Why is it important to find prostate cancer early?

The word screening refers to testing to find a disease like cancer in people who do not have symptoms of that disease. For some types of cancer, screening can help find cancers in an early stage when they are more easily cured. The goal of screening is to help people live healthier, longer lives.

The goal of screening for prostate cancer is to find it early, in the hope that it can be treated more effectively.

Prostate cancer can often be found early by testing the amount of prostate-specific antigen (PSA) in your blood. Another way to find prostate cancer early is the digital rectal exam (DRE). For this exam, your doctor inserts a gloved finger into the rectum to feel the prostate gland. These 2 tests are described below in more detail.

If prostate cancer is detected during routine yearly exams with the PSA test or DRE, your cancer will likely be at an early, more treatable stage.

Since using early detection tests for prostate cancer became relatively common (about 1990), the prostate cancer death rate has dropped. But it isn't clear yet that this drop is a direct result of screening. It could also be caused by something else, like improvements in treatment.

Unfortunately, there are limits to the current screening methods. Neither the PSA test nor the DRE is 100% accurate. Abnormal results of these tests don't always mean that cancer is present, and normal results don't always mean that there is no cancer. Inconclusive or false results on testing could cause confusion and anxiety. Some men might undergo a prostate biopsy (which carries its own small risks) when cancer is not present, while others might get a false sense of security from normal test results when cancer is actually present.

There is no question that the PSA test can help spot many prostate cancers early, but it's important to know that this test can't tell how dangerous the cancer is. Finding and treating all prostate cancers early may seem like a no-brainer. But some prostate cancers grow so slowly that they would likely never cause problems. Because of an elevated PSA level, some men may be diagnosed with a prostate cancer that they would have never even known about at all -- it would never have caused any symptoms or lead to their death. But they may still be treated for these cancers, either because the doctor can't be sure how aggressive the cancer might be, or because the men are uncomfortable not having any treatment. Treatments, such as surgery and radiation, can have side effects that seriously affect a man's quality of life. Doctors and patients are still struggling to decide who should receive treatment and who might be able to be followed without being treated right away (an approach called watchful waiting or expectant management).

Studies are under way to try to determine if early detection tests for prostate cancer in large groups of men will lower the prostate cancer death rate. Early results from two large studies haven't offered clear answers.

Early results from a study done in the United States found that annual screening with PSA and DRE did detect more prostate cancers, but this screening did not lower the death rate from prostate cancer. A European study did find a lower risk of death from prostate cancer with PSA screening (done about once every 4 years), but the researchers estimated that about 1,400 men would need to be screened (and 48 treated) in order to prevent one death from prostate cancer. Neither of these studies has shown that PSA screening helps men live longer (lowered the overall death rate).

Prostate cancer tends to be a slow growing cancer, so the effects of screening in these studies will likely become clearer in the coming years. Both of these studies are being continued to see if longer follow-up will provide more definitive results.

At this time, the American Cancer Society recommends (see below) that men should make informed decisions based on available information, discussion with their doctor, and their personal perspectives on the benefits and side effects of screening and treatment.

Until more information is available, you and your doctor can decide whether you should have tests to screen for prostate cancer. There are many factors to take into account, including your age and health. If you're young and develop prostate cancer, it will probably shorten your life if it's not caught early. If you're older or in poor health, prostate cancer may never become a major problem because it is generally a slow-growing cancer.

American Cancer Society recommendations for prostate cancer early detection

The American Cancer Society (ACS) does not support routine testing for prostate cancer at this time. The ACS does believe that health care professionals should discuss the potential benefits and limitations of prostate cancer early detection testing with men before any testing begins. This discussion should include an offer for testing with the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) yearly, beginning at age 50, to men who are at average risk of prostate cancer and have at least a 10-year life expectancy. Following this discussion, those men who favor testing should be tested. Men should actively take part in this decision by learning about prostate cancer and the pros and cons of early detection and treatment of prostate cancer

This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).

