Early Detection Is Critical There are currently two common tests available in preventive medicine to screen for early detection of prostate cancer – the prostate-specific antigen (PSA) and the digital rectal examination (DRE) tests. The PSA blood test is sometimes combined with the DRE where the doctor feels your prostate with a finger to detect any surface anomalies. This information is designed to help men understand the importance of early detection and decide if they want to be screened for prostate cancer.
When should you start screening? First, talk to your doctor at your next checkup to go over your particular risk factors. As a Veteran you should consider yourself in a higher risk category of developing prostate cancer than other men. Through your time in service you have been exposed to various chemicals, radiation sources, and combat stress. There are studies ongoing about the effects of all these on the increased incidence rate of cancer among Veterans.
Bottom line - GET SCREENED and KNOW YOUR NUMBER!
In general, discussions with your doctor about screening for prostate cancer should begin at age 35 for Veterans. Here are some rough guidelines for other considerations: Do you have family history of prostate, ovarian, breast, colon, or pancreatic cancers, or do you know that gene mutations (such as BRCA) are present in your family? You can request a DNA Sequencing from your Veteran Medical Center.
How do I get screened? The “gold-standard” test for prostate cancer screening is the PSA (prostate specific antigen) blood test. The PSA test measures levels of prostate-specific antigen in the blood. PSA is a protein produced by the cells of the prostate. Because cancerous cells tend to produce more PSA, a spike in your PSA level may signify a problem, however, there are other benign conditions that may cause an uptick in PSA. If you’re having a PSA test, it can often be added on to other blood work you may be having that day, and you may not need a separate blood draw.
Tracking your PSA over time can be valuable to distinguish a temporary increase (e.g., due to an infection) from a gradual, yet persistent rise. Even if your level is still within normal range, but is higher than it was the last time it was tested, it’s worth checking further. After a single high PSA result, often the first step is to repeat the test a couple of weeks later to confirm that it is, in fact, elevated. This should be done at the same lab as the previous test, to avoid fluctuations due to different equipment.
What happens next? Subsequent to PSA screening, depending on your results, your doctor may recommend follow-up tests and/or a biopsy. There are many other supplementary tests and considerations that can help you and your doctor decide if a biopsy is necessary, including:
Are You at Risk for Prostate Cancer? Find out when you should start screening. TAKE THE QUIZ
Digital rectal exam (DRE)
Free PSA test (<10% Free PSA indicates greater risk of having cancer; <25% is concerning)
PSA velocity or the rate of rise over time (faster increase means more risk)
PSA density = PSA per volume of prostate (higher density means more risk)
PSA-based markers (e.g., Prostate Health Index, 4K score)
Other markers, e.g., urinary PCA3 or Select MDx text
MRI of the prostate
The DRE, or digital rectal exam, may also be used as a baseline test along with the PSA test, though is not recommended as a screening test by itself. Your doctor will insert a gloved, lubricated finger into your rectum and press toward the front of your body to feel the prostate. A prostate that’s enlarged or irregularly shaped, or bigger than it was at your previous exam, is a red flag that should be investigated.
Are there any other tests I should have as part of my screening routine? Better cancer-specific blood- and urine-based tests are on the horizon, as well as options for using imaging, such as MRI, to help screen and target the biopsy for prostate cancer. However, at this time they do not replace the PSA for screening and early detection.
How is the PSA used after diagnosis? PSA is the primary tool for screening—that is, testing of healthy men without symptoms. Once the diagnosis of prostate cancer is confirmed by biopsy, PSA is also routinely used for risk assessment, active surveillance in men with low-risk cancer who elect this approach, and post-treatment monitoring. Your doctor will use the PSA test as one of many guides to indicate whether treatment is working and, down the line, whether the cancer recurs.
The ExoDx™ Prostate, Test for Veterans
The ExoDx Prostate Test is a simple, non-invasive urine test that can help you and your doctor determine the need for an initial prostate biopsy, or repeat biopsy due to a prior negative biopsy. The ExoDx Prostate Test is unique because it provides an additional data point not obtained through the general workup — it offers exclusive information that is not influenced by DRE, family history, PSA or other clinical information. If you’re visiting your doctor today, ask about the ExoDx Prostate Test.