The U.S. Food and Drug Administration (FDA) approved the PSA test, along with a digital rectal exam (DRE), to help detect prostate cancer in men age 50 and older. During a DRE, a doctor inserts a gloved finger into the rectum and feels the prostate gland through the rectal wall to check for bumps or abnormal areas. Doctors often use the PSA test and DRE as prostate cancer screening tests; together, these tests can help doctors detect prostate cancer in men who have no prostate cancer symptoms.
The FDA has also approved the PSA test to monitor patients with a history of prostate cancer to see if the cancer has come back (recurred). An elevated PSA level in a man with a history of prostate cancer does not always mean that the cancer has come back. A man should discuss an elevated PSA level with his doctor. The doctor may recommend repeating the test or performing other tests to check for evidence of recurrence.
It is important to note that a man who is receiving hormone therapy for prostate cancer may have a low PSA reading during or immediately after treatment. The low level may not be a true measure of PSA activity in the man's body. Men receiving hormone therapy should talk with their doctor, who may advise them to wait a few months after hormone treatment before having a PSA test.
Doctors' recommendations for prostate screening vary. Some encourage yearly prostate cancer screening for men over age 50; some advise men who are at a higher risk for prostate cancer to begin screening at age 40 or 45. Others caution against routine screening, while still others counsel men about the risks and benefits on an individual basis and encourage men to make personal decisions about screening. Currently, Medicare provides coverage for an annual PSA test for all men age 50 and older.
Several risk factors can increase a man's chances of developing prostate cancer. These factors may be taken into consideration when a doctor recommends screening. Age is the most common risk factor, with nearly 70 percent of prostate cancer cases occurring in men age 65 and older.
Other risk factors for prostate cancer include:
- Family history
- Diet (possibly).
Men who have a father or brother with prostate cancer have a greater chance of developing the condition. African American men have the highest rate of prostate cancer, while Asian and Native American men have the lowest rates. In addition, there is some evidence that a diet higher in fat, especially animal fat, may increase the risk of prostate cancer.