You may think that finding cancer early is always a good thing. But with prostate cancer, it's not that simple.

The U.S. Preventive Services Task Force (USPSTF) issued new guidelines on prostate cancer screening in August 2008:

• The USPSTF does not recommend routine screening in men older than 75. In this age group, it is unlikely that screening offers any long-term benefit.
• The USPSTF does not recommend either for or against screening in men younger than 75. More evidence is needed to tell if the benefits outweigh any risks in testing. These men should discuss screening with their doctor.
• Men should be informed by their doctor about the potential benefits and harms of testing and treatment and helped to weigh these as they consider screening.

The USPSTF is the leading independent panel of experts on prevention and primary care. Before 2008, it had not taken a stand on prostate cancer screening in healthy older men without symptoms.

Currently, most major medical organizations recommend that doctors talk to men between the ages of 50 and 75 about their individual risk for prostate cancer. They should also discuss the pros and cons of screening to help men make an informed decision.

What's the problem with screening?
Some of the problems have to do with the disease. Others have to do with the screening test itself.

• Prostate cancer often grows very slowly. So far, doctors don't know if finding and treating it before it causes symptoms improves the chance of living longer.
• Very small prostate cancers may not cause any problems. Finding them early may lead to treatments that cause harmful side effects, such as bladder control problems and erectile dysfunction.
• The PSA test can give incorrect results. Some men with prostate cancer have a normal PSA, which could give them a false sense of security. And some men have an elevated PSA but don't have prostate cancer. The test results could lead to fear and unneeded tests.

How do doctors screen for prostate cancer?
Doctors have two main ways to screen for prostate cancer: the prostate-specific antigen (PSA) test and the digital rectal exam. If a man decides to be screened, he should have the prostate specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done.

• The PSA test is a blood test that measures a protein made by prostate cells. PSA estimates the likelihood of prostate cancer.
• A digital rectal exam is a manual exam in which a doctor inserts a gloved and lubricated finger into the rectum. The doctor feels for any abnormally firm or irregularly shaped area of the prostate that might be cancer. The prostate gland is near the rectum, and many prostate tumors begin in an area that can be felt during a rectal exam.

If a doctor suspects cancer after doing a PSA test and digital rectal exam, a biopsy is done to find out if cancer is present.

Should I be screened?
It can be hard to decide whether to have prostate cancer screening. To make your choice, talk with your doctor about:

• Your personal risk factors for prostate cancer, such as your age, race and family history of prostate cancer
• The risks and benefits of prostate cancer screening and treatment

Keep in mind that expert guidelines are meant to help doctors in their medical practice. They are not specific rules for any one man. You're the only one who can decide whether screening is right for you.

Also remember that these recommendations are only for men who have no symptoms of prostate disease. If you have any urinary problems or other symptoms, you need to talk to your doctor right away.

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External Sources Lin K, Lipsitz R, Miller T, Janakiraman S. Benefits and harms of prostate-specific antigen screening for prostate cancer: an evidence update for the U.S. Preventive Services Task Force. Annals of Internal Medicine. 2008;149(3):192-199. Accessed August 5, 2008. American Cancer Society. Detailed guide: can prostate cancer be found early? Accessed August 5, 2008. Agency for Healthcare Research and Quality. U.S. Preventive Services Task Force. Screening for prostate cancer. August 2008. Accessed August 5, 2008.

This article was reviewed and updated 08-01-2009.