This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age).

If, after this discussion, a man asks his health care professional to make the decision for him, he should be tested (unless there is a specific reason not to test).

Recommendations of other organizations

No major scientific or medical organizations, including the American Cancer Society (ACS), American Urological Association (AUA), US Preventive Services Task Force (USPSTF), American College of Physicians (ACP), National Cancer Institute (NCI), American Academy of Family Physicians (AAFP), and American College of Preventive Medicine (ACPM) support routine testing for prostate cancer at this time.

These organizations (the ACS, AUA, ACP, NCI, AAFP, ACPM and the USPSTF) recommend that health care professionals discuss the possible benefits, side effects, and unresolved questions regarding early prostate cancer detection and treatment so that men can make informed decisions taking into account their own situation and risk.

The USPSTF published an update of its recommendations in 2008. It concluded that the risks of screening for prostate cancer outweigh the benefits for men age 75 years or older (as well as for men whose life expectancy is 10 years or fewer). For these men, the USPSTF is now recommending against prostate cancer screening. For men younger than 75 years old who have a life expectancy more than 10 years, the USPSTF indicated that the studies completed so far still do not provide enough evidence to know whether the benefits of testing for early prostate cancer outweigh the possible risks. For men in this age group, the USPSTF continues to recommend that health care providers discuss the potential benefits and known harms of PSA screening and then allow the patients' personal preferences to guide the decision of whether to order the test.

In addition, the American Cancer Society and the American Urological Association recommend that health care professionals offer the option of testing for early detection of prostate cancer to men who are at least 50 years old (or younger if at higher risk).

What tests can detect prostate cancer?

The following tests are used to look for warning signs of prostate cancer. But these early detection tests can’t tell for sure whether or not cancer is present. If the results of one or more of these tests are abnormal, you will likely need a prostate biopsy to determine if you have cancer. (A biopsy involves using needles to take samples from the prostate and looking at the cells under a microscope.)

Prostate-specific antigen (PSA) blood test

Prostate-specific antigen (PSA) is a substance made by cells in prostate gland (it is made by both normal cells and cancer cells). Although PSA is mostly found in semen, a small amount is also found in the blood. Most healthy men have levels under 4 nanograms per milliliter (ng/mL) of blood. The chance of having prostate cancer goes up as the PSA level goes up.

When prostate cancer develops, the PSA level usually goes above 4. Still, a level below 4 does not mean that cancer isn't present -- about 15% of men with a PSA below 4 will have prostate cancer on biopsy. Men with a PSA level in the borderline range between 4 and 10 have about a 1 in 4 chance of having prostate cancer. If the PSA is more than 10, the chance of having prostate cancer is over 50%.

The PSA level can also be increased by a number of factors other than prostate cancer, such as:

• Benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate that many men get as they grow older.

• Age: PSA levels will also normally go up slowly as you get older, even if you have no prostate abnormality.

• Prostatitis, an infection or inflammation of the prostate gland

• Ejaculation can cause the PSA to go up for a short time, and then go down again. This is why some doctors will suggest that men abstain from ejaculation for 2 days before testing.

Some things cause PSA levels to go down (even when cancer is present), including:

• Certain medicines used to treat BPH or urinary symptoms, such as finasteride (Proscar or Propecia) or dutasteride (Avodart). You should tell your doctor if you are taking these medicines, because they may lower PSA levels and require the doctor to adjust the reading.

• Some herbal mixtures that are sold as dietary supplements "for prostate health" may also mask a high PSA level. This is why it is important to let your doctor know if you are taking any type of supplement. Saw palmetto (an herb used by some men to treat BPH) does not seem to interfere with the measurement of PSA.

• Obesity: Obese (having a high amount of extra body fat) men tend to have lower PSA levels

If your PSA level is high, your doctor may advise a prostate biopsy to find out if you have cancer. Some doctors may consider using newer types of PSA tests (discussed below) to help decide if you need a prostate biopsy. Still, not all doctors agree on how to use these other PSA tests. If your PSA test result is not normal, ask your doctor to discuss your cancer risk and your need for further tests.

