The prostate, a male sexual accessory gland, produces a major portion of the seminal fluid that facilitates the transport of sperm cells.
The prostate is located in the lower part of the abdomen and sits in front of the rectum, the chamber at the end of the large intestine through which bowel movements pass, and below the bladder, which holds urine. The urethra, the thin tube that carries urine from the bladder out of the body, runs through the prostate’s center.
In adult men, a normal prostate is about the size of a walnut. As men age, it is common for the prostate to grow in size. Sometimes, the growing prostate constricts the urethra, causing problems in passing urine. This is called benign prostatic hyperplasia, or BPH. This benign enlargement of the prostate does not lead to cancer.
The risk of developing prostate cancer increases as men age. Because of this, you and your urologist may want to discuss whether screening is right for you. This shared decision-making approach takes into consideration your own values, along with your doctor’s experience and the latest medical evidence.
Two screening methods are available.
Digital Rectal Exam
In a digital rectal exam, a doctor uses a gloved finger to check the prostate by feeling it through the rectum. The doctor assesses the size of the prostate and checks for any abnormalities. A normal prostate has a rubbery, soft feel and is symmetric with a smooth groove down the middle, separating the right side from the left.
A firm or hard region in the prostate called a nodule can indicate that prostate cancer is present. If the urologist feels a prostate nodule, other diagnostic tests are recommended. The doctor may also recommend these tests if the prostate feels asymmetric, with one side larger than the other.
Prostate-specific antigen, or PSA, is a protein produced by the prostate gland that can be measured in the blood. Because the level of PSA in the blood can be elevated in men with prostate cancer, this test is sometimes used in conjunction with digital rectal exam to screen for the condition.
Widespread PSA screening has been primarily responsible for reducing overall prostate cancer mortality rates by almost 50 percent.
The PSA test is not a perfect screening test for prostate cancer and cannot be used alone to diagnose prostate cancer. That’s because elevated PSA levels may also indicate a urinary tract infection, prostatitis, which is an inflammation of the prostate, or BPH. The test may also “overdiagnose” prostate cancer—that is, it can result in the detection of slow-growing cancers that would pose no harm if left untreated.
Our specialists can help you decide whether a PSA test is right for you.
Doctors at NYU Langone’s Perlmutter Cancer Center advise men who are at an increased risk of prostate cancer, such as those with a family history of prostate cancer and African American men, to undergo PSA tests beginning at age 40. For men between ages 55 to 69 who aren’t at high risk, our doctors agree with the American Urological Association guidelines, which recommend that men talk with their doctors about the benefits and risks of PSA screening and the frequency of PSA testing.
A PSA test result is considered “abnormal” based on a man’s age and the size of the prostate. A younger man with a result that shows a small increase in PSA level may be more likely to have cancer than an older man with a higher PSA level that is more stable.
If you have a single PSA test result that shows an elevated level, your doctor repeats the test before recommending further diagnostic tests.
Our researchers are developing promising new tests to screen for prostate cancer.
Our researchers are developing and evaluating other tests for screening for prostate cancer, including tests that measure different forms of PSA; a test to identify a biomarker, a substance that indicates cancer, in the urine called PCA3; and tests that measure the genetic instability, or changes in chromosomes, of prostate cells.
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