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Prostate Cancer and Early Detection

Sep 6, 2021

Prostate cancer is the most common cancer in American men. The American Cancer Society’s estimates for prostate cancer in the United States for 2021 are:

  • About 248,530 new cases of prostate cancer
  • About 34,130 deaths from prostate cancer

Deaths from prostate cancer

Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 41 will die of prostate cancer.

Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 3.1 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

Risk Factors

While all men are at risk for prostate cancer, certain factors can elevate the risk:

  • Age: Risk increases with age. About 60% of all prostate cancers are diagnosed in men over the age of 65
  • Race & Ethnicity: Certain groups, such as African American men, are at an increased risk
  • Family History: Close relatives, especially first-degree relatives (father, brother, paternal grandfather, etc.)

Signs and Symptoms

Cancer that develops in the prostate may stay localized (entirely contained within the prostate) for many years and cause few noticeable symptoms. Most cases of prostate cancer are slow-growing, and symptoms begin to emerge only when the tumor mass grows large enough to constrict the urethra. This can cause symptoms such as:

  • Frequent urination, especially at night
  • A weak or interrupted urine stream
  • Pain or burning upon urination or ejaculation
  • Pus or blood in urine or semen
  • Discomfort in the lower back, pelvis, or upper thighs

Laboratory Testing

Laboratory testing may be used to detect prostate cancer, rule out other diseases and conditions that may be causing or worsening a person’s symptoms, monitor the effectiveness of treatment for cancer, and monitor for recurrence.

Testing may include:

  • PSA (total prostate specific antigen) – to detect and monitor prostate cancer; when evaluating test results, the healthcare practitioner must consider both the level of PSA in the blood and the volume of the man’s prostate. (See Screening above and the PSA test page for discussion of variations of the PSA test.)
  • Free PSA – PSA exists in two main forms in the blood: complexed (cPSA, bound to other proteins) and free (fPSA, not bound). The free PSA test may be used to help to determine whether a biopsy should be done when the total PSA is only slightly elevated. Men with BPH tend to have higher levels of free PSA and men with prostate cancer tend to have lower amounts of free PSA. A relatively low percentage of free PSA (% fPSA) increases the chances that a cancer is present, even if the total PSA is not significantly elevated.

Similar to free PSA, some other tests have been developed to aid some men and their healthcare practitioners in decisions about the whether to undergo biopsy when PSA is elevated. Biopsies used as a follow up to positive PSA results can cause discomfort, anxiety, and sometimes complications. These tests are relatively new:

  • [-2] proPSA – this test looks for a precursor of PSA, which may be produced by prostate cancer cells at a higher rate than benign prostate cells. The percentage of [-2] proPSA relative to the total PSA level has been used, like the % fPSA, to help decide whether a biopsy is indicated.
  • PCA3 – PCA3 is a protein produced only in the prostate gland. The test measures the urine level of PCA3 RNA.
  • TMPRSS2ERG gene fusion – this is a urine test that detects a gene rearrangement (a piece of chromosome breaks off and reattaches to another chromosome). The gene rearrangement is over-expressed in more than 50% of prostate cancers, so an elevated level may help to indicate that a prostate cancer is present.
  • Prostate health index (phi) – this test combines results from total PSA, fPSA, and proPSA tests. The phi results can assess a man’s chances of having prostate cancer and needing a biopsy when total PSA levels are elevated but the digital rectal examination is unremarkable.
  • p2PSA – this test measures the levels of p2PSA, one of the forms of PSA that has similar functions. The level of p2PSA in the blood helps predict prostate cancer in men with elevated total PSA levels prior to biopsy. An elevated level increases the likelihood that the prostate cancer is aggressive. The accuracy of prostate cancer diagnosis is improved when p2PSA test results are combined with total and fPSA test results.

These tests do not provide a definitive answer as to whether a man has prostate cancer or not. Rather, they are intended to help predict whether a biopsy would be useful in helping to establish a diagnosis.

General Lab Tests

Sometimes other tests may be done to rule out other conditions that cause similar symptoms:

  • Urinalysis – to screen for kidney disorders and urinary tract infection (UTI)
  • Urine culture – to help diagnose a UTI
  • Blood urea nitrogen (BUN) and Creatinine – blood tests to evaluate kidney function


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