These FAQs are organized by topic: click the topic of your choice. "Go to top" will return here.
TWO TESTS
What is the purpose of screening?
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To look for cancer early, before any symptoms are present.
How many screening tests are there?
Two. The PSA blood test and the digital rectal exam.
THE PSA TEST
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Can the PSA test tell me if I have prostate cancer?
No. The PSA test can indicate you might have cancer but only a biopsy can prove that a man has cancer.
Can the PSA test indicate cancers long before symptoms develop?
Yes
What could an elevated PSA and a bump on my prostate mean?
it could mean nothing
it could mean early signs of a treatable condition that could prevent a lot of pain and suffering later on.
or it could mean a more serious medical problem
What can the PSA blood test tell me?
that you might be at risk for prostate cancer
it can not tell you with certainty that you need a biopsy
it can not tell you that you have “clinically significant” prostate cancer
if you do have a biopsy later, the PSA test can not tell you with certainty whether you need a treatment
If I am not expected to live more than 10 years because of other health issues, should I bother with the test?
Probably not.
At what age should I consider having my first test?
40 for a “baseline” test, recommends the American Urological Association
Earlier if you are African-American
Or if you have a history of PC in your family.
Is there one specific test that will tell me for sure, if I have prostate cancer?
No.
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Should I have a PSA test if I’m over 75?
You can consider skipping the test
Or you can get a test to establish a baseline
Or get a test to see if you have advanced cancer.
Before I get tested, do I have to take any pills or laxative? Any preparations of any kind?
No.
Does the PSA test hurt?
No. It’s only a drawing of a small amount of blood. Usually from your arm.
How long does it take?
About five minutes.
Will I have any after-effects from the PSA test like pain or nausea?
No. It’s only a blood test.
How much will it cost me?
It’s covered by Medicaid and probably by your insurance company.
When will I get the results?
In about a week.
What is a “base line” PSA test?
It is a man’s first PSA test. Its purpose is to able to compare future PSA test results against this baseline. A fast-rising PSA is a strong indicator of cancer.
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What is the best thing that might happen to me if I have a PSA blood test?
It could save your life. The test might indicate a potential cancer, which turns out to be life-threatening.
What is the worst thing that might happen to me if I have a PSA blood test?
You might choose to have a treatment which proves to be unnecessary, and causes permanent side effects.
What’s the worst thing that could happen if I choose not to have a PSA test?
You might have life-threatening prostate cancer and not know it. It spreads through out your body untreated, and kills you.
Is screening for men who already have symptoms of prostate cancer?
No.
If I choose to be tested, who will perform the screening?
Your doctor, or other primary care provider
What happens next if the test indicates I might have cancer?
Your doctor might recommend that you have another PSA test in 3-6 months. Or he might recommend that you meet with a urologist.
Is the PSA test a routine part of a standard battery of tests that I might have?
Often, but not always. To be sure, ask your doctor.
What percent of men have a PSA screening each year?
CDC says 22.5% of men 40-49 were screened last year.
53.7% of men over 50 were screened.
What is the average age of men who are diagnosed with prostate cancer?
69
THE PROSTATE GLAND
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How big is my prostate and where is it?
It’s a gland about the size of a walnut located below and around the exit of your bladder. It’s next to your rectum and about one inch from your anus.
What’s the function of the prostate?
It provides part of the fluid that makes up your semen.
Do I need my prostate to make babies?
Yes.
Do I need my prostate to be potent (to get an erection)?
No
What is PSA?
It’s a protein made by the prostate gland that is mainly in the semen. Normally a small amount leaks into the
blood stream where it is easily measured. A high level of PSA can indicate the presence of cancer.
PROBLEMS OF PROSTATE CANCER
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How many men in the U.S. will die of prostate cancer in 2009?
28,000 forecasts the American Cancer Society.
How serious a problem is prostate cancer in the US?
It is the greatest cancer killer of men over 50.
It is the second greatest cancer killer of all men, regardless of age.
More men are diagnosed with prostate cancer than women with breast cancer.
