Prostate Cancer Screening

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 abdomen, below the bladder, which holds urine, and in front of the rectum, the chamber at the end of the large intestine through which bowel movements pass. The urethra, the thin tube that carries urine from the bladder out of the body, runs through the prostate’s center.

VIDEO: Urologic oncologist Dr. Hebert Lepor discusses the importance of prostate cancer screening and knowing the risk factors of prostate cancer.

In adult men, a normal prostate is about the size of a walnut. As men age, it is common for the prostate to grow. 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, but because early detection does not necessarily mean you require treatment, you and your urologist may want to discuss whether screening is right for you. This shared decision-making 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 may 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.

PSA Test

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 often used in conjunction with a 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.

Our researchers are developing and evaluating highly sensitive tests that detect aggressive cancers more accurately than previously possible while reducing the incidence of false-positive and false-negative results. For instance, the prostate health index (PHI) blood test and 4Kscore test measure different forms of PSA in the blood; other tests detect molecular markers associated with aggressive prostate cancer in urine.

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 are leading authorities in PSA screening and can help you decide whether a PSA test is right for you.

Investigators at NYU Langone Health have played a pivotal role in investigating molecular markers that help doctors determine whether prostate biopsy is needed.

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 have PSA tests beginning at age 40.

Whether or not a PSA test result is considered abnormal is based on a man’s age and the size of the prostate. A younger man with a relatively “low” PSA level may be more likely to have cancer than an older man with a higher PSA level that is stable over time.

If you have a single PSA test result that shows an elevated level or a progressively increasing level, your doctor repeats the test before recommending further diagnostic tests.