The following content is provided by University Hospitals.

Following skin cancer, prostate cancer is the second most common cancer in American men, with nearly a quarter million new cases diagnosed every year. Fortunately, with early detection, prostate cancer is very treatable.

According to urologist Lee Ponsky, MD, prostate cancer usually has no symptoms in its early stages. That’s why screening is so important.

“There is at least a 90 percent chance that a patient with low-risk prostate cancer will be cured,” he says. “But the longer it takes to be diagnosed, the greater the risk that the cancer may progress to a more dangerous stage.”

Two annual exams are usually done in tandem to check for the possibility of prostate cancer:

PSA test: This is a blood test that measures the level of a protein called prostate-specific antigen, or PSA, in the blood. An elevated level of PSA may indicate the presence of cancer or another condition, like an inflamed prostate.

Digital rectal exam: If you know that “digital” is medical terminology for a finger, you can guess how this test works. Because the prostate abuts the rectum, a doctor is able to feel for lumps or nodules on the gland during this exam. One of the limitations of a digital rectal exam, Dr. Ponsky says, is that the entire prostate cannot be felt through the rectum.


“Neither of these screenings is perfect, but they are the best tests we have today,” he says. “PSA is not a great test in terms of its ability to be specific to cancer. When a man has an elevated PSA there is approximately a 25 percent chance that cancer will be subsequently diagnosed. The rectal exam allows us to feel a nodule on a portion of the prostate, but most cancer we detect doesn’t have a nodule.”

Although they are not highly accurate, having these screenings done annually – generally starting at the age of 50, but earlier for men at a higher risk for prostate cancer – provides the best chance to detect early-stage prostate cancer that can be treated.

Or not.

“Prostate cancer is usually a slow-progressing disease,” Dr. Ponsky says. “We have realized over the last several years that a large number of patients who have been diagnosed with low-risk disease can be observed under what we call ‘active surveillance.’ That means they may not need to go through treatment right away, but they are closely monitored because it could potentially progress to a more aggressive disease.

“A recently published study in the Journal of Clinical Oncology showed that 55 percent of patients who are on active surveillance are still being followed without the need for treatment after 15 years,” he says.

If your screening reveals a potential for prostate cancer, your doctor usually follows up with a specialized prostate MRI imaging and a prostate biopsy to confirm or rule out the disease. Also, if you’re considered high risk, you should begin your annual screenings as early as age 40. You’re considered high risk if you have a history of cancer in your family – particularly a father or a brother – or are an African American man.

“There are some medical groups who believe that prostate screening in men, and mammograms in women, should not be done annually because of the costs involved with over-testing,” Dr. Ponsky says. “If the cost of screening versus the number of patients who are saved is the issue, who gets to decide the right cost for one person’s life being saved?”

In the end, he says, the decision to screen or not should be made by each patient in consultation with his doctor.

Lee Ponsky, MD is a urologist and the division chief of the Urologic Oncology Center, part of University Hospitals Urology Institute. You can request an appointment with Dr. Ponsky or any doctor online.