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Prostate Cancer Screening: 4 Questions Answered

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Why do doctors screen nearly all men for prostate cancer? Because it’s currently one of the most common cancers in men, says Johns Hopkins urologist Christian Pavlovich, M.D. 

Is it effective? (Spoiler alert: Yes!) Prostate cancer death rates are down overall, but doctors are still working hard to improve detection rates. In fact, new and more accurate prostate screening tools recently became available.

Pavlovich answers patients’ most common questions about prostate cancer screening. Here’s what you should know. 

Q. Is prostate cancer screening effective?

A. In short, yes. The prostate-specific antigen (PSA) screening test was introduced in the 1980s. For the past 30 years, it has been the gold standard for prostate cancer detection. It’s still quite useful today.

Screening is part of the reason we’re seeing such success in prostate cancer treatment. Most men benefit from prostate cancer screening and early detection and treatment of prostate cancer.

Q. Why are better prostate cancer screening tests needed? 

A. For many years, if a PSA test came back abnormal, the next step was a prostate biopsy. This means removing a tissue sample from the prostate for analysis. A prostate biopsy is the only definitive way to confirm a prostate cancer diagnosis. 

More than 1 million prostate biopsies are performed each year in this country. However, of these, there are 220,000 new prostate cancer diagnoses. That means an abnormal result from a PSA is causing a lot of men to have biopsies unnecessarily. 

It would be beneficial to use more precise risk assessment measures so that fewer men are undergoing unnecessary biopsies.

Q. How do we improve prostate cancer screening ? 

A. There are several things we can do. First, doctors can do more individualized screening. That means recommending to men when and how often they should get screened. This is based on their:

  • Age
  • Family history
  • Race

We also have more precise blood and urine tests, and advances in prostate imaging, such as MRI, available today that can more accurately predict prostate cancer risk. That means men with abnormal PSA scores have more diagnostic options to discuss with their doctor before deciding if a prostate biopsy is the right next step.

Q. Does an abnormal PSA test mean that I have cancer?    

A. No, not necessarily. Because there are new screening tests available today, the PSA test may be just the first screening your doctor recommends. Either way, only a prostate biopsy can confirm a prostate cancer diagnosis. 

A prostate’s size could also contribute to a high PSA score. If your doctor suspects you may have a large prostate, he or she may recommend an ultrasound to better gauge its size. For men with a larger prostate, your doctor can calculate PSA density, which is a more accurate way to assess prostate cancer risk. 

Read more about prostate cancer screening guidelines  and ask your doctor about whether new screening tests might benefit you.

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