Prostate screening

The pros and cons of screening for prostate cancer should be discussed with your doctor to help guide you in deciding if it is the right course of action.

Should I have a prostate cancer screening test?

Routine testing for prostate cancer in all men without symptoms is not recommended in New Zealand at present. Being tested for prostate cancer is your choice. Learning about the pros and cons of prostate testing can help you decide if it is right for you.

To help you decide if a prostate check is right for you, the Ministry of Health has developed the Kupe website. It will help you understand the risks, benefits and implications of prostate testing, so you can have an informed conversation with your doctor. 

If you are unsure about whether you need to get tested for prostate cancer, contact your GP for a discussion on the risks and benefits of testing.

What tests are used to check for prostate cancer?

Checks for prostate cancer normally involve a blood test, called the prostate specific antigen (PSA) test, and a digital rectal examination (DRE).

If your test results suggest you are at high risk for cancer, you will be referred to a specialist, who may recommend another test called a prostate biopsy.

The prostate-specific antigen (PSA) test

This test measures the level of PSA in your blood. PSA is a protein made by your prostate. Higher than normal levels can occur when there is a problem with your prostate, such as an infection, an enlarged prostate or prostate cancer.

Most men with raised PSA levels don’t have prostate cancer and some men with prostate cancer have normal PSA levels. However, high PSA levels are a risk factor for prostate cancer.

Digital rectal examination

This is a quick way for your doctor to check for prostate problems. Your doctor will feel the size and shape of your prostate by inserting a gloved finger into your rectum (bottom). A prostate that is rough, irregular or hard is more likely to have cancer. Some cancers may be too small to be found by a rectal examination.

Specialist referral and biopsy

Your doctor will discuss your prostate check results with you. If the PSA and DRC results suggest you have a high risk for prostate cancer, your doctor will refer you to a urologist (specialist).

The specialist will discuss having a prostate biopsy, in which a small sample of your prostate gland cells are taken for examination.

The aim of the biopsy is to confirm whether or not you have prostate cancer and, if so, whether it needs treatment. The treatment options will then be discussed with you.

If the biopsy shows no evidence of cancer, you may be advised to attend future check-ups.

When should I have a prostate check?

Generally, if you aged 50 years or older and have any urinary symptoms, you should let your doctor know. They will discuss with you whether or not you should have a prostate check.

Symptoms include:

  • poor flow of urine (pee)
  • trouble stopping peeing
  • dribbling after you are done peeing
  • needing to pee more often, at night or urgently
  • trouble starting peeing
  • incontinence (starting to pee without wanting to)
  • pain when peeing
  • blood in your pee.

If you have no symptoms, it is recommended that you get checked if you:

  • you are a man aged 50–70 years old but don’t have any family history
  • you are a man aged 40–70 years old and your father or brother has had prostate cancer
  • you are a man aged more than 70 years old and you have family history of prostate cancer or you have had an abnormal PSA test previously, and you have a life expectancy of more than 10 years.

Having a prostate check is your decision. The tests for prostate cancer can be uncomfortable but they may reduce your chance of being harmed or dying from prostate cancer.

If your test results suggest you are at risk of cancer, you will need to decide whether to have further testing and possibly treatment. In making this decision, you will need to consider whether your quality of life will be better living with a slow growing cancer than having treatments, which may cause you more harm than the cancer ever will.

Your doctor can help you weigh up the benefits and risks of being tested, by taking into consideration factors such as your age and family history.

Video: The prostate specific antigen test: to test or not to test? Michael Evans and Reframe Health Films Inc, 2014

Decision checklist

Visit the Option Grid website and use their interactive guide or pdf version to help you and your doctor decide whether or not you will have a PSA test.

Learn more

Is a check right for you? Kupe, NZ

References

  1. Testing for prostate cancer – helping patients to decide BPAC, NZ
  2. Prostate cancer testing decision support tool for patients and their families BPAC, NZ
  3. Prostate cancer management and referral guidance Prostate Cancer Working Group and Ministry of Health, NZ
  4. Diagnosis and management of prostate cancer in New Zealand men: Recommendations from the Prostate Cancer Taskforce Ministry of Health, NZ
  5. PSA screening in asymptomatic men: the debate continues BPAC, NZ
  6. Prostate specific antigen test: yes or no? Option Grid, US

Reviewed by

Dr Jeremy Tuohy is an Obstetrician and Gynaecologist with a special interest in Maternal and Fetal Medicine. Jeremy has been a lecturer at the University of Otago, Clinical leader of Ultrasound and Maternal and Fetal Medicine at Capital and Coast DHB, and has practiced as a private obstetrician. He is currently completing his PhD in Obstetric Medicine at the Liggins Institute, University of Auckland.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Jeremy Tuohy, Obstetrician & Researcher, University of Auckland Last reviewed: 08 Oct 2020