Screening Guidelines, Tests, and Symptoms

Screening Tests for Men

• Prostate Cancer
• Testicular Cancer

Prostate Cancer

Screening for prostate cancer is controversial. Although three types of screening tests are available, each test can produce false results, which could lead to unnecessary treatments which can be harmful. Research is being done to determine the best method of screening for prostate cancer. Talk with your doctor about what is best for you.

Screening Guidelines:

American Cancer Society (ACS)
Both the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy. Men at high risk (African-American men and men with a strong family history of one or more first-degree relatives (father, brothers) diagnosed at an early age) should begin testing at age 45. Men at even higher risk, due to multiple first-degree relatives affected at an early age, could begin testing at age 40. Depending on the results of this initial test, no further testing might be needed until age 45.

Information should be provided to all men about what is known and what is uncertain about the benefits and limitations of early detection and treatment of prostate cancer so that they can make an informed decision about testing.

Men who ask their doctor to make the decision on their behalf should be tested. Discouraging testing is not appropriate. Also, not offering testing is not appropriate.

National Cancer Institute (NCI)
The evidence is insufficient to determine whether screening for prostate cancer with prostatic specific antigen (PSA) or digital rectal exam (DRE) reduces mortality (death) from prostate cancer. Screening tests are able to detect prostate cancer at an early stage, but it is not clear whether this earlier detection and consequent earlier treatment leads to any change in the outcome of the disease.

The U.S. Preventative Services Task Force
The U.S. Preventative Service Task Force does not recommend routine screening with the digital rectal exam, PSA blood test, or transrectal ultrasound.

Patients who request screening should be given information about the potential benefits and harms of early detection and treatment and discuss these issues with your doctor.

If screening is performed, the best approach is to screen with digital rectal exam and the PSA blood test.

Exams and Tests Explained:
For a digital rectal exam, the doctor gently inserts a gloved, lubricated finger into the rectum and feels the prostate for hard or lumpy areas.

The Prostatic Specific Antigen (PSA) Blood Test measures the level of a certain protein. In some men with prostate cancer, this level will rise, alerting the doctor that there may be a tumor. However, a normal PSA level does not rule out cancer, and an elevated level may be due to a benign condition.

Symptoms to Report to Your Doctor:

• A need to urinate frequently, especially at night
• Difficulty starting urination or holding back urine
• Inability to urinate
• Weak or interrupted flow of urine
• Painful or burning urination
• Painful ejaculation
• Blood in urine or semen
• Frequent pain or stiffness in the lower back, hips, or upper thighs

Testicular Cancer

The performance of testicular self-examination is controversial. No studies have ever been done to determine the effectiveness of testicular self-examination or clinical testicular examination in reducing mortality from testicular cancer. Ask your physician if you should perform self-examination and/or have clinical testicular examinations.

Symptoms to Watch For:

• A lump in either testicle
• An enlargement of a testicle
• A feeling of heaviness in the scrotum
• A dull ache in the lower abdomen or the groin
• A sudden collection of fluid in the scrotum
• Pain or discomfort in a testicle or in the scrotum
• Enlargement or tenderness of the breasts