Prostate Cancer Screening FAQs

By David T. Marshall, M.D.

According to the American Cancer Society, prostate cancer is the second leading cause of cancer death in American men. About 200,000 men in the U.S. are diagnosed with prostate cancer each year. Prostate cancer has a high cure rate when found in early stages, so detecting it before it has spread is a big concern.

How should men manage that risk, and should patients get screened for prostate cancer? We sat down with David Marshall, M.D., chair of radiation oncology at MUSC Health Hollings Cancer Center, to get the skinny on prostate cancer screenings and what men need to know.

What screening is available for prostate cancer?

One of the most common types of screening is called a Prostate Specific Antigen (PSA) test. This blood test is both easy for a physician to obtain, and the results come back quickly. This test looks at the PSA levels in the blood to help physicians detect the possibility of cancer. Elevated PSA levels may be a sign of prostate cancer, but many other things can also affect your PSA level.

The digital rectal exam (DRE) is another form of screening. A DRE is a very nonspecific and nonsensitive test and is often combined with the PSA test. So if your PSA is elevated for your age and/or something is abnormal with your digital rectal exam, this leads to further investigation. Often, a patient would receive a referral to a urologist who would discuss the pros and cons of proceeding with further workups such as an MRI or a biopsy.

Should every man get screened for prostate cancer?

I think it's vital that every man discusses with their primary care physician when they get to their forties and fifties whether they should do a PSA screening for prostate cancer.

If their physician doesn't bring it up, I recommend that the patient bring it up with their doctor. Prostate cancer affects a lot of men in the United States every year, and it's essential to have that dialogue with your provider.

What are the recommendations for getting a PSA screening?

I follow the guidelines from the American Urological Association, which recommends that men should discuss receiving a PSA screening for prostate cancer at around the age of 55, unless you're at high risk of prostate cancer. If you are at higher risk, meaning you have a first-degree relative with prostate cancer or you are an African American, it's important to discuss this at around the age of 40. There is also some evidence that Agent Orange exposure may increase the risk of prostate cancer. So men need to share that history with their primary care provider.

What preventative measures can patients take to lower their risk of prostate cancer?

The main thing I encourage patients to do is to live a heart healthy lifestyle. A heart healthy lifestyle consists a diet of less red meat and more fruits and vegetables, regular exercise, avoiding all tobacco products, and alcohol in moderation. Heart disease is still the number one killer in men with prostate cancer, so it's essential to live a heart-healthy lifestyle, whether you're living with or aiming to preventing prostate cancer.

Dr. Marshall is professor of Radiation Oncology and Urology at MUSC Health and department chair of radiation oncology. He is also the clinical trials office medical director at Hollings Cancer Center.

Learn more about the MUSC Health Prostate and Genitourinary Cancers Program.