Medically reviewed by Susan Kerrigan, MD and Marianne Madsen
Prostate cancer is the second most common cancer in American men, eclipsed only by skin cancer. It is the second leading cause of cancer death (lung cancer is first) in men. The American Cancer Society estimates that in 2021, there will be nearly 250,000 new cases of prostate cancer, with about 35,000 deaths from this disease. About 1 out of every 8 men will be diagnosed with prostate cancer in his lifetime, and about 1 man in every 41 who are diagnosed will die of prostate cancer. It’s a serious disease, but most men diagnosed with prostate cancer don’t die from it–it is generally a slow-growing cancer, and “watchful waiting” may be part of the treatment plan. As with all cancers, early detection is key to getting the best possible outcome with prostate cancer. MRI has been found to be an effective tool to add to prostate cancer screening methods and can support the watchful-waiting process.
Risk Factors
Prostate cancer is unusual in men under 40. It is more likely to develop in men who are 65 about older and in non-Hispanic black men. Nearly 60% of cases are diagnosed in men 65 and older, with 66 as the average age at diagnosis.
Another risk factor is whether you have a history of prostate or other types of cancer in your family. According to Sara Carroll, MS., CGC at Cleveland Clinic, “It’s helpful to ask which of your relatives has had cancer, what type of cancer they were diagnosed with, and what ages those relatives were when they were diagnosed with cancer.” If you find a history of prostate, breast, ovarian, pancreatic, or colorectal cancer, especially in younger people, you may want to start the screening process for prostate cancer at around age 40 rather than wait until age 50 (the guideline for men who are at average risk).
The Screening Process
The screening process often involves a blood test and a physical exam. Based on the results, you may be recommended for further testing, which may involve a biopsy of prostate tissue, or a more current and accurate recommendation–an MRI. An MRI is a prostate cancer screening test similar to the widely accepted mammogram for breast cancer screening, and it may have many advantages over a biopsy.
Anyone considering screening for prostate cancer should have a thorough and detailed consultation with a trusted doctor regarding the various risks, benefits, and methods involved in the screening process. Some of the main concerns in prostate cancer screening are false negatives and false positives from either a PSA test, a digital rectal exam, or a biopsy. An incorrect test result can lead to unnecessary stress and avoidable treatments or to not finding a significant cancer. Because many prostate cancer treatments have uncomfortable side effects, such as urinary incontinence or bowel dysfunction, one may not want to be treated unless it is absolutely necessary. An MRI provides a safer alternative to biopsy and can be used to guide a treatment plan.
Screening Tests
PSA Test. The first step in screening a man for prostate cancer is often the PSA (prostate-specific antigen) test. This blood test checks for a protein produced exclusively in the prostate. Cancerous cells produce more PSA than regular tissue, meaning that a higher-than-normal level of PSA is a strong indication that an individual may have prostate cancer. Most men who do not have prostate cancer have a PSA value of 4 or lower. A range of between 4 and 10 is a borderline result; your doctor may or may not recommend further testing based on other factors but will probably recommend yearly testing to monitor your situation. A PSA of more than 10 warrants further investigation.
Digital Rectal Examination. Some practitioners may combine the PSA test with a digital rectal examination, in which the doctor inserts a gloved and lubricated finger into the patient’s rectal cavity to feel the prostate for abnormal growths. However, in 2018, the US Preventive Services Task Force stated that it no longer recommends this screening test as its benefits are unclear. Your doctor may or may not recommend it for you.
Biopsy. Based on the results of your PSA, your doctor may recommend a prostate biopsy. This involves removing a sample of prostate tissue, which is then analyzed for any cancerous cells. However, a biopsy has certain risks. Frequently, there are minor complications, such as bleeding, infection, and painful, bloody, and/or difficult urination. There are few, but significant, major complications, such as sepsis from a urinary tract infection, acute urinary retention (not being able to urinate), excessive bleeding from the rectum, and infections in the scrotum, testicles, or penis.
MRI. An alternative to biopsy, or even to a PSA test, can be an MRI of the prostate. Researchers have found that the unpredictable results of PSA tests leading to unnecessary invasive biopsies can be avoided with an MRI. Data show that MRI outperforms the PSA test in identifying men with clinically significant prostate cancers. MRIs can also be used to monitor men who are in the borderline area of prostate cancer screening and to stage possible cancers to determine best types of treatment. MRIs are generally considered to be risk free to the average person.
Conclusion
As men age, prostate cancer becomes more likely, and the advisability of screening for it rises in proportion. An MRI is a welcome addition to screening for this disease as it is virtually risk-free for most men and has a good track record of finding prostate cancer without false positives or false negatives. Even if a prostate cancer diagnosis is reached, a schedule of consistent MRIs can be used to monitor the situation if “watchful waiting” is part of the treatment plan.
Written by Shlomo Witty
References
- Key Statistics for Prostate Cancer
- Prostate Cancer
- Why Knowing Your Inherited Risk of Prostate Cancer Is Important
- Considering Prostate Cancer Screening Options? A Prostate MRI May Save You From an Unnecessary Biopsy
- Rethinking prostate cancer screening: could MRI be an alternative screening test?
- The role of magnetic resonance imaging in prostate cancer
- Tests to Diagnose and Stage Prostate Cancer
- The Prostate-Specific Antigen (PSA) Test
- Digital Rectal Exam for Prostate Problems
- Prostate Cancer: Screening
- Prostate biopsy
- Complications of transrectal ultrasound-guided 12-core prostate biopsy: a single center experience with 2049 patients
- Role of mpMRI of the prostate in screening for prostate cancer
- Prostate Cancer: MRI