How many men are diagnosed with prostate cancer each year?
200,000.
How many men are screened for prostate cancer each year?
In 2006, nearly two thirds of men in the U.S. between 50 and 74 were tested within the two previous years.
How many men have been diagnosed with prostate cancer because of screening?
About one million.
What is the chance of my dying of prostate cancer?
Three percent. (3%) Of every 100 men who die, three will die of prostate cancer.
How many men will have prostate cancer sometime during their life?
One of every six.
How many men died of prostate cancer in 1997?
41,800
How many died in 2007?
27,050
What caused the drop in the number of deaths?
No one knows for sure but early detection and improved treatments are likely major reasons.
WHAT ARE THE ODDS?
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Who is at risk for prostate cancer?
African-American men
Men with a family history of prostate cancer
Men over 50
What’s my chance of getting prostate cancer according to my age?
Birth to 39 1% 1 in 12,000
40-59 2% 1 in 44
60-79 14% 1 in 7
Lifetime 17% 1 in 6
What percent of men over 50 who are tested will have an elevated PSA?
10-15%.
Of those 10-15%, how many will be diagnosed with prostate cancer?
About one-third.
Does the PSA test save relatively few lives?
Yes.
Might finding cancer early save my life?
Yes. The earlier that cancer is diagnosed and treated (if necessary), the fewer complications from the cancer and
its treatment, and the greater the chance of a complete recovery.
What percent of prostate cancer deaths are caused by finding the cancer too late?
Theoretically, all.
What are the odds that the PSA test might save my life?
Let’s say that your PSA test led to a biopsy that revealed you have prostate cancer. And you chose to be
treated for that cancer. Having this treatment provides a one in 50 chance that 10 years later, you will have been spared death
from a cancer that would otherwise have killed you.
What’s the chance that my treatment was not necessary?
The figures above mean there is a 49 in 50 chance that you will have been treated unnecessarily. And that it was
not necessary that you suffered the after-effects of the treatment.
More than 70% of prostate cancers are diagnosed in men over 65. True or false?
True.
SIDE EFFECTS OF TREATMENTS
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What are the possible side effects of treatments?
Incontinence (inability to control flow of urine)
Need to urinate frequently and urgently.
Erectile dysfunction (erections inadequate for intercourse)
Bowel problems
If I’m diagnosed with PC, and choose to be treated, how likely am I to have some or all of these side effects?
It depends on the treatment you choose, but generally all treatments have at least one side effect.
UNNECESSARY TREATMENTS
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What is an “unnecessary treatment?”
Some men who receive a treatment may have had a less aggressive form of prostate cancer. Their cancer posed no threat to their health. But as a result of their
treatment, they suffered significant side affects. Their treatment was unnecessary.
Why do so many men who have recently been diagnosed with prostate cancer agree to be treated, when the treatment is probably not needed?
Many men demand, “Get this cancer out of my body! Cancer scares me.”
Does the PSA test lead to risky and unnecessary treatments for large numbers of men?
Yes.
When told they have been diagnosed with a low grade cancer that is unlikely to kill them and does not require immediate treatment, what percent of men delay treatment?
Fewer than 10%. More than 90% choose to be treated.
What does "over diagnosis” mean?
The PSA test may detect small cancers that would never become life-threatening.
Is this true? Most cancers grow slowly and are not life-threatening.
Yes.
Is this true?
Some men who receive treatment may have had a less aggressive form of prostate cancer that posed no serious threat
to their health. But, as a result of treatment, they suffered significant side effects.
TREATMENT DECISIONS
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Is it true that the majority of cancers will not cause health problems and therefore do not need treatment?
Yes.
Who makes the decision as to whether I will be treated?
You do. But you will want the input of your doctor, urologist, spouse and others.
Who makes the decision as to the type of treatment?
You do. But you will want the input of your doctor, urologist, etc.
How will I know which treatment would be best for me?
