Prostate cancer is a malignant enlargement of the prostate gland. The enlargement or tumour is a lump of tissue that occurs when some of the cells of the prostate grow abnormally. For many types of cancer finding and treating the disease early has proven benefits. With prostate cancer we are not sure.

Screening, or testing well men with no symptoms, for prostate cancer is a controversial issue. Unlike breast and cervical cancers, where there is a reliable test to support screening all women in certain age groups, there is no test reliable enough to support screening all men for prostate cancer.

There is concern that testing well men for prostate cancer exposes them to tests that can cause harm and treatment that may not offer long-term benefits but may leave them with side effects such as impotence and incontinence.

Before you decide whether you want to be tested, particularly if you have no symptoms or you have been offered the test, you should weigh up all the pros and cons. Talking it over with your doctor will help you make up your mind.

If you are at above-average risk for prostate cancer, that is if your father or brother/s have had prostate cancer, particularly if it was picked up before they turned 60, discuss the pros and cons of being tested with your doctor.

While younger men are less likely to be diagnosed with prostate cancer than older men, the younger a man is when he develops prostate cancer the more likely the cancer will threaten his health and life. This is because the cancer has more time to progress. It is also the case that older men are more likely to develop other life-threatening health problems.

The tests

The two usual tests are the digital rectal examination (DRE) and the Prostate Specific Antigen (PSA) blood test. Men who want to be tested usually have both tests, but they are not 100% accurate.

Digital Rectal Examination (DRE)

In the DRE, the doctor inserts a gloved finger up the anus and actually feels through the wall of the rectum for lumps or enlargement in the prostate. But while most of the irregularities found this way are not cancer, many cancers are missed because they're out of reach of the searching finger.

Prostate Specific Antigen (PSA)

The PSA blood test measures a protein that the prostate gland makes called prostate specific antigen (PSA). A higher than normal PSA level usually means there's a prostate problem. It doesn't necessarily mean cancer. Generally most men's PSA levels rise anyway as they get older, so what's 'normal' for a man of 70 may be quite a bit higher than what was normal for him when he was 40.
The PSA test can give both false alarms (two-thirds of men who have raised PSA levels don't have prostate cancer) and misses (a few men with prostate cancer don't have raised PSA levels). And the test can't tell the difference between the slow-growing forms of prostate cancer that rarely kill, and the more aggressive form that can be fatal.

Transrectal ultrasound (TRUS)

If either test suggests you have prostate problems, there'll be more tests, usually starting with a transrectal ultrasound (TRUS), where a probe is inserted into the rectum to take ultrasound pictures of the prostate. A needle biopsy, where a sample of the prostate is taken with a small needle to be examined for cancer cells, can be done at the same time.
For more information contact the Cancer Helpline on 13 11 20.