Prostate Cancer Screening and Diagnosis

At UC San Diego Health, our urologic cancer specialists take the approach that because prostate cancer often occurs without symptoms, screening saves lives by helping to detect cancer early, while it is still treatable. Our urologic cancer specialists, who include physicians on the national guideline committees for the early detection and treatment of prostate cancer, believe:

  • Men should get screened for prostate cancer. The screening can be performed with your primary care provider.  
  • Prostate specific antigen (PSA) testing helps to identify men who may be at risk for developing an aggressive prostate cancer. PSA testing alone does not diagnose cancer. 

Prostate cancer is the most frequently occurring cancer in men and the second most deadly after lung cancer, according to the American Cancer Society. An estimated 29,430 men will die in 2018 from prostate cancer, representing about 9 percent of all cancer-related deaths in men.

What Are the Symptoms of Prostate Cancer?

Prostate cancer is often silent until it is advanced. Lower back pain and urinary problems may be symptoms of advanced prostate cancer. However, benign conditions can also cause these same symptoms. Prostate cancer screenings aim to detect prostate cancer early before there are any symptoms of disease and while the cancer is still localized within the prostate.

Who Should Get a PSA Test?

We follow the American Urological Association’s screening guidelines. The guidelines strongly recommend:

  • Men between the ages of 55 and 59 at normal risk of prostate cancer discuss PSA screening with their primary care physician for shared decision-making about proceeding, based on a man’s values and preferences
  • A routine screening interval of two years or more in men who have decided to be screened

Men with a family history of prostate cancer or who are of African-American decent should consider being screened at a younger age.

What Is the Concern with PSA Testing?

PSA testing can lead to false positives, meaning that men may undergo treatment for a cancer that was never destined to be life-threatening. These false positives occur because benign prostate conditions and infections and inflammation of the prostate can elevate PSA levels. In addition, many prostate cancers are slow growing and not life threatening, particularly in older men. A PSA test does not measure the aggressiveness of a cancer. Over treating a non-aggressive prostate cancer can cause more harm than benefit.

At UC San Diego Health, we often recommend watchful waiting (also called active surveillance) if a low-risk prostate cancer is diagnosed. For men that need treatment, we offer the most advanced surgeries and radiation therapies available.

 

How is Prostate Cancer Diagnosed? 

If your PSA  is elevated, your primary care provider may recommend that you see a urologist for a biopsy. UC San Diego Health has several urologists who specialize in prostate cancer biopsies.

Prostate cancer is diagnosed according to the results of a biopsy, not PSA testing. The aggressiveness of the cancer is determined by your PSA levels and the grade and stage of the tumor. Any family history of prostate cancer and your ethnicity may also be considered when assessing your risk of developing an aggressive prostate cancer. (Visit our Health Library for information about Gleason scoring and staging of prostate tumors.) See the table below for details.

Low Risk
(Meets all of the following)
Intermediate Risk
(Meets one of the following)
High Risk
(Meets one of the following)
PSA < 10PSA 10-20PSA > 20
Gleason Sum </= 6Gleason Sum of 7 Gleason Sum of 8-10
Stage T1c or T2aStage T2bStage >/= T2c

PSA screening, followed by a prostate biopsy for diagnostic confirmation, has been shown in randomized controlled trials to help detect prostate cancer early.

The Best Prostate Cancer Screening in San Diego

  • Our doctors are on the national guideline committees for the early detection of prostate cancer and prostate cancer treatment.
  • We perform the only targeted prostate biopsy in San Diego. Men with an abnormal PSA have a high-resolution 3T MRI prior to biopsy. The MRI is used with an ultrasound to guide the biopsy so that cancerous cells are found and removed for examination under a microscope.
  • Urologic cancers can be difficult to grade and stage. Our pathologists have sub-specialty expertise in urologic cancers, which means they have the highest level of training in diagnosing the grade and stage of prostate cancer. Accurate diagnostics are crucial to developing a treatment plan.

When this video was produced, MRI-directed biopsies were a new technique, developed at UC San Diego Health. Today, these targeted biopsies are the standard of care for our patients.