Google keeps track of what is searched most frequently. Sinceprostate canceris common, it’s hardly surprising that people who research aches or pains “down there” in the lower part of the abdomen search for “symptoms of prostate cancer.”
The most commonly googled question related to prostate cancer is, “What are the symptoms?” Given what’s published online, however, you would think that prostate cancer has all sorts ofsymptoms: urinary problems, pain, sexual difficulties, even rectal problems. The truth is that in this modern era of PSA testing,prostate cancer has no symptoms whatsoever! Prostate cancer is a totally silent process unless it is very advanced.
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Detecting Prostate Cancer With PSA Screenings
Now that we havePSA screening, it means that it is practically impossible for undiagnosed prostate cancer to cause discomfort, urinary problems, difficulty with erections, or any other symptom related to prostate cancer. This is not to say that men can’t have prostate symptoms fromnoncancerouscauses, such asprostatitis, benign glandular swelling, urinary tract infections, orsexually transmitteddiseases.But PSA testing can ensure that any symptoms that may be present are coming from something unrelated to prostate cancer.
I mentiontestosteronebecause the one circumstance where prostate cancer could be advanced while the PSA remains low is when testosterone levels are also low.Having a marked degree of testosterone suppression, however, is quite uncommon. And it isn’t even necessary to have a blood test to know when testosterone levels are low. A really low testosterone level causes a total disappearance of libido, which easily gets a man’s attention and leads him to seek medical attention to determine what is going on.
Since PSA screening practically eliminates the possibility of being diagnosed with advanced prostate cancer, let’s review the standard operation procedure for proper testing. The threshold for PSA being “abnormal” varies, but generally a PSA above 4.0 in men over 60 should be further evaluated. Younger men whose PSA levels are above 2.5 should also probably have further evaluation.
In my world, working as a prostate cancer practitioner, it is hard to believe that men over 40 skip annual PSA testing. Surprisingly, however, statistics clearly show that many men make the mistake of not regularly checking their PSA. PSA testing is theonlypractical way to detect prostate cancer at an early stage (the finger in the rectum test has some value, but not much).
The Nuts and Bolts of PSA Screening
Prior to the FDA’s approval of PSA testing in 1987 (along with random prostate biopsy that same year), the behavior of early-stage prostate cancer was shrouded in mystery. Now, doctors are detecting and quantifying early-stage prostate cancer with ever-increasing accuracy.
Other PSA Roles besides Screening
Confusion about PSA can arise because it may be used for other purposes besides screening. Screening is the most familiar role and it is a big deal. Over 200,000 men are diagnosed annually because ofPSA screening.However, there are other uses. One example is how PSA helps to define the cancer’s stage after prostate cancer is detected. In men with cancer, a PSA level under 10 is associated with a moreindolenttype of prostate cancer. On the other hand, a PSA level over 20 is characteristic of a more aggressive type of prostate cancer.PSA also plays an important role for cancer monitoring to determine the effectiveness of various treatments.
A delayeddiagnosis of prostate cancerincreases the chance of cancer spreading.How then, can anyone be opposed to PSA screening? Can an early diagnosis of cancer be bad? Surprisingly, experience has shown PSA is actuallyover-sensitive,leading to the unnecessary diagnosis of 100,000 men annually who have such harmless early-stage cancers that they are at practically zero risk for it spreading.
This would not be a problem if the medical system was prepared to simply monitor these harmless cancers. Unfortunately, due to these tiny specks of disease being called “cancer,” doctors and patients alike overreact and rush into unnecessary radical treatment, risking terrible problems with sexual and urinary function.
Multi-Parametric MRI Scans: The Salvation of PSA Screening
Rather than stopping PSA testing, there is a much better way to limit overtreatment. While an elevated PSA indicates that something is amiss with the prostate, it does not specifically indicate that the problem is cancer-related. The other causes of PSA elevation besides cancer are prostate enlargement due to aging, called benign prostatic hypertrophy, and prostate inflammation, called prostatitis. Neither of these conditions have anything to do with prostate cancer.
PSA Elevation From Large Prostate Glands
Until recently, the only way to sort through all these possibilities of PSA elevation was to puncture the prostate 12 times with a needle biopsy to remove tissue cores for evaluation under the microscope.Due to an inordinate fear of missing cancer, many doctors recommended random biopsy anytime the PSA was slightly elevated. One million men are biopsied in the United States every year.This aggressive behavior was perhaps justified when biopsy was the only way to find cancer.
A Suggested PSA Screening Protocol
It’s reasonable to start checking PSA yearly in men over the ages of 45. Men with a family history of prostate cancer or men who are African-American should start annual testing at age 40. Men over age 75 who are in good health should continue screening.
