I've Tested Positive, Now What?
Screening for cancer
This section covers these topics:
- Benefits and harms of cancer screening
- Types of screening
- Screening recommendations for high-risk men
- Screening recommendations for average-risk men
Benefits and harms of screening
There are benefits and potential harms associated with cancer screening.
- Most cancers can be very slow growing and unlikely to spread or cause harm. Detecting and treating these slow-growing cancers early may not improve health outcomes and side effects from biopsy or treatment may cause harm.
- Some cancers can be very aggressive, spreading to other organs and increasing the risk of death. Finding these cancers early through screening may help men live longer. These aggressive cancers are more common in:
- African American men.
- Men with inherited mutations in certain genes, including , and .
- Men with a family history of young-onset or aggressive cancer.
The benefits and risks of cancer screening differ based on several personal factors:
- overall health
- lifetime risk for cancer
- risk for developing aggressive disease
- personal preferences
Several expert groups have guidelines for cancer screening and each is slightly different. Most experts agree that men should have a discussion with their doctor about cancer screening, that includes:
- their risk for developing cancer
- their risk for developing aggressive disease
- the benefits and harms of cancer screening compared to not screening
Types of screening
Screening for cancer may include a combination of the following:
- Specific Antigen () is a blood test used to screen for cancer.
- During a Digital Rectal Exam (DRE) a doctor inserts a gloved, lubricated finger into the rectum to feel the gland for enlargement or lumps.
- Clinical trials are looking at screening using imaging.
Screening for high risk men
The National Comprehensive Cancer Network (NCCN) has guidelines for cancer screening in men who are at high risk for cancer due to an inherited mutation.
- African American men should consider annual screening with and DRE beginning at age 40.
- Men with an inherited mutation, should begin annual screening with and DRE at age 40.
- Men with an inherited mutation should consider annual screening with and DRE beginning at age 40.
- There has not been enough research to show a benefit from early, or annual screening for cancer in men who have an , , , or other mutations linked to cancer. For these men, experts recommend managing these risks based on family history of cancer.
Men at high risk for cancer should consider enrolling in a screening clinical trial.
Screening for average risk men
There are several different guidelines for cancer screening in average risk men:
- NCCN recommends beginning at age 45, men should have a conversation with their doctor about their risk for cancer and the benefits, risks and limitations of cancer screening using and DRE.
- For men who choose to undergo screening, and DRE should be performed every 2-4 years as long as DRE is normal and is low (<1 ng/ml).
- For men with slightly elevated of 1-3 ng/ml and normal DRE, screening should be repeated every 1-2 years.
- After age 75, screening every 1-4 years should be considered for healthy men.
- The U.S. Preventive Services Task Force () recommends that men who are 55 to 69 years old should talk to their doctor about the benefits and harms of screening for cancer and make their own decisions about being screened for cancer with a specific antigen () test.
- Men who are 70 years old and older should not be screened for cancer routinely.
- The American Cancer Society (ACS) recommends beginning at age 50, men should discuss the benefits, risks, and limitations of cancer screening with their doctor in order to make an informed decision about whether to be screened for cancer.
- For men who choose screening, and DRE should be performed every 2 years as long as DRE is normal and is low (<2.5 ng/ml).
- For men who choose screening, and DRE should be performed every year if DRE is normal and is 2.5 ng/ml or higher.
When an abnormality is found
If the feels abnormal on DRE, or the is high or rising over time, doctors will usually order a biopsy of the . Doctors may also order imaging tests, such as or additional tests.
Urologists are experts who specialize in care of the bladder, urinary tract and the male reproductive system. Ideally, experts recommend that men at high risk for cancer receive their screening from urologists trained in care for high-risk people. If you already have a urologist, find out if they regularly see high-risk patients and if they are familiar with screening recommendations. The following resources can help you find a urologist in your area.
- The Urology Care Foundation has a tool which allows you to search for urologists in your area.
- The National Cancer Institute (NCI)-designated comprehensive cancer centers deliver cutting-edge cancer care to patients in communities across the United States. Most centers have specialized screening and prevention centers for high risk people. Find a center near you and learn about its specific research capabilities, programs, and initiatives.
- Register for the FORCE Message Boards to get referrals from other members. Once you register, you can post on the Find a Specialist board to connect with other people who share your situation.
The following are studies looking at ways to screen for cancer in people at high risk:
- NCT05129605: Cancer Genetic Risk Evaluation and Screening Study (PROGRESS). This study will look at how enhanced cancer screening using will improve early detection rates and further understanding of how inherited mutations can lead to development of cancer.
- NCT03805919: Men at High Genetic Risk for Cancer. This is a cancer screening study using in high risk men. This study is open to men with an inherited mutation in any of the following genes: , , HOXB13, , , , , , , , , , , , or FANCA.
- NCT04472338: Screening for Men With Inherited Risk of Developing Aggressive Cancer, PATROL Study. This study is looking at ways to detect cancer earlier in men who are at increased genetic risk of developing cancer that forms, grows, or spreads quickly (aggressive). The study is open to men with mutations associated with cancer risk.
NCT05608694: Screening in Men at High Risk of Developing Cancer. The purpose of this study is to determine whether or not Magnetic Resonance Images () will identify high-grade cancers earlier and more frequently in men at high risk of developing cancer.