. Cancerous cells as small as 3mm can then be detected anywhere in the patient’s body.

A PET scan must be requested by a specialist doctor and must meet specific criteria to meet Medicare eligibility. Find out more here

Diagnosis and resources

A prostate cancer diagnosis can be extremely anxiety inducing for patients. There are several effective treatments available including radiation therapy, surgery and androgen deprivation therapy.

There are a few high-quality resources available online where individuals can learn more about prostate cancer screening, diagnosis and treatment. These include:

The Cancer Council 

Australian Prostate Cancer Collaboration 

Healthy Male 

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Our team of content writers create website materials that adhere to the principals set out in content guidelines, to ensure accuracy and fairness for our patients. Dr. Ronald Shnier, our Chief Medical Officer, personally oversees the fact-checking process, drawing from his extensive 30-year experience and specialised training in radiology.