Percent-free PSA

PSA occurs in 2 major forms in the blood. One form is attached to blood proteins while the other circulates free (unattached). The percent-free PSA (fPSA) is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not.

This test is sometimes used to help decide if you should have a prostate biopsy if your PSA results are in the borderline range (between 4 and 10). A lower percent-free PSA means that your likelihood of having prostate cancer is higher and you should probably have a biopsy. Many doctors recommend biopsies for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. Using these cutoffs detects most cancers while helping some men to avoid unnecessary prostate biopsies. This test is widely used, but not all doctors agree that 25% is the best "cutoff point" to decide on a biopsy.

A newer test, known as complexed PSA, directly measures the amount of PSA that is attached to other proteins (the portion of PSA that is not "free"). This test is done instead of checking the total and free PSA, and it could give the same amount of information as the other two done separately. Studies are now under way to see if this test provides the same level of accuracy

PSA velocity

The PSA velocity is not a separate test. It is a measure of how fast the PSA rises over time. Even when the total PSA value isn't over 4, a high PSA velocity suggests that cancer may be present and a biopsy should be considered. For example, if your PSA was 1.7 on one test, and then a year later it was 3.8, this rapid rise may be cause for concern.

This can be useful if you are having the PSA test every year. For men whose initial PSA value is less than 4, a PSA velocity of 0.35 (ng/mL) per year or greater (for example, if values went from 2 to 2.4 to 2.8 over the course of 2 years) may be cause for concern. For men whose PSA value is between 4 and 10, a biopsy should be more strongly considered if it goes up faster than 0.75 (ng/mL) per year (for example, if values went from 4 to 4.8 to 5.6 over the course of 2 years). Most doctors believe that PSA levels should be measured at least 3 different times over a period of at least 18 months in order to get an accurate PSA velocity.

PSA density

PSA levels are higher in men with larger prostate glands. The PSA density (PSAD) tries to adjust for this. It is sometimes used for men with large prostate glands. The doctor measures the volume (size) of the prostate gland with transrectal ultrasound (discussed below) and divides the PSA number by the prostate volume. A higher PSA density (PSAD) indicates greater likelihood of cancer. PSA density has not been shown to be that useful. The percent-free PSA test has so far been shown to be more helpful.

Age-specific PSA ranges

PSA levels are normally higher in older men than in younger men, even when there is no cancer. A PSA result within the borderline range might be very worrisome in a 50-year-old man but cause less concern in an 80-year-old man. For this reason, some doctors have suggested comparing PSA results with results from other men of the same age.

But because the usefulness of age-specific PSA ranges is not well proven, most doctors and professional organizations (as well as the makers of the PSA tests) do not recommend their use at this time.

Digital rectal exam (DRE)

For a digital rectal exam (DRE), the doctor inserts a gloved, lubricated finger into the rectum to feel for any bumps or hard areas on the prostate that might be cancer. As shown in the picture below, the prostate gland is located just in front of the rectum, and most cancers begin in the back part of the gland that can be reached by a rectal exam. This exam is uncomfortable, but it's not painful and only takes a short time.

DRE is less effective than the PSA blood test in finding prostate cancer, but it can sometimes find cancers in men with normal PSA levels. For this reason, the American Cancer Society guidelines recommend that when prostate cancer screening is done, both the DRE and PSA blood test should be used.

Transrectal ultrasound (TRUS)

Transrectal ultrasound (TRUS) uses sound waves to make an image of the prostate on a video screen. For this test, a small probe that gives off sound waves is placed in the rectum. The sound waves enter the prostate and create echoes that are picked up by the probe. A computer turns the pattern of echoes into a black and white image of the prostate.

The procedure takes only a few minutes and is done in a doctor's office or outpatient clinic. You will feel some pressure when the TRUS probe is placed in your rectum, but it is usually not painful.

