Prostate cancer is one of the most common cancers affecting men worldwide. Early detection through proper screening can improve outcomes and reduce complications. However, screening should be approached with careful consideration of both benefits and risks.

Symptoms of Prostate Cancer

Prostate cancer often shows no symptoms in its early stages. As the disease progresses, the following symptoms may appear:

• Frequent urination, especially at night

• Feeling of incomplete urination

• Pain or burning during urination

• Decreased urine output

• Persistent pain in the hips, back, or pelvis

These symptoms are not exclusive to prostate cancer and may be caused by other conditions such as benign prostatic hyperplasia (BPH) or prostatitis (inflammation of the prostate). If you experience any of these symptoms, consult a healthcare provider for further evaluation.

How is Prostate Cancer Screening Done?

The primary screening tool for prostate cancer is the PSA test (Prostate-Specific Antigen test). This simple blood test measures PSA levels, which can be elevated due to:

• Prostate cancer

• Benign prostatic hyperplasia (BPH) (enlargement of the prostate)

• Prostatitis (prostate inflammation or infection)

Since an elevated PSA level does not always mean cancer, additional tests such as MRI, a prostate biopsy may be recommended before confirming a diagnosis.

While PSA screening can reduce prostate cancer-related deaths, it also has risks, including false positives (leading to unnecessary biopsies) and overdiagnosis (detecting slow-growing cancers that may never cause harm).

Screening Recommendations

Screening guidelines vary based on age and risk factors:

1. Average Risk:

• Men with no family history of prostate cancer should start discussing PSA screening with their doctor at age 50.

2. High Risk:

• Men at higher risk (e.g., those with a first-degree relative diagnosed with prostate cancer before age 65, or African American men) should consider screening at age 45.

3. Age 55-69:

• The U.S. Preventive Services Task Force (USPSTF) and major medical organizations recommend shared decision-making for men in this age group. This means discussing the risks and benefits of PSA screening with a doctor before deciding whether to proceed.

4. Age 70 and Older:

• Routine PSA screening is not recommended unless there are specific medical reasons, as the risks of screening may outweigh the benefits in older adults.

Key Considerations for PSA Screening

Pros:

•  Early detection can improve treatment outcomes.

•  Screening may reduce prostate cancer mortality.

•  Advanced diagnostic tools (MRI fusion biopsy, biomarker tests) help refine risk assessment.

Cons:

•  False positives can cause unnecessary anxiety and lead to unneeded biopsies.

•  Overdiagnosis may result in overtreatment, which can lead to side effects such as:

• Erectile dysfunction

• Urinary incontinence

• Bowel issues 

Since not all prostate cancers are aggressive, some men may opt for active surveillance instead of immediate treatment if diagnosed with low-risk prostate cancer.

What Happens if PSA Levels are High?

If your PSA level is elevated, your doctor may recommend:

1. Repeating the PSA test after a short period to rule out temporary fluctuations.

2. Prostate MRI to look for suspicious areas before proceeding with a biopsy.

3. A prostate biopsy, which is the only way to confirm prostate cancer.

Not all men with an elevated PSA need a biopsy immediately—advanced imaging and biomarker tests can help reduce unnecessary biopsies.

Treatment Options for Prostate Cancer

If diagnosed, treatment options depend on the stage and aggressiveness of the cancer:

• Active Surveillance: For slow-growing, low-risk prostate cancer, regular monitoring may be an option instead of immediate treatment.

• Surgery (Radical Prostatectomy): Involves removing the prostate gland, often recommended for localized but aggressive cancer.

• Radiation Therapy: Used for localized cancer, sometimes combined with hormone therapy.

• Hormone Therapy: Helps slow cancer growth by reducing testosterone levels.

• Chemotherapy & Targeted Therapy: Used for advanced or metastatic prostate cancer.

The choice of treatment should be based on discussions with a urologist and oncologist, considering factors such as age, overall health, and cancer stage. At Amrita Hospital, we have a specialized Uro Oncology department for prostate cancer treatment and care.

PSA screening is an important tool for detecting prostate cancer early, but it is not without risks. Talk to your doctor about your personal risk factors and the pros and cons of screening before making a decision.

By staying informed and proactive about your health, you can take the right steps toward early detection and better outcomes.