Screening Guidelines: Prostate Health

As men age, it is not uncommon for them to experience prostate problems. Prostatitis (inflammation of the prostate gland) is most common in men under 50. Benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate that can cause urination problems, is more common in men over 50. Prostate cancer, which is less common than BPH, primarily affects men over the age of 65.

Prostatitis symptoms include urinary and genital pain. Symptoms can vary in intensity from mild to severe. In diagnosing prostatitis, your health care professional may decide to perform a digital rectal exam (DRE) and urinalysis.

BPH symptoms include a frequent need to urinate in short intervals, a feeling of little warning when urge of urination develops, a need to urinate during the night, a weak urine stream, delay and difficulty in initiating urination, a feeling of incomplete emptying of the bladder and stopping and starting of urination several times during voiding.

BPH diagnostic tools include: urinalysis; digital rectal exam; prostate-specific antigen (PSA) blood test, which measures the level of PSA in the blood; transrectal ultrasound; and urine flow study. For more information on BPH, visit the Benign Prostatic Hyperplasia fact sheet and risk assessment.

Prostate cancer symptoms are similar to those for prostatitis and BPH and can also include blood in urine or semen, painful ejaculation and constant pain in the lower back, pelvis or upper thighs. Symptoms often do not occur until many years after cancer develops.

An annual DRE and PSA blood test can identify prostate cancer at its earliest stages when treatment can be most successful. With early treatment, symptoms may not develop. Since the use of early detection tests became relatively common about 15 years ago, the prostate cancer death rate has dropped. But it has not been proven that this is a direct result of screening. Because neither the PSA test nor the DRE is 100 percent accurate, inconclusive or false testing results can cause confusion and anxiety
That's why no major medical or scientific organizations unequivocally advocate routine testing for prostate cancer at this time.

However, the American Cancer Society, along with several other medical organizations, recommends that health care professionals offer these screening tests to all men beginning at age 50. They should openly discuss the benefits and risks of testing at annual checkups.

The American Cancer Society also recommends that men at high risk (African-American men and men with one or more first-degree relative who were diagnosed with prostate cancer before age 65) be told about the options of annual testing at age 45. Men with multiple first-degree relatives diagnosed at an early age may begin testing at age 40.

This publication was supported by an educational grant from sanofi-aventis.