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Screening For Prostate Cancer: What You Need To Know

In the U.S., prostate cancer is the most commonly diagnosed non–skin cancer and the second leading cause of cancer death behind lung cancer. One in nine men will be diagnosed with the disease in his lifetime and one in 41 men will die from prostate cancer.

In spite of this, the practice of screening men for prostate cancer is controversial, and opinions vary on whether it actually delivers benefits.

Part of the problem is this: not all prostate cancers are the same. Some may grow slowly and never represent a threat to a man’s life while others may be lethal. In the case of aggressive cancers, men may not have symptoms initially. As the cancer grows and spreads, it may lead to problems including trouble urinating, kidney obstruction, bone pain, weight loss and, ultimately, death. Relying on a doctor with prostate cancer treatment experience is vital.

The goal of screening is to find the right group of men who will benefit from treatment to prevent such complications while sparing unnecessary testing and treatment for those with either slow-growing cancers or no cancer at all.  

The following patient factors are taken into consideration when screening for prostate cancer:


Prior to 2012, an annual PSA blood test and prostate exam were recommended for all men in the U.S. Because of concerns about overdiagnosis and overtreatment, the U.S. Preventive Services Task Force (USPSTF) in 2012 assigned a grade of D (recommending against screening) for men of all ages. This led to a disturbing increase in the number of men being diagnosed with late-stage cancers and, ultimately, to a revision of their statement in 2017. Their new recommendations are now more in line with other organizations such as the American Cancer Society and the American Urologic Association (AUA) and are outlined as follows:

The American Urologic Association (AUA) reviewed these new guidelines and made the following additional points:


Prostate-specific antigen (PSA)—First approved by the FDA in 1994, the PSA is a blood test that measures a protein in the bloodstream produced by cells in the prostate. PSA is “prostate-specific” but not “cancer-specific”.  

Causes of an elevated PSA may include:

What is a normal PSA?  

The short answer is a PSA 0-4.0 ng/mL. Some experts use an “age-adjusted” reference range as follows:


PSA cutoff (ng/mL)









Another useful tool is the National Comprehensive Cancer Network (NCCN) clinical practice guidelines as follows:

Age 45-75:

Digital rectal exam (DRE)—In this exam, the doctor will insert their “digit” (a lubricated, gloved finger) into the rectum to feel the surface of your prostate. From this position, the doctor can detect any abnormalities in the shape, size, or texture of the prostate gland. If any abnormalities are found, further testing may be indicated.


The AUA expert panel recommended the use of one or more of the following tools to help decide which patients with an elevated PSA might require a prostate biopsy. These tools can help identify men who are more likely to harbor a prostate cancer and which may have a more aggressive, clinically significant type. These include:

Use of better “biomarkers”: These tests outperform PSA alone in determining the need for a biopsy and include blood tests such as the “4K score” (https://4kscore.com/) and “PHI test” (https://www.beckmancoulter.com/products/immunoassay/phi). There are also urine tests available such as the “urine PCA3 test” (https://www.medicalnewstoday.com/articles/319675.php).

PSA “derivatives”: These include the % free to total PSA, PSA velocity (rate of rise/year), PSA density (total PSA/prostate volume), and PSA-based nomograms incorporating age, exam findings, family history, and prostate volume.

Prostate MRI: Prostate MRI’s are now able to accurately identify any area of suspicion inside the gland and have significantly improved the ability (via targeted biopsy) to find a cancer if one is present. In addition, if a prostate MRI shows no abnormal findings, one can be reasonably certain that there is no need for a biopsy or further prostate cancer treatment.


In summary, although it remains controversial whether screening for prostate cancer can actually save lives, most experts agree that stopping PSA screening altogether is not the answer.

With better technology and more focused-screening, urologists can offer a smarter approach that is better able to identify those who are at most risk for an aggressive cancer and, therefore, those who may benefit from early diagnosis and prostate cancer treatment. I hope this blog was helpful. Stay tuned for more regarding prostate cancer treatment options.


If you live in the Houston area and have been diagnosed with an elevated PSA or would like to learn more about prostate cancer treatments and screening, feel free to make an appointment with Dr. Durrani at 281-589-7175 or visit us at www.durranimd.com.

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