Screening For Prostate Cancer

99% of cases of prostate cancer primarily develop in men over the age of 50. Therefore, diagnosing cancer in these patients may lead to unnecessary and painful biopsies being done and then over-treating the patient at the end of the day. This would then lead to exposing the patient to complications and side effects which could have been prevented if the correct protocols were followed. The first rule of medicine is to do no harm.

The way prostate cancer is diagnosed and staged is by performing biopsies of the prostate. This includes inserting a large bore cutting needle multiple times through the perineum to reach different parts of the prostate. Many small specimens are collected in order to cover as large an area of the prostate as possible. Besides being a very uncomfortable procedure, this investigation can result in side effects and complications and that is why screening correctly for prostate cancer is so important.

The American Cancer Society has made the recommendation that men should discuss screening for prostate cancer with their primary care doctors. The decision to be screened should then be made after the patient has received the necessary information regarding any risks and benefits associated with screening.

The discussion regarding prostate screening should be done at:

• Age 50 for men who have an average risk of developing prostate cancer and who are expected to survive 10 or more years.
• Age 45 for men who are high risk candidates for developing prostate cancer. This would include black men and men who have a relative (such as a son, brother or father) who were diagnosed with prostate cancer before age 65.
• Age 40 for men who are at an even higher risk (those with more than one above-mentioned relative who had prostate cancer at an early age).

A patient who isn’t expected to live over the next 10 years shouldn’t have any prostate screening done because even if they are diagnosed with prostate cancer, no further management will be initiated.

If the patient agrees and gives consent to screening then blood is drawn to check for the prostate-specific antigen (PSA) level which is a protein released by the prostate in conditions such as prostate cancer. A digital rectal exam (DRE) is also done to feel the consistency of the prostate and to see whether any nodules are felt.

Experimental urine test

The urine test is called ExoDxTM Prostate and it detects RNA from 3 genes (namely ERG, PCA3 and SPDEF) which have been linked to the development and progression of prostate cancer. The RNA of these genes is bound in exosomes which are excreted by the cancer cells into the urine.

READ Abnormal Urine Color: What It Tells (And Doesn't Tell) About Your Health

This analysis of the results of the test showed that it correctly spotted 92% of patients with already diagnosed high-grade cancer. The test also found high-grade cancer in 66% of patients whose biopsies showed low-grade or no cancer. In a clinical setup, use of the test would have spared 27% of patients from having unnecessary prostate biopsies done.