TRUS is usually not recommended as a routine test by itself to detect prostate cancer early because it doesn't always distinguish normal from cancerous tissue. Instead, it is most commonly used during a prostate biopsy (described below). TRUS is used to guide the biopsy needles into the right area of the prostate.

TRUS is useful in other situations as well. It can be used to measure the size of the prostate gland, which can help determine the PSA density and may also affect which treatment options a man has.

What if the test results aren't normal?

If the results of early detection tests -- the prostate-specific antigen (PSA) blood test and/or digital rectal exam (DRE) -- suggest that you might have prostate cancer, your doctor will do a prostate biopsy to find out if the disease is present.

The prostate biopsy

A biopsy is a procedure in which a sample of body tissue is removed and then looked at under a microscope. A core needle biopsy is the main method used to diagnose prostate cancer. It is usually done by a urologist, a surgeon who treats cancers of the genital and urinary tract, which includes the prostate gland. Using transrectal ultrasound to "see" the prostate gland, the doctor quickly inserts a needle through the wall of the rectum into the prostate gland. When the needle is pulled out, it removes a small cylinder of tissue, usually about 1/2-inch long and 1/16-inch across. This is repeated from 8 to18 times, although most urologists will take about 12 samples. These are sent to the lab to see if cancer is present.

Though the procedure sounds painful, it may only cause a very brief, uncomfortable sensation because it is done with a special spring-loaded biopsy instrument. The device inserts and removes the needles in a fraction of a second. Most doctors who do the biopsy will numb the area first with local anesthetic. You might want to ask your doctor if he or she plans to do this.

Some doctors will do the biopsy through the perineum, the skin between the rectum and the scrotum. The doctor will place his or her finger in your rectum to feel the prostate and then insert the biopsy needle through a small incision in the skin of the perineum. The doctor will also use a local anesthetic to numb the area.

The biopsy itself takes about 15 minutes and is usually done in the doctor's office. You will likely be given antibiotics to take before the biopsy and for a day or 2 after to reduce the risk of infection.

For a few days after the procedure, you may feel some soreness in the area and will likely notice blood in your urine. You may also have some light bleeding from your rectum. Many men also see some blood in their semen, which can cause the semen to become rust colored. This can last for several weeks after the biopsy.

Your biopsy samples will be sent to a pathology lab. There, a pathologist (a doctor who specializes in diagnosing disease in tissue samples) will see if there are cancer cells in your biopsy by looking at the samples under the microscope. If cancer is present, the pathologist will also assign it a grade (see below). Getting the results usually takes at least 1 to 3 days, but it can take longer.

Even with many samples, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a "false negative" result. If your doctor still strongly suspects prostate cancer (due to a very high PSA level, for example) a repeat biopsy may be needed to help be sure. Prostate biopsy results are sometimes called suspicious. This means that the cells do not look quite normal, but they don't look like cancer, either. If your biopsy results come back suspicious, your doctor may want to repeat the biopsy.

More information about the possible results of prostate biopsies can be found in our document: Prostate Cancer.

What are the signs and symptoms of prostate cancer?

Early prostate cancer usually causes no symptoms and is most often found by a PSA test and/or DRE. Some advanced prostate cancers can slow or weaken your urinary stream or make you need to urinate more often. But non-cancerous diseases of the prostate, such as BPH (benign prostatic hyperplasia) are a more common cause of these symptoms.

If the prostate cancer is advanced, you might develop blood in your urine (hematuria) or trouble getting an erection (impotence). Advanced prostate cancer commonly spreads to the bones, which can cause pain in the hips, back, ribs, or other areas. Sometimes cancer that has spread to the bones of the spine will press on the spinal cord or its nerves. This can result in weakness or numbness in the legs or feet, or even loss of bladder or bowel control.

Other diseases can also cause many of these same symptoms. It is important to tell your doctor about any of them so that the cause can be determined and treated.

