Prostate Screening

The prostate gland is situated beneath the bladder in men and is involved in the production of fluid which makes up the semen.

Prostate Diseases

There are several diseases that affect the prostate but the two most important are prostate cancer and benign (non-cancerous) enlargement of the prostate (BPH).

Prostate Cancer: Prostate cancer is the commonest form of cancer in men in the UK, with over 30,000 new cases being diagnosed a year. Prostate cancer is the second leading cause of death after lung disease in the UK, causing in excess of 10,000 deaths a year.

In the early stages there are rarely symptoms but as the cancer grows and spreads there may be problems with urination and pain. The quandary with prostate cancer is knowing which cancers are life threatening and which are not. This can only be answered by inspection of a piece of prostate tissue under the microscope, or a biopsy.

Benign Prostate Hyperplasia (BHP): Most men after middle age will develop benign enlargement of the prostate and many of these will develop symptoms associated with enlargement such as getting up at night to pass urine or having difficulty in starting or stopping or having to visit the toilet frequently with a sense of urgency. It is important to seek medical advice and help if such symptoms are present.

Prostate Screening

Prostate screening involves the measurement of a protein in the blood. The protein is called prostate specific antigen, frequently referred to as PSA.

In addition to this, a clinical examination of the prostate should be performed by insertion of a gloved finger into the rectum. This is called a digital rectal examination (DRE) and is important as it enables the doctor to gauge the size, shape and consistency of the prostate. It will also help the doctor to decide whether cancer, infection or an enlarged prostate is present.

There are controversies around prostate cancer screening, specifically to do with PSA tests. Some cancers may be missed (known as false negative results) and sometimes the PSA test may suggest a cancer is there when in fact it is not (known as a false positive result). This confirms the importance of also performing a DRE because there have been cases when a PSA level has been ‘normal’ but the DRE is suspicious for cancer. Other issues around detecting prostate cancer have centred around the ‘tigers and pussy cat’ debate. Many cancers will be of low risk if detected early and therefore not pose a serious risk to the patient. If the patient has an aggressive ‘tiger’ cancer then radical treatment using surgery or radiotherapy can be curative if the condition is caught early. Therefore if a PSA and DRE investigation indicates there may be a risk of prostate cancer, the only definitive way of knowing whether the cancer is a ‘tiger or pussy cat’ is to undertake a biopsy to analyse the cells.

Probably one of the most useful measures a man can take if he wishes to undergo prostate cancer screening is to have his PSA test undertaken on a regular basis, usually annually depending upon his age and other factors. There is good evidence that if the PSA value does not rise beyond a certain threshold over time then the presence of prostate cancer is highly unlikely. This testing is called PSA velocity as it looks at the speed at which the PSA level changes over the years and is probably the most useful way of using the PSA test in screening.