Screening and Early Detection

This content has been reviewed and approved by

Daniel P. Petrylak, MD
Associate Professor of Medicine
Director, Genitourinary Oncology Program
Columbia University Medical Center

"Screening" means the regular use of examinations or tests for people who are at high risk for cancer, but do not have any cancer symptoms. If you have certain risk factors, then you may be at high risk for a particular type of cancer. Screening will help to ensure that you discover any cancer at the earliest possible time. In most cases, this will greatly increase your chances of a cure.

In the case of prostate cancer, it is not known if screening actually reduces the number of deaths from the disease. Often, after a diagnosis of prostate cancer, physicians and patients will choose a course of "watchful waiting" rather than beginning treatment.

All the same, men should undergo annual screening using digital rectal examination (DRE), PSA blood test, or transrectal ultrasonography. It is recommended by the American Cancer Society and American Urological Association that men begin annual PSA and DRE screening at age 50. African-American men and men with a strong family history of prostate cancer should begin annual screening at age 45.

Digital rectal exam (DRE) - During a digital rectal exam, a physician inserts a gloved finger into the rectum to assess the texture and size of the prostate. The DRE is the most common prostate screening procedure and has been used for many years.

PSA blood test - A simple blood test allows laboratory technicians to determine PSA levels. PSA is a protein that is normally secreted and disposed of by the prostate gland. High PSA levels can indicate either the presence of prostate cancer cells or other noncancerous prostate conditions.

Transrectal ultrasonography (ultrasound) - During transrectal ultrasonography, a small probe is inserted into the rectum. The probe emits high-frequency sound waves that bounce off the prostate and produce echoes. A computer uses these echoes to create a picture-called a sonogram-that can show abnormal areas.

Strategies to Improve Screening and Prevention

Research is continuing to find better and more accurate screening and early detection techniques. These may lead to earlier detection and better cure rates.

Improved PSA testing - Researchers continue to develop and refine laboratory tests to improve PSA testing. PSA results that are more specific may help eliminate the need for further invasive testing, relieve anxiety, and reduce medical costs in patients with elevated PSA levels who have benign conditions. These include PSA density and free versus bound PSA.

Insulin-like growth factor - Insulin-like growth factor (IGF-I) and intact IGF-binding protein-3 (IGF-BP3) might help distinguish benign prostatic hyperplasia (BPH) from prostate cancer. Increased levels of IGF-I and IGF-BP3 in men with low to moderate PSA levels can predict prostate cancer.

Predictive genetic testing - Researchers have recently identified a genetic alteration that increases the risk of developing prostate cancer. There are four different alterations of the hereditary prostate cancer 2 gene (HPC2) that place men at either a moderate or high risk of developing prostate cancer. Although the identification of the HPC2 is a promising development in prostate cancer research, more research is needed before HPC2 testing becomes available.

Microbubble ultrasound - Microbubbles are tiny bubbles of gas that can be injected into blood vessels without creating any harm. They allow physicians to see blood flow much more clearly during ultrasound. Since there are more blood vessels and blood flow in cancerous tissues than in regular tissues, microbubbles allow tumors to be seen more clearly.