You will want to listen to the recommendations of medical people and survivors. There is much valuable information on the internet, in books and pamphlets, and
from the many national cancer organizations. Each man has his own fears and expectations. But in the end, you need to make your own decision.
What can happen if the biopsy finds cancer and I choose to have no treatment?
Much depends on the aggressiveness of your own particular cancer.
SLOW GROWING AND FAST GROWING CANCERS
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What percent of cancers are fast growing and could kill a man within a year?
Less than 10%.
Is it true that many cancers are so slow-growing they may not require treatment at all, ever?
Yes.
Is it true that at least 50% of men diagnosed with prostate cancer in the US have a low-grade form of cancer that experts say does not need
immediate treatment and may never need treatment?
Yes
What percent of deaths are caused by fast-growing cancers?
Most.
Can doctors distinguish between cancers that would be deadly without treatment, from cancers that would not?
Not for certain. But they have a good idea that a cancer that looks "angry" under the microscope, and is larger, is more likely to be deadly.
HOW AND WHEN WILL I KNOW IF I HAVE PROSTATE CANCER?
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If the PSA test is only an indicator, how will I know if I have prostate cancer?
The only proof that you have cancer is if pathologists discover cancer in your biopsy.
What are my options if I'm diagnosed with PC?
"Watch and wait" (Your doctor closely monitors your condition. No treatments at this point.)
Active surveillance.
Another PSA test in 3-6 months. And further biopsies at intervals.
BIOPSY, THE ONLY PROOF OF CANCER
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What is a biopsy?
Samples of tissue are taken (often 12) from within your prostate gland. In the lab, a pathologist searches for
cancer in those samples.
What is the purpose of a biopsy?
To look for cancer.
Who would recommend or advise me to have a biopsy?
Your urologist.
Does a biopsy hurt?
Sometimes. It certainly is not comfortable.
How long does a biopsy take?
About 15 minutes. It's done in the urologist's office.
How much will a biopsy cost me?
It's probably covered by your insurance. But make sure it is.
How would I know positively that I have prostate cancer?
Only if pathologists discover cancer in your biopsy.
How many biopsies are negative (no cancer found)?
Four of five biopsies are negative. But it depends upon the level of the PSA that triggered the biopsy.
If a biopsy finds cancer in my prostate, what should I do?
Consult with your physician and those he/she suggests.
WHAT'S IT LIKE TO GET PROSTATE CANCER?
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How does prostate cancer affect the body?
It can spread locally to block the bladder or the kidneys. It can invade the rectum or compress the lymph chambers or veins. It can spread to bones and other organs outside the pelvis.
Other than physical effects, what other affects might there be?
It might affect your ability to perform your job.
What is it like to die of prostate cancer?
Cancer spreads to the bones where it causes pain and interrupts the blood-producing bone marrow, causing anemia. It may also spread to organs such as the
liver, lungs and brain, or obstruct the drainage of kidneys. There may be bleeding from the prostate if it is still there.
WHAT THE NATION'S HEALTH ORGANIZATIONS SAY ABOUT THE PSA TEST
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American Urological Association.
In April of 2009, this group recommended that men should be offered a baseline PSA test at age 40, and follow-ups at intervals based on each man’s situation.
The American Cancer Society.
It recommends that when a man reaches age 50, he consult with his doctor whether he should be tested. If he is African-American, or has a history of PC
in his family, he should be tested at age 45.
American Cancer Society and US Food and Drug Administration.
Both are in favor of doctors offering the test to men at age 50, who are at average risk.
The National Comprehensive Cancer Care Network.
It recommends an initial PSA for men of all races.
The American Academy of Family Physicians.
It recommends that patients and physicians engage in shared decision-making to decide whether to get a PSA test.
U.S. Preventive Services Task Force.
They say evidence of testing is not strong enough for doctors to make recommendations to patients. Doctors should inform patients of the pros and cons of
testing and let them decide. Recommends doctors not to test men over 75.
Prostate Conditions Education Council (PCEC)
Recommends a baseline test for all men at age 40 and at 35 for men at high risk.
