Prostate Cancer Screening: A Collaborative Decision Between You and Your Doctor
The decision to undergo screening for prostate cancer is a personalized one, best made through a shared discussion between a man and his healthcare provider, typically a primary care physician (PCP). There is no universal “one-size-fits-all” approach, and major medical organizations emphasize the importance of weighing the potential benefits of early detection against the possible harms of overdiagnosis and overtreatment.
The initial and most crucial step in the screening process is a conversation with your PCP. This discussion should cover your personal risk factors, your values and preferences, and the latest clinical guidelines. Key risk factors that may prompt an earlier or more frequent discussion about screening include:
Age: The risk of prostate cancer increases significantly after the age of 50.
Family History: A close relative (father, brother, son) diagnosed with prostate cancer, especially at a young age, increases your risk.
Race: African American men have a higher risk of developing and dying from prostate cancer.
During this consultation, your PCP will explain the two primary screening tools:
Prostate-Specific Antigen (PSA) Blood Test: This test measures the level of PSA, a protein produced by the prostate gland, in your blood. Elevated PSA levels can be an indicator of prostate cancer, but can also be caused by other non-cancerous conditions such as an enlarged prostate (benign prostatic hyperplasia) or inflammation.
Digital Rectal Exam (DRE): In this physical examination, a doctor inserts a gloved, lubricated finger into the rectum to feel the prostate for any lumps, hard spots, or other abnormalities.
Based on your individual risk profile and the shared decision-making process, you and your PCP will decide if, when, and how to proceed with screening.
The Role of the Urologist
A referral to a urologist, a specialist in urinary tract and male reproductive system diseases, is typically made if the initial screening results are abnormal or concerning. A urologist will conduct further investigations to determine the cause of the elevated PSA or abnormal DRE findings. These may include:
Repeat PSA testing: To see if the levels remain elevated over time.
Advanced imaging: Such as an MRI of the prostate, to get a more detailed view.
Prostate biopsy: The definitive way to diagnose prostate cancer, which involves taking small tissue samples from the prostate for examination under a microscope.
In essence, the screening process for prostate cancer is a collaborative effort. It begins with an open and informative conversation with your primary care physician, who will guide you through the initial steps. A urologist becomes involved when specialized expertise is needed for further evaluation and diagnosis. Therefore, the responsibility for initiating and overseeing prostate cancer screening is a shared one, with the individual at the center of the decision-making process, supported by their primary care provider and, when necessary, a urologist.
