The Need and Relevance of Prostate Screening
Prostate screening is highly important and recommended for men aged 50 and above due to the high incidence of prostate infection and cancer for men within this age range. The two basic tests commonly used in screening for prostate infection or cancer are digital rectal exam (DRE) and prostate specific antigen (PSA) test. It is advised that men above age 50 screen their prostate annually using these tests in order to detect prostate infection and especially prostate cancer early enough. Of course, early detection of prostate cancer will serve as a great edge in treating the condition and saving the man’s life.
Digital Rectal Exam (DRE)
Digital rectal exam is a prostate screening test done by inserting a lubricated and gloved finger into the rectum in order to examine and feel the prostate. This examination is not specific to men, it can be used to check for problems in the female reproductive organ. In general, DRE is often used in examining issues with structures and organs in the lower belly and pelvis.
The enlargement or growth of the prostate is the major concern of DRE in men. The doctor identifies the condition as prostate enlargement if it feels like a bulge in the rectum wall. However, if on examination there seems to be a bump on the already smooth prostate wall, it indicates the presence of cancer.
What to Expect During DRE
Digital rectal examination may take just a few minutes to complete and it may not really cause pain but it may be discomforting. In some cases, slight pain may be felt and the pain becomes even more pronounced if the prostate is irritated or swollen. During this prostate screening, the doctor would firmly press on the prostate and therefore you may feel a sudden urge to urinate. In addition, make sure you inform your doctor about any condition related to anal fissures, hemorrhoids or anal sores in general. As a matter of fact, DRE may become painful due to these conditions and bleeding may occur. But with proper information, the doctor can do his best to ensure that he does not upset the conditions.
When testing for prostate cancer, a digital rectal exam does not provide a conclusive indication of the presence or absence of cancer. However, further prostate screening must be done, namely PSA test to determine the presence of prostate cancer. Moreover, even with the two screening done, prostate biopsy and perhaps, a transrectal ultrasound, may be done to conclude on the presence of prostate cancer.
Prostate-Specific Antigen (PSA) Test
Another prostate screening process used to determine the presence of prostate cancer and infection is prostate-specific antigen (PSA) test. The protein, prostate-specific antigen (PSA), is produced by prostate gland cells. The prostate gland releases PSA into the bloodstream. On a general note, the more the enlargement of the prostate with age, the more PSA is released into the bloodstream. Prostate enlargement and prostatitis, of course, play active parts in increasing the level of PSA but prostate cancer also results to high PSA level. Other factors that can increase the level of PSA in the blood include digital rectal exam (DRE), ejaculation, injury and so forth.
Prostate-specific antigen is simply a blood test that measures the level of PSA in the blood. After the test, the blood sample is analyzed in the lab to determine the nanogram (ng) of PSA in each milliliter (mL) of blood.
In the past, 4.0 ng/mL PSA level and below are considered normal and higher values are considered abnormal. However, recent studies have shown that there is no designated normal or abnormal PSA level in the blood. As a matter of fact, it is possible that men with PSA level below 4.0 ng/mL to have prostate cancer whereas men with higher PSA values have no prostate cancer.
Factors Responsible for PSA fluctuation
Several factors are responsible for PSA fluctuation and some of these factors have already been discussed. Some of the factors are enumerated below:
- Urinary tract infection
- Prostate surgery
- Prostate biopsies
- Drugs like dutasteride and finasteride may lower the PSA level
Detecting Prostate Cancer with PSA
A single PSA test does not provide a conclusive basis for prostate cancer. If the PSA prostate screening shows high values but the patient shows no symptom of cancer, the doctor may recommend another PSA test for confirmation. If the further test still shows high PSA value, the doctor may recommend DRE and PSA to be carried out regularly with time. If the DRE test shows the presence of a lump or the PSA test shows an increasing PSA value, urine or imaging tests such as cystoscopy, x-rays, and transrectal ultrasound may be recommended. A prostate biopsy may be recommended if prostate cancer is suspected.
False Positive or False Negative PSA Test Results
As explained above, the PSA prostate screening may indicate high PSA values when cancer is not present. This is known as a false-positive test. Several side effects occur due to false positive result. Since cancer is suspected, a prostate biopsy may be recommended and of course, this could be harmful to the health causing bleeding, infections, and pains. In fact, studies show that only 25% of men who undergo biopsies due to high PSA level have prostate cancer.
A false negative result can occur when the test shows low PSA level when prostate cancer is actually present. The danger of this kind of result cannot be overstated. It gives the man an assurance of health when he should have been taking necessary precautions to prevent cancer from spreading. Metastatic prostate cancer can easily occur with false negative PSA results.
A Better Way to Live
Prostate screening is very important to determine prostate infection and cancer early enough and therefore to treat them. But what if you prevent the infection or cancer from occurring in the first place? Prostate cancer and infection can, of course, be prevented but this dependent on the lifestyle we live, especially early in life. You can prevent prostate diseases by eating healthy prostate diets, having regular exercises and a rich sex life, and visiting your doctor often for vital information and examination.