Prostate cancer screening

Prostate cancer screening includes a blood test (PSA) and often a digital rectal exam. The purpose of cancer screening is to find cancer at an early stage, which is when treatment has the best chance of leading to a cure.

Routine testing for prostate cancer for all men without symptoms isn’t currently recommended in Aotearoa New Zealand. If you’re 50 years of age or older and have urinary symptoms (see below), talk to your healthcare provider.

Why is routine screening for prostate cancer not recommended?

Routine screening isn't recommended because the tests we have are not accurate enough to do more good than harm for people without symptoms and risk factors. Being screened for prostate cancer is your choice.

Read more about the potential benefits and harms of testing below. Read more about why screening isn't routinely done on this screening for prostate cancer(external link) page from the UK. 

The prostate is a small gland found in men. It's about the size of a walnut, and it lies just below your bladder. It surrounds the tube (urethra) that drains urine (pee) from your bladder. Your prostate gland produces a milky fluid which mixes with sperm to make semen. 

Image credit: CRUK via Wikimedia Commons(external link)

Prostate cancer is caused by cells in your prostate gland growing out of control and invading and destroying healthy cells. Most prostate cancers grow slowly, stay in the prostate and are unlikely to cause serious problems. But rarely prostate cancer can grow quickly and spread to other areas, such as your bones, liver and lungs.

Checks for prostate cancer involve a blood test, called the prostate specific antigen (PSA) test and, often, a digital rectal examination (DRE). 

The prostate-specific antigen (PSA) test

This test measures the level of PSA in your blood. PSA is a protein made by your prostate. Some of the protein leaks into your blood, but how much depends on your age and the health of your prostate. Higher than normal PSA levels can be caused by many prostate problems such as an infection, an enlarged prostate or prostate cancer.

PSA tests aren't routinely used to screen for prostate cancer because results can be unreliable.

• Your PSA level can be raised by other non-cancerous conditions.
• Most men with raised PSA levels don’t have prostate cancer. This is called a false positive result. 3 in 4 men (75%) with a raised PSA don't have cancer.
• Some men with prostate cancer have normal PSA levels. This is called a false negative result. 8 to 10 men in 100 (8 to 10%) with prostate cancer have a normal PSA level. Some of these cancers can be found with a digital rectal examination (DRE). However, high PSA levels are a risk factor for prostate cancer. 

Digital rectal examination

This is a quick way for your healthcare provider to check for prostate problems. They will feel the size and shape of your prostate by inserting a gloved and lubricated finger into your rectum (bottom). A prostate that is rough, irregular or hard is more likely to have cancer. Most cancers are too small to be found by a rectal examination. However, some prostate cancers that would be missed by PSA screening can be found this way.

Prostate enlargement is very common, about 1 in 2 men over 50 years of age has an enlarged prostate. Most of these men do not have prostate cancer. Read more about prostate enlargement. 

Specialist referral 

Your healthcare provider will discuss your prostate cancer screening results with you. If the PSA or DRE results suggest you have a high risk for prostate cancer, you will be referred to a urologist (a doctor who specialises in urinary and prostate conditions).

You’ll need to decide whether to have further testing and possibly treatment. In making this decision, you’ll need to consider whether your quality of life will be better living with what may be a slow-growing cancer or having treatments which may cause you more harm than the cancer will.

Biopsy

The urologist will talk to you about having a prostate biopsy. This is when small samples of your prostate gland cells are taken with a needle for examination. Your skin is numbed with local anaesthetic for this test.

The aim of the biopsy is to help confirm whether or not you have prostate cancer and, if so, whether it needs treatment. The urologist will then discuss treatment options with you.

If the biopsy doesn’t show any sign of cancer, you may be advised to attend future check-ups so your progress can be monitored.

Up to 2 in 100 people with a prostate (2%) get side-effects from the biopsy. This can be bleeding, infection or not being able to pee for a few days. Biopsies don't find all cancers. 

If  have any bladder control problems, you should see your healthcare provider.  If you’re 50 years of age or older they’ll talk to you about whether or not you should have prostate cancer screening.

Symptoms to watch for include:

• poor flow of urine (pee)
• trouble stopping peeing
• dribbling after you’ve finished peeing
• needing to pee more often, at night or urgently
• trouble starting peeing
• incontinence (starting to pee without wanting to)
• pain when peeing
• blood in your pee.

Routine testing for prostate cancer for all men without symptoms isn’t currently recommended in Aotearoa New Zealand. Being tested for prostate cancer is your choice. Your decision depends on:

• whether you have a family history of prostate cancer in your father or brother (this doubles your risk of prostate cancer).
• your age and life expectancy – if you're over 70 years of age, or expect your lifetime to be less than 10 years, you shouldn't have prostate cancer screening as the harm is higher than the benefit.
• how you feel about having more investigations and treatment, which have risk of side effects – including continence and erectile function problems.
• whether you want to know you have a cancer which may not be treated.

Benefits of testing

• Reduces your chance of dying from prostate cancer (1 death prevented for every 1000 men screened for 10 years), though it may not lengthen your life overall.
• Reduces the chance of finding prostate cancer which has already spread. Early prostate cancer is more likely to be treatable.

Harms of testing:

• High false positives rates – 3 in 4 men (75%) with a raised prostate specific antigen (PSA) don't have cancer.
• False negatives – 8 to 10 in 100 men (8 to10%) with prostate cancer have a normal PSA level. Some of these cancers can be found with a digital rectal examination (DRE).
• Up to 2 in 100 men (2%) get side-effects from the biopsy. This can be bleeding, infection or not being able to pee for a few days. Biopsies do not find all prostate cancers.
• Overdiagnosis – 28 in 1000 (2.8%) men receive a diagnosis of cancer that would not have had symptoms.
• Overtreatment – 25 in 1000 (2.5%) men choose to undergo treatment that they may not have needed.

Not all prostate cancer needs treatment and some people can be monitored (watch and wait). Read more about prostate cancer treatment. 

If you’re not sure about whether you need to get tested for prostate cancer, discuss the risks and benefits of testing with your healthcare provider.

To help you decide about prostate cancer screening, Health New Zealand | Te Whatu Ora has developed the Kupe(external link) website. It will help you understand the risks, benefits and implications of prostate testing, so you can have an informed conversation with your doctor.

Read more about the pros and cons of the PSA test(external link).

Video: The prostate specific antigen test – to test or not to test?

If I decide I want to go ahead with prostate cancer screening, when is the right age to start?

• If you have symptoms, see your healthcare provider straight away.
• If your brother or father had prostate cancer, start at 40 years of age.
• If you have no family history, start at 50 years of age.

Screening is not recommended past the age of 70 years.

How often should I have prostate cancer screening?

• If you have an abnormal test result your healthcare provider will advise you about further screening.
• If your first test result is normal but you have a father or brother who was diagnosed with prostate cancer, screening is often once a year.
• If your first test result is normal and you don’t have a family history, there's no evidence in support of further screening. However, you can choose to continue to be screened every 1 to 4 years. Discuss this with your healthcare provider.

You can decide to stop getting screening at any time.

Note: If you're having a PSA test you shouldn’t ejaculate (come during sex or masturbation), have receptive anal sex, have a digital rectal examination or exercise heavily in the 2 days before the test. These can all make your PSA level higher.