What are the risk factors for prostate cancer?

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers.

But risk factors don't tell us everything. Many people with one or more risk factors never get cancer, while others with this disease may have had no known risk factors.

We don't yet completely understand the causes of prostate cancer, but researchers have found several factors that change the risk of getting it. For some of these factors, the link to prostate cancer risk is not yet clear.

Age

Age is the strongest risk factor for prostate cancer. Prostate cancer is very rare before the age of 40, but the chance of having prostate cancer rises rapidly after age 50. Almost 2 out of 3 prostate cancers are found in men over the age of 65.

Race/ethnicity

Prostate cancer occurs more often in African-American men than in men of other races. African-American men are also more likely to be diagnosed at an advanced stage, and are more than twice as likely to die of prostate cancer as white men. Prostate cancer occurs less often in Asian-American and Hispanic/Latino men than in non-Hispanic whites. The reasons for these racial and ethnic differences are not clear.

Nationality

Prostate cancer is most common in North America, northwestern Europe, Australia, and on Caribbean islands. It is less common in Asia, Africa, Central America, and South America. The reasons for this are not clear. More intensive screening in some developed countries likely accounts for at least part of this difference, but other factors are likely to be important as well. For example, lifestyle differences (diet, etc.) may be important: men of Asian descent living in the United States have a lower risk of prostate cancer than white Americans, but their risk is higher than that of men of similar backgrounds living in Asia.

Family history

Prostate cancer seems to run in some families, which suggests that in some cases there may be an inherited or genetic factor. Having a father or brother with prostate cancer more than doubles a man's risk of developing this disease. (The risk is higher for men with an affected brother than for those with an affected father.) The risk is much higher for men with several affected relatives, particularly if their relatives were young at the time the cancer was found.

Genes

Scientists have found several inherited genes that seem to raise prostate cancer risk, but they probably account for only a small number of cases overall. Genetic testing for most of these genes is not yet available. Recently, some common gene variations have been linked to the risk of prostate cancer. Studies to confirm these results are needed to see if testing for the gene variants will be useful in predicting prostate cancer risk

Some inherited genes raise the risk for more than one type of cancer. For example, inherited mutations of the BRCA1 or BRCA2 genes are the reason that breast and ovarian cancers are much more common in some families. Mutations in these genes may also increase prostate cancer risk in some men, but they account for a very small percentage of prostate cancer cases.

Diet

The exact role of diet in prostate cancer is not clear, but several different factors have been studied.

Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer. These men also tend to eat fewer fruits and vegetables. Doctors are not sure which of these factors is responsible for raising the risk.

Some studies have suggested that men who consume a lot of calcium (through food or supplements) may have a higher risk of developing advanced prostate cancer. Most studies have not found such a link with the levels of calcium found in the average diet, and it's important to note that calcium is known to have other important health benefits.

Obesity

Most studies have not found that being obese (having a high amount of extra body fat) is linked with a higher risk of getting prostate cancer. Some studies have found that obese men have a lower risk of getting a low-grade (less dangerous) form of the disease, but a higher risk of getting more aggressive prostate cancer. The reasons for this are not clear. Also, several studies have found that obese men may be at greater risk for having more advanced prostate cancer and of dying from prostate cancer, but this was not seen in other studies.

Exercise

In most studies, exercise has not been shown to lower the chance of getting prostate cancer. But some studies have found that high levels of physical activity, particularly in older men, may lower the risk of advanced prostate cancer. More research in this area is needed.

Inflammation of the prostate

Some studies have suggested that prostatitis (inflammation of the prostate gland) may be linked to an increased risk of prostate cancer, but other studies have not found such a link. Inflammation is often seen in samples of prostate tissue that also contain cancer. The link between the two is not yet clear, but this is an active area of research.

Infection

Researchers have also looked to see if sexually transmitted infections (like gonorrhea or chlamydia) might increase the risk of prostate cancer. These infections could increase cancer risk by leading to inflammation of the prostate. So far, studies have not agreed, and no firm conclusions have been reached.

