Prostate Cancer Screening

Prostate Cancer Screening

Prostate cancer is among the most common cancers diagnosed for men in Maine. It is also the second leading cause of cancer death among all men in the US. Talk to your doctor, who will help you make an informed decision about whether prostate cancer screening is right for you.

Prostate cancer screenings tests include:

Prostate specific antigen (PSA) test. The test checks a man’s blood for high PSA levels, a marker for prostate cancer. High PSA levels also can indicate other conditions, including inflammation or infection of the prostate. Certain medicines, a patient’s medical history, and an enlarged prostate also can affect PSA levels.

Digital rectal exam (DRE). The DRE checks the prostate manually through the rectum to feel the prostate for lumps or other abnormalities.

There are limits to the prostate cancer screening tests used today. They are not 100% accurate. A positive result from a prostate cancer screening, known as a PSA test, may lead to more invasive tests or treatment that may not be necessary. MaineHealth recommends that men make an informed decision with a health care provider about whether to be tested for prostate cancer. Prostate cancer screening recommendations:

If you are

  • under age 40, no routine PSA screening is needed.
  • 45-50 years old, no routine PSA screening is needed for healthy men; however for patients who are African American or have positive family history of more than one family member with prostate cancer, a one-time PSA level at 45 may be appropriate to provide a baseline for future PSA test results. In all cases, men should have a discussion with their physician about benefits and risks.
  • 50-70 years old with life expectancies greater than 15 years, decisions about PSA tests should be based on a discussion with your doctor.
  • For men >70 years old, no routine PSA screening is needed. For men in excellent health, screening until age 75 may be appropriate as decided by you and your doctor.

At the MaineHealth we are working every day to support men so that they can make the best decision for themselves, because every patient is unique. Maine Medical Partners Urology and Intermed have teamed up to create a decision aid for men thinking about undergoing PSA screening. This decision aid is a tool for promoting meaningful shared decision-making conversation between clinicians and patients. Click here to view and print the decision aid.

Diagnosing prostate cancer

If a PSA or DRE test detects an abnormality, your doctor may recommend a prostate biopsy. A prostate biopsy can be performed with a standard transrectal ultrasound or a MRI/Ultrasound Fusion Guided Biopsy. Your doctor will discuss which approach is right for you.

  • Transrectal ultrasound (TRUS): Using ultrasound images for guidance, the Urologist will remove small samples (biopsy) which are then looked at under a microscope. Most urologists will take about 12 core samples from different parts of the prostate. This is done in the office setting.
  • MRI/Ultrasound Fusion Biopsy: The MRI/Ultrasound fusion biopsy begins with a MRI of the prostate. The MRI images are read by a trained Radiologist and abnormal areas are outlined if present. These images from the MRI are fused with the real time ultrasound at the time of the biopsy. Any abnormal areas that have been identified are targeted. In addition to the targeted biopsy, an additional standard sampling of the prostate (12 biopsy cores, as above) will be performed. If no suspicious areas were identified on the MRI, only the standard 12 core transrectal ultrasound-guided non-targeted biopsy will be performed.