By Thomas Haus, M.D., Family Medicine

While it’s easy to make light about the men’s prostate exam, prostate health is no laughing matter. Men should have their first prostate exam by age 50, but if your family history includes prostate cancer, we recommend being examined at age 45.

Prostate screening: PSA test and DRE

The prostate screening exam includes a digital rectal exam (DRE) and a simple blood test to determine the amount of prostate-specific antigen (PSA) in the blood. The prostate gland produces the PSA protein, and when the gland isn’t functioning properly, more PSA is produced.

If you are experiencing these symptoms, ask your doctor if a PSA test is needed:

• Difficulty urinating or frequently urinating
• Slow urine flow
• Difficulty holding in urine

Both screening assessments (PSA test and DRE) are needed because the DRE can find prostate cancer in men whose PSA levels may appear normal. The lab results don’t return a specific normal or abnormal level of PSA in the blood, as the level varies by age and individual. But if the number is considered high (around 4.0 ng/mL or greater), or if the PSA level rises by a certain amount in a year, more testing, such as a prostate biopsy, may be needed.

Several factors are considered before a biopsy is performed, such as age, general health, family history, health history, and lifestyle behaviors. If the level is considered mildly higher, your doctor may recommend being retested in six months. If tests reveal that the PSA continues to rise, it may indicate prostate cancer.

Those at risk for prostate cancer:

• 50 years or older
• Family history of prostate cancer
• Genetics that may lead to developing prostate cancer
• African-American or Caribbean lineage

If cancer is diagnosed, treatment options range from surgery or radiation to ultrasound, cryotherapy (extreme cold), hormone treatment, or chemotherapy—depending on the situation and what the doctor prescribes.

While an elevated PSA may be concerning, it doesn’t always mean cancer.

Other causes for an elevated PSA:

• Prostate enlargement/inflammation (prostatitis)
• Urinary tract infection
• Urinary catheter placement
• Some medications also affect PSA

Whether you are concerned about symptoms or haven’t been screened by age 45–50, ask your provider about a PSA test to rule out cancer or other conditions of the prostate gland. Learn more about regular checkups for men in Glacial Ridge Health System’s Men’s Health Guide.