Vasectomy

Some earlier studies had suggested that men who had a vasectomy (minor surgery to make men infertile) -- especially those younger than 35 at the time of the procedure -- may have a slightly increased risk for prostate cancer. But most recent studies have not found any increased risk among men who have had this operation. Fear of an increased risk of prostate cancer should not be a reason to avoid a vasectomy.

Can prostate cancer be prevented?

Because the exact cause of prostate cancer is not known, at this time it is not possible to prevent most cases of the disease. Many risk factors such as age, race, and family history cannot be controlled. But based on what we do know, some cases might be prevented.

Diet

The results of research studies are not yet clear, but you may be able to reduce your risk of prostate cancer by changing the way you eat.

The American Cancer Society recommends choosing foods and beverages in amounts that help achieve and maintain a healthy weight, eating a variety of healthful foods with an emphasis on plant sources, and limiting your intake of red meats, especially high-fat or processed meats (hot dogs, bologna, and lunch meat). Eat 5 or more servings of fruits and vegetables each day. Whole-grain breads, cereals, rice, pasta, and beans are also recommended. These guidelines on nutrition may also lower the risk for some other types of cancer, as well as other health problems.

Tomatoes (raw, cooked, or in tomato products such as sauces or ketchup), pink grapefruit, and watermelon are rich in lycopenes. These vitamin-like substances are antioxidants that help prevent damage to DNA. Some earlier studies suggested lycopenes may help lower prostate cancer risk, although a more recent study found no link between blood levels of lycopene and risk of prostate cancer. Research in this area continues.

There has been hope for some time that taking vitamin or mineral supplements might affect prostate cancer risk. Some studies have suggested that taking vitamin E daily might lower risk. But other studies have found that vitamin E supplements have no impact on cancer risk, and larger doses may increase risk for some kinds of heart diseases. Some studies have also suggested that selenium, a mineral, might lower the risk of prostate cancer.

To study the possible effects of selenium and vitamin E on prostate cancer risk, doctors conducted the Selenium and Vitamin E Cancer Prevention Trial (SELECT). In this clinical trial, about 35,000 men were randomized to take one or both of these supplements or to take an inactive placebo. After an average of about 5 years of daily use, neither supplement was found to lower prostate cancer risk.

Taking any supplements can have risks and benefits. Before starting vitamins or other supplements, you should talk with your doctor.

Several studies are now looking at the possible effects of soy proteins (called isoflavones) on prostate cancer risk. The results of these studies are not yet available.

Medicines

Some drugs may also help reduce the risk of prostate cancer.

5 alpha-reductase inhibitors

5 alpha-reductase is the enzyme that changes testosterone into dihydrotestosterone (DHT). DHT is the hormone which causes the prostate to grow. 5 alpha-reductase inhibitors are drugs that block that enzyme and prevent the formation of DHT.

Finasteride (Proscar) is a 5 alpha-reductase inhibitor that is already used to treat benign prostatic hyperplasia (BPH). It is also available in a lower dose form (called Propecia) to treat male pattern baldness.

The Prostate Cancer Prevention Trial (PCPT) was a large clinical trial designed to see if finasteride could lower the risk of prostate cancer. Half of the men in the study took finasteride each day for 7 years, while the other half took a placebo (sugar pill). At the end of the study, men taking finasteride were less likely to have prostate cancer than those getting the placebo. At first it looked like the men taking finasteride had slightly more cancers with high Gleason scores - cancers that looked like they were more likely to grow and spread. It is now thought that this is not true, and men who took finasteride are not more likely to develop high grade cancer. Researchers are still watching the men in the study to see if the men taking the drug lived longer.

Finasteride was more likely to cause sexual side effects such as lowered sexual desire and impotence. But it seemed to help with urinary problems such as trouble urinating and leaking urine (incontinence).

