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PROSTATE SCREENING
Patient Information
What is the prostate?
That sounds good, what are the disadvantages?
The prostate is a chestnut-sized organ that sits under
your bladder. It has an important role in the production
of semen.
The blood test that we use to check the prostate is not
specific for cancer. Other conditions such as benign
prostatic hypertrophy (the age-related swelling of the
Prostate gland) can cause it to be elevated also. At
moderately raised levels we know that only
approximately one quarter of men will have cancer
diagnosed on subsequent biopsy.
Why do I hear all this discussion about the
prostate?
In a significant amount of men, as they age, cancer can
develop in the prostate. In fact, it is the commonest
male cancer in Ireland.
What are my chances of getting it?
Statistics suggest that once you reach 50 years of age
you have over a 50% chance of developing it.
How dangerous is it?
Again, taking a 50 year old man, he has a 3% chance of
dying from prostate cancer over his lifetime.
That seems like a low figure, I thought all cancers
were the same?
Prostate cancer behaves very differently from other
cancers, for example lung or bowel cancer. The
majority of prostate cancers are slow growing and will
rarely impact on a man’s health or life-expectancy. It is
said that most men will die with it rather than from it.
Should I have my prostate checked?
This is primarily a personal choice that should be made
in consultation with your GP. At this point in time we
simply do not know if men are better off from having
regular checks on their prostate. The indirect evidence
seems to suggest that they are, but we are waiting for 2
large research trials to conclude, within the year, and
hopefully get a definite answer.
What are the advantages of having my Prostate
checked?
Regular checking or “screening” of your prostate can
provide reassurance that there is no evidence of
cancer. We also know that prostate cancer, if caught
early, can be cured.
Surely it’s a good thing if you identify the cancer
early?
In general it is, but where prostate cancer differs is that
we actually identify a large number of cancers that
would never have caused any problems. Statistics
suggest that only 1 in 8 screening-detected cancers is
likely to cause death if left untreated. We are therefore
giving a significant number of men a diagnosis of a
cancer that they would otherwise never have known
about.
Isn’t it better to over-diagnose the condition?
We will certainly identify more cancers but bear in mind
that we will also expose a large number of men to
unnecessary worry about abnormal blood test results
and cancer that may not have led to any health
problems. We find it difficult to distinguish slowgrowing cancers from aggressive, fast-growing ones.
Is screening right for me?
You need to decide if you want to know about your
prostate and be willing to submit to regular screening
and biopsy, if indicated from your tests.
If you are between 50 and 70 years of age the
consensus is that you would be more likely to benefit
from screening. The rationale is that because prostate
cancer is a comparatively slow-growing cancer it is
generally younger men whose life-expectancy will be
increased if early cancers are cured.
If you have a first degree relative with prostate cancer
or if you are of Afro-Caribbean origin then screening
should be considered at 45.
How often should I be screened?
This is based on your results. If your PSA blood test is
low, then screening every 2 years should be fine. Your
GP may decide on yearly screening if your results are
closer to the upper limit of normal.
Published April, 2008, © ICGP 2008
How is my Prostate checked?
I cannot decide. What should I do?
The prostate gland is checked in 2 ways. Firstly a
blood test called PSA is done. We know that there is
an association between elevated PSA and Prostate
cancer. Also, your GP will examine your prostate
directly by means of a rectal exam. He or she will insert
a finger in your back passage and feel the prostate
gland. The aim is to identify any lumps or abnormalities
on the gland that could indicate cancer.
If you are of an age where screening will most likely
benefit you, i.e. between 50 and 70, consider whether
you would prefer knowing your risk of having prostate
cancer. Understand that while an early, aggressive
cancer can be cured you may be exposed to ongoing
monitoring and investigation of a cancer that ultimately
may not have impacted on your health. If you are over
70 you are far less likely, in terms of life-expectancy, to
benefit from even curative treatment. Testing at this
stage is much more likely to introduce unnecessary
worry which may impact on your quality of life. In all
cases discuss your options with your GP and he or she
will aid you in coming to a decision that is right for you.
What happens if my blood test is raised or my
doctor finds a lump?
Your doctor will refer you for specialist opinion from an
urologist. The urologist will decide on what further
steps need to be taken. They may decide to keep your
blood tests under active monitoring or to proceed to
biopsy.
Useful links / contacts:
What does the biopsy involve?
Irish Cancer Society
A small probe is inserted into the rectum which uses
ultrasound, a form of imaging, to identify the prostate
gland. Once identified, the doctor will collect a number
of samples from the prostate using a biopsy needle.
The procedure is generally safe, though some men find
it uncomfortable and minor symptoms such as blood in
the urine can occur.
43/45 Northumberland Road, Dublin 4
Telephone:
E-mail:
Website:
01 2310500
[email protected]
www.cancer.ie
Action Prostate Cancer
Prostate Cancer Information Service
What if the biopsy is negative?
If the biopsy is negative the urologist will consider this
along with blood test results and findings on rectal
examination. If your urologist’s index of suspicion is low
that you have a significant cancer, based on all these
criteria, he or she will be able to reassure you
accordingly and advise about routine follow-up and
screening. If, however, he or she remains suspicious
that they have not identified a significant cancer they
will devise a schedule for further investigation which
may include a further biopsy.
43/45 Northumberland Road, Dublin 4
Telephone:
E-mail:
Website:
1800 380 380 (free phone)
[email protected]
www.cancer.ie
Men Against Cancer (MAC)
c/o Irish Cancer Society,
43/45 Northumberland Road, Dublin 4
What if the biopsy is positive?
If cancer is identified then the urologist will consider all
the criteria. Detailed treatment options are beyond the
scope of this document because of the variability of
practice in different treatment centres. Broadly speaking
a decision will be made whether to treat or to actively
monitor the cancer. Treatment options include the
removal of the prostate (radical prostatectomy),
radiotherapy (using radiation to destroy the cancer) and
hormonal treatment. If the cancer is confined to the
prostate, there is a good chance of cure with surgery or
radiotherapy. All these treatments have side effects
including urinary incontinence, impotence and the risk
of cancer recurrence and these must be carefully
weighed up before proceeding.
Telephone:
E-mail:
Website:
Published April, 2008, © ICGP 2008
1800 200 700 (free phone)
[email protected]
www.cancer.ie