Early detection efforts should be directed at men with at least a ten-year life expectancy. The Program offers periodic, free on-site screening to support the objective of early detection for as many men as possible.
Prostate cancer screening incorporates two simple tests: a PSA (Prostate Specific Antigen) and a DRE (Digital Rectal Examination) that assess irregularity of the prostate gland and/or the presence of a nodule. Both tests are necessary, since the majority of men with localized cancer have a normal prostate examination. Conversely, 30% of men with localized cancer will have a normal PSA but a nodule detected on rectal exam.
Prostate specific antigen (PSA) was first recognized in 1988. While both benign and malignant prostate cells produce PSA, an elevation of PSA level in the blood may or may not signal the presence of a cancer. Several different conditions may cause an elevation in blood PSA level. BPH, or benign enlargement of the prostate, is the most common cause of PSA increase. Inflammation in the urinary tract, such as a urinary tract infection or a prostate infection known as prostatitis, can cause the PSA level to increase significantly. Ejaculation can cause transient increases in PSA concentration, if the blood test is performed within a few hours of climax. Prostate manipulation such as a prostate biopsy, prostate massage or cystoscopic examination can also cause acute increases in PSA. A routine rectal exam does not cause significant elevations in PSA level. Prostate cancer can cause elevation in PSA concentration. The normal PSA level is based on a person’s age. When first introduced, a level of 4 ng/ml was considered the cut-point or critical value. However, as men get older, the prostate size increases. As such, PSA levels will normally increase with age.
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Use of age specific PSA reference ranges makes PSA testing more sensitive in younger healthier men who potentially have the most to gain from an early diagnosis of prostate cancer.