At this time, not all doctors agree whether taking finasteride to prevent prostate cancer is a good thing. Men thinking about this should discuss it with their doctors. The results of the PCPT will become clearer over the next few years.

Dutasteride (Avodart), another 5 alpha-reductase inhibitor, is currently being tested in a clinical trial to see if it can lower the risk of prostate cancer.

Other drugs

In a small study, toremifene, an anti-estrogen, decreased the risk of prostate cancer in men with high grade prostatic intraepithelial neoplasia. A larger study to confirm this finding is going on now. Other drugs that may help prevent prostate cancer are now being tested in clinical trials..

State efforts to ensure prostate cancer screening coverage

The American Cancer Society supports legislation assuring that men will receive insurance coverage for prostate screening exams. The Society recognizes that differing opinions exist as to whether early detection testing for prostate cancer lowers disease-specific mortality. Until such time when studies are conclusive, patients, in consultation with their doctors, should be free to determine on an individual basis whether testing is appropriate. Prostate cancer screening should not be prevented because of the reimbursement limitations of health insurance plans.

The American Cancer Society does not support routine testing for prostate cancer at this time because we believe proper pretest guidance and education is necessary. Doctors and other clinicians should provide information on the potential risks and benefits of PSA testing to appropriate patients, allowing them to make an informed decision on testing.

States have passed laws on a variety of issues relating to prostate cancer including:

• assured health insurance coverage for prostate cancer screening
• public education on prostate cancer
• prostate cancer research funds

Twenty-seven states and the District of Columbia have laws assuring that private health insurers cover procedures to detect prostate cancer, including the PSA test and DRE (see table below). Four of these states also assure that public employee benefit health plans provide coverage for prostate cancer screening procedures. Most state laws assure annual coverage for asymptomatic men ages 50 and over and for high-risk men, ages 40 and over. High risk refers to African-American men and/or men with a family history of prostate cancer. Maryland requires annual coverage for men age 40 to 75.

States with prostate cancer screening coverage laws

* A Mandated Offering Law requires insurance companies to offer coverage for prostate cancer screening. It is not required that the purchaser select prostate cancer screening coverage.

Sources: National Conference of State Legislatures, August 2009, Department of Insurance, State of South Carolina

Medicare coverage

Medicare covers a digital rectal exam and a PSA blood test once a year for all men with Medicare age 50 and over. There is no co-insurance and no Part B deductible for the PSA test. For other services, the beneficiary would pay 20% of the Medicare approved amount after the yearly Part B deductible.

Additional resources

More information from your American Cancer Society

The following related information may also be helpful to you. These materials may be ordered from our toll-free number, 1-800-227-2345.

• Facts on Prostate Cancer and Prostate Cancer Testing

• Guidelines for the Early Detection of Cancer (also available in Spanish)

• Prostate Cancer (also available in Spanish)

• Sexuality and Cancer: For the Man Who Has Cancer and His Partner (also available in Spanish)

The following books are available from the American Cancer Society. Call us at 1-800-ACS-2345 (1-800-227-2345) to ask about cost or to place your order.

• American Cancer Society's Complete Guide to Prostate Cancer

• Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment, and Recovery, Second Edition

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit cancer.org.

References

American Cancer Society. Cancer Facts & Figures 2009. Atlanta, Ga: American Cancer Society; 2009.

American Cancer Society. Prostate cancer. Cancer Information Database. 2009.

Andriole GL, Grubb RL, Buys SS, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360:1310-1319.

National Conference of State Legislatures. Prostate cancer screening mandates. 2009. Accessed at www.ncsl.org/programs/health/prostate.htm on August 4, 2009.

Lucia MS, Epstein, Goodman PJ, et al. Finasteride and high-grade prostate cancer in the Prostate Cancer Prevention Trial. J Natl Cancer Inst. 2007;99:1375-1383.

Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360:1320-1328.

Last Medical Review: 08/06/2009
Last Revised: 08/06/2009