Why prostate check-ups are crucial

Prostate screenings, which include blood tests and digital rectal exams, help detect early signs of prostate issues. Here's when to get screened, what each test involves, and what they can reveal.

Prostate cancer is the most common cancer in men, excluding skin cancers, and it is the fifth leading cause of death for men worldwide. In South Africa, prostate cancer is also the most common type of solid organ cancer found in men, affecting all ethnic backgrounds, according to the Cancer Association of South Africa (CANSA).

Two tests that screen for prostate cancer are a prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE), also known as a prostate exam. Men should have both tests, whether they are symptomatic or not. Symptoms of prostate cancer include a weak urination stream, interrupted urinary flow, urgency and blood in urine.

The blood test measures the level of a protein called PSA, which is produced by the prostate gland and found in the blood. The DRE is used to check for any abnormalities in the prostate. Both screening tests can be performed by GPs or urologists.

“It’s critical that men who are well informed by their doctor and have a life expectancy of more than 10 years undergo these two screening tests,” says Dr Samkele Salukazana, a urologist at Mediclinic Constantiaberg. This is because treatments for prostate cancer can be riskier for older men, and the side-effects of treatment may not be worth the benefits. For men with less than 10 years to live, a urologist will help guide them on the best treatment options.

The PSA test

It’s possible to detect prostate cancer with a PSA test at an early stage before there are any symptoms and when treatment is still most effective. If your PSA levels are raised, your doctor will want to conduct further tests.

“The PSA is a very sensitive test, but it is not specific to cancer. This means that while high PSA levels can suggest prostate cancer, they can also be raised in other conditions, like benign prostatic hyperplasia (BPH), which is a non-cancerous enlargement of the prostate, or prostatitis, which is inflammation of the prostate,” says Dr Salukazana. “Our main concern is to exclude prostate cancer, which is why we conduct subsequent investigations when a patient has an elevated PSA level or abnormal DRE.”

The recently published South African Prostate Cancer Screening guidelines recommend initiating annual PSA screening for asymptomatic men who are at risk from prostate cancer from age 50. “The guidelines also recommend PSA screening from age 45 for all asymptomatic black African men, and all men with a first-degree relative with a positive history of prostate and/or breast cancer,” he says.

Men without symptoms who have genetic testing and are found to carry certain genes – like BRCA2, BRCA1, ATM, CHEK2, or HOXB13 – should start having PSA tests at age 40. These genes are linked to a higher risk of prostate cancer. These recommendations are similar to guidelines followed in Europe and the US.

How often PSA tests are done after that depends on the patient's risk, age, and their initial PSA level, but generally, annual tests are recommended or may be decided by the urologist.

The prostate exam

During a DRE, the doctor examines the patient’s prostate by inserting their index finger through the anal canal. This is to feel the prostate gland for any abnormalities such as nodules or lumps, which indicate an increased risk of prostate cancer diagnosis.

“A smooth prostate isn’t necessarily a sign of a cancer-free prostate, which is why it’s crucial to combine this with a PSA and an MRI of the prostate as your urologist may suggest,” says Dr Salukazana. The PSA test isn't always a clear way to diagnose prostate cancer but combining it with a DRE can provide more certainty in the diagnosis.

“In almost one in five cases, prostate cancer can be detected by an abnormal DRE irrespective of the PSA level. We also know that a small percentage of poorly differentiated prostate cancers don’t produce much PSA. A combination of an elevated PSA and an abnormal DRE is associated with a more than double risk of a positive biopsy, which is why we prefer doing both tests.”

Using a prostate MRI has helped doctors get more accurate diagnoses and identify prostate cancer that is serious enough to need treatment. If you’re diagnosed with prostate cancer, your urologist will discuss the best treatment options with you.

Dr Salukazana says that finding prostate cancer early is linked to better survival rates and fewer side-effects from treatment, especially for patients with cancer that's still localised.

• Remember, if cancer is found early, it’s often treatable. Don’t put off your screening tests.
• To book a prostate exam, contact our Mediclinic Engagement Centre via WhatsApp 087 240 6367 or click here for alternative contact options.