Know this: As long as the PSA is in the normal range, in general, men can rest assured that any prostate-related symptoms they are experiencing are most likely originating from something unrelated to cancer. PSA testing detects early stage prostate cancer so reliably that when the PSA is normal, one can be sure that any prostate-related symptoms are due to some other cause.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Prostate Cancer Foundation.Prostate Cancer Symptoms and Signs.American Urological Association. Urology Care Foundation.Advanced Prostate Cancer.Ignacio F, Pablo A, Rojas WC, DeWolf AM.Low free testosterone levels predict disease reclassification in men with prostate cancer undergoing active surveillance.BJUI. Volume114, Issue2, August 2014. Pages 229-235. doi:10.1111/bju.12682American Cancer Society.Screening Tests for Prostate Cancer.American Cancer Society.Can prostate cancer be found early?Columbia University Herbert Irving Comprehensive Cancer Center.Prostate Cancer.American Cancer Society.Prostate Cancer Staging and Other Ways to Assess Risk.Johns Hopkins Medicine.Johns Hopkins study reveals significant rise in prostate biopsy complications and high post-procedure hospitalization rate. Sept. 22, 2011Ghai S, Haider MA.Multiparametric-MRI in diagnosis of prostate cancer.Indian J Urol. 2015;31(3):194-201. doi:10.4103/0970-1591.159606Bjurlin MA, Mendhiratta N, Wysock JS, Taneja SS.Multiparametric MRI and targeted prostate biopsy: Improvements in cancer detection, localization, and risk assessment.Cent European J Urol. 2016;69(1):9-18. Epub 2016 Jan 25. doi:10.5173/ceju.2016.734
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Prostate Cancer Foundation.Prostate Cancer Symptoms and Signs.American Urological Association. Urology Care Foundation.Advanced Prostate Cancer.Ignacio F, Pablo A, Rojas WC, DeWolf AM.Low free testosterone levels predict disease reclassification in men with prostate cancer undergoing active surveillance.BJUI. Volume114, Issue2, August 2014. Pages 229-235. doi:10.1111/bju.12682American Cancer Society.Screening Tests for Prostate Cancer.American Cancer Society.Can prostate cancer be found early?Columbia University Herbert Irving Comprehensive Cancer Center.Prostate Cancer.American Cancer Society.Prostate Cancer Staging and Other Ways to Assess Risk.Johns Hopkins Medicine.Johns Hopkins study reveals significant rise in prostate biopsy complications and high post-procedure hospitalization rate. Sept. 22, 2011Ghai S, Haider MA.Multiparametric-MRI in diagnosis of prostate cancer.Indian J Urol. 2015;31(3):194-201. doi:10.4103/0970-1591.159606Bjurlin MA, Mendhiratta N, Wysock JS, Taneja SS.Multiparametric MRI and targeted prostate biopsy: Improvements in cancer detection, localization, and risk assessment.Cent European J Urol. 2016;69(1):9-18. Epub 2016 Jan 25. doi:10.5173/ceju.2016.734
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Prostate Cancer Foundation.Prostate Cancer Symptoms and Signs.American Urological Association. Urology Care Foundation.Advanced Prostate Cancer.Ignacio F, Pablo A, Rojas WC, DeWolf AM.Low free testosterone levels predict disease reclassification in men with prostate cancer undergoing active surveillance.BJUI. Volume114, Issue2, August 2014. Pages 229-235. doi:10.1111/bju.12682American Cancer Society.Screening Tests for Prostate Cancer.American Cancer Society.Can prostate cancer be found early?Columbia University Herbert Irving Comprehensive Cancer Center.Prostate Cancer.American Cancer Society.Prostate Cancer Staging and Other Ways to Assess Risk.Johns Hopkins Medicine.Johns Hopkins study reveals significant rise in prostate biopsy complications and high post-procedure hospitalization rate. Sept. 22, 2011Ghai S, Haider MA.Multiparametric-MRI in diagnosis of prostate cancer.Indian J Urol. 2015;31(3):194-201. doi:10.4103/0970-1591.159606Bjurlin MA, Mendhiratta N, Wysock JS, Taneja SS.Multiparametric MRI and targeted prostate biopsy: Improvements in cancer detection, localization, and risk assessment.Cent European J Urol. 2016;69(1):9-18. Epub 2016 Jan 25. doi:10.5173/ceju.2016.734
Prostate Cancer Foundation.Prostate Cancer Symptoms and Signs.
American Urological Association. Urology Care Foundation.Advanced Prostate Cancer.
Ignacio F, Pablo A, Rojas WC, DeWolf AM.Low free testosterone levels predict disease reclassification in men with prostate cancer undergoing active surveillance.BJUI. Volume114, Issue2, August 2014. Pages 229-235. doi:10.1111/bju.12682
American Cancer Society.Screening Tests for Prostate Cancer.
American Cancer Society.Can prostate cancer be found early?
Columbia University Herbert Irving Comprehensive Cancer Center.Prostate Cancer.
American Cancer Society.Prostate Cancer Staging and Other Ways to Assess Risk.
Johns Hopkins Medicine.Johns Hopkins study reveals significant rise in prostate biopsy complications and high post-procedure hospitalization rate. Sept. 22, 2011
Ghai S, Haider MA.Multiparametric-MRI in diagnosis of prostate cancer.Indian J Urol. 2015;31(3):194-201. doi:10.4103/0970-1591.159606
Bjurlin MA, Mendhiratta N, Wysock JS, Taneja SS.Multiparametric MRI and targeted prostate biopsy: Improvements in cancer detection, localization, and risk assessment.Cent European J Urol. 2016;69(1):9-18. Epub 2016 Jan 25. doi:10.5173/ceju.2016.734
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