Prostate Cancer is one of those health issues, especially among men, that is commonly ignored until it gets brought up by a friend, some health initiative, or a family doctor. Nonetheless, it is one of the most commonly occurring types of cancer in men, and screening and early detection can significantly improve outcomes. However, screening in itself is the first step, and the most common question that arises is what is the appropriate age to start screening.
Let's break it down with clearer explanations and without complicated health terms to help you make appropriate decisions for yourself, or for the men in your family.
The prostate, responsible for the production of some of the fluid that makes up semen, is a small gland the size of a walnut and is situated just beneath the bladder. Like many other uncontrolled and unmonitored issues, the prostate can change over time, and in some situations, can develop cancerous cells. Prostate Cancer commonly progresses at a leisurely pace, and during the early stages, the cancer is most often asymptomatic.
Screening prevents the probable progression of cancer from spreading further. It is not meant to invoke panic; instead, it is meant to provide the best outcome, and Prostate cancer is most optimally treated at the initial stages.
In the case of Prostate cancer, PSA tests and Prostate DRE are the most commonly used.
The PSA test verifies the presence of prostate-specific antigens. It is essential to note that elevated PSA levels do not automatically indicate the presence of cancer. Further evaluation is mandatory to make a concrete conclusion.
In a DRE, the prostate is checked for abnormalities by the healthcare professional through the rectum. It may be uncomfortable, but from a healthcare perspective, it is a swift way to gather information regarding prostate health.
It is essential to note that these tests can be supplemented with scans or biopsies to determine the presence of cancer more accurately.
When considering screening, older adults should have screening discussions by the age of 45, and even earlier if risk factors such as family medical history, personal history, and ethnicity are compromising. Most men are encouraged to have discussions with their doctors around the age of 50, and considering the family history of prostate cancer diagnosis.
You have a father, brother, or son diagnosed with Prostate Cancer, and especially diagnosed at a younger age. You belong to the African or Caribbean ethnicity, as research has shown these groups are at a greater risk of developing the disease.
Starting these discussions with your general practitioner at an early stage is vital, as it aids in personal situation screening discussions.
One of the reasons men may delay getting screened for prostate cancer is the controversies surrounding prostate cancer screening. Although screening provides the chance to save lives through early detection, there is the danger of overdiagnosis, which is the detection of indolent cancers—cancers which grow slowly and would not cause harm in a man's life, but would lead to the man being treated for the cancer resulting in life-altering side effects of a cancer treatment--incontinence, or erectile dysfunction.
This is the reason why not every man of a certain age is screened. There needs to be a more nuanced approach which combines talking with the GP, knowing personal health and family history, calculating risk factors, and the man's personal needs.
You do not necessarily have prostate cancer just because you have abnormal PSA and DRE results. There are a lot of cases where no cancer is found after performing additional tests. Your GP may recommend retesting the PSA after some weeks, performing scans, or performing a biopsy, which looks at prostate tissue under a microscope.
In case a diagnosis has been made, your physician will detail the stages and grading of the disease, which will serve as a guide for subsequent necessary actions. For slowly progressing, early-stage Prostate Cancer, immediate treatment may not be necessary. Instead, the patient can be put on a watchful monitoring strategy known as active surveillance. In contrast, more aggressive cancers will require active treatment.
Looking after your health goes beyond a single screening. Eating a well-balanced diet, exercising, not smoking, and living a healthy, active lifestyle can help manage the overall risk of cancer. Are you experiencing any symptoms such as changes in urination, or the presence of blood in the urine or semen, or unexplained pain in the hips or back? If so, those changes can help.
Just as important, Prostate Cancer most often does not show symptoms in the beginning, and that is the reasoning behind having these discussions with your GP, regardless of how healthy you feel.
Think of two 55-year-old men. One of them has a routine check-up where a PSA test is conducted. It shows a slightly elevated level, which is followed up with further investigation to find a small, early-stage cancer. The results are favourable as he has multiple treatment avenues and a good outlook since it was detected early.
The other man has no symptoms and chooses to forgo screening. A few years down the line, he develops back pain and learns that the cancer has metastasised to his bones. His treatment has become more intricate, and while it is still beneficial, it now prioritises controlling the disease instead of curing it.
With Prostate Cancer screening, it is a matter of personal discretion to make the decision as to whether to screen or not. It is a decision that is best made with the right information. Initiate the discussion with your GP during the appropriate time for your risk category. Educate yourself on the advantages as well as the possible drawbacks. Strive to improve your overall health. And never forget that you are screening for well beyond cancer – you are screening for your overall health and well-being in the years to come.
Taking the initiative to look after your prostate health may, in fact, be the most critical decision you make.
1. At what age should I start screening for Prostate Cancer?
Most men should start to engage with the screening discussion with their GP around age fifty. If you are in a higher risk category, for example, a family history or of African or Caribbean descent, consider leaning into the conversation around age 45 or even sooner.
2. Does high PSA always signify cancer?
No. PSA levels can be raised for other reasons, such as prostatitis infection, benign enlargement of the prostate, or even due to recent sexual activity. It suggests that further tests may be required, but not necessarily for cancer.
3. Is the whole procedure painful?
PSA test blood sampling is similar to any other blood test. A digital rectal examination may be uncomfortable, but only for a very short duration, and it should not be painful at all.