Prostate cancer typically takes years to manifest and in most men, the cancer advances slowly. However, prostate cancer is one of the largest killers among men worldwide.
Screening for cancer is an important part of patient care and aims to diagnose cancer at an early stage before symptoms begin and while there is a greater chance of treating and curing the cancer. Currently, there is no national screening programme for prostate cancer in the UK but men who visit their doctor concerned about prostate cancer may be offered the following tests.
Digital rectal examination (DRE)
This may be performed by a nurse or doctor who checks for abnormalities in the prostate gland such as areas of irregularity, hardness, or increased size. The doctor or nurse uses their finger to feel the prostate gland through the wall of the rectum.
Since the rectum lies behind the prostate gland, it may be felt by the finger through the front wall of the rectum. The procedure does not usually take long or feel painful but it may be a bit uncomfortable. In the case of benign prostatic hyperplasia (BPH), the gland feels enlarged but smooth and firm, while in prostate cancer the gland may feel hard and lumpy.
Blood tests for prostate-specific antigen (PSA) level
PSA is a protein that is secreted by the prostate gland. PSA is normally present in a man's blood and the level increases with age, but in the case of prostate cancer, the levels may be significantly raised. This test, however, is not specific for prostate cancer and a high PSA level can be caused by infection, benign prostate enlargement or even physical activity or sex.
If an abnormality is detected through DRE or PSA assessment, a doctor may order an ultrasound scan which uses sound waves to generate an image of the prostate gland that can be evaluated. A biopsy is also performed in which a sample of cells are taken from the prostate and sent for laboratory analysis to confirm whether cancer is present or not.
If any of the screening tests reveal the early stages of prostate cancer, a treatment approach called watchful waiting or active surveillance is often adopted. If the cancer is not causing symptoms and is slow growing and localized to a small area of the prostate, watchful waiting with regular monitoring of the cancer is considered a safe approach. Such monitoring involves blood PSA checks, further DREs and ultrasounds scans performed at regular intervals (usually every 3 to 6 months) to check for growth of the cancer.
Reviewed by Sally Robertson, BSc