The best way to pick up prostate cancer at an early stage is with a program of regular PSA testing combined with a rectal examination. Regular testing increases your chance of detecting prostate cancer when it is still confined to the prostate gland, when potentially curative treatment is possible. If a man chooses to be tested, testing can be as often as yearly from the age of 50 years. If a man has a family history of prostate cancer (father or brother diagnosed at an early age) your doctor may recommend beginning testing earlier, at 40–45 years.
Consider asking your GP about a longer consultation for a ‘Well Man’s Health Check’.
There are some drawbacks to early detection programs:
• you may get an abnormal result from a PSA test but not have cancer
• the PSA test can detect cancers that may not threaten your life
• the PSA test may miss some cancers.
While we now have evidence that regular PSA testing can reduce deaths from prostate cancer (6), we also know that many men diagnosed with and treated for prostate cancer may not have needed that treatment and may be harmed by it. This makes it a more difficult decision. In a Swedish study, the risk of death from prostate cancer without screening was in 5 in 1000. Nearly 300 men needed to be screened and 12 men diagnosed with prostate cancer to prevent one prostate cancer death.
We suggest that in making your decision you:
1. Clarify your main concern.
2. Find out your personal risk.
3. Balance up the benefits and risks of an early detection program
(see Table 2 below).
Remember, a single PSA test may give you helpful information about your personal risk of developing prostate cancer in the future.