All men are at risk of developing prostate disease.  The decision as to when and by what method to begin screening (testing for it) is based upon factors unique to each individual.

For example, although the causes of prostate cancer are currently unknown, we do know some risk factors (things that seem to increase the chance of a man getting the disease).  These include:

• Age: The chance of getting the disease goes up with age.  Most men with prostate cancer are older than 65; it rarely strikes men younger than 45. 
• Family history: The chance of getting the disease goes up (is higher than average) if a close relative had it.
• Race: The chance of getting the disease is higher for African-American men than white men, including Hispanic white men. It is lowest for Asian and American Indian men. The reasons for this are not known.
• Diet: The chance of getting the disease may go up if you eat a diet high in animal fat or meat and may go down if you eat a diet high in fruits and vegetables.
• Certain prostate changes: The chance of getting the disease may go up if you have abnormal prostate cells (called high-grade prostatic intraepithelial neoplasia or PIN). 

Having one or more of these risk factors does not mean you will definitely get prostate cancer.  But not having any of them does not mean you will not get the disease.  So you should be aware of its symptoms, which include:

• Urinary problems
• Inability to urinate
• Difficulty starting or stopping the urine flow
• Urinary frequency (the need to urinate frequently) especially at night
• Urinary urgency (strong need to urinate and/or difficulty controlling it)
• Weak or interrupted urine flow
• Painful or burning urination
• Blood in the urine or semen
• Frequent pain or stiffness in the lower pelvic area, and in lower back, hips, upper thighs, or bones
• Unexplained weight loss or appetite loss

However, it's important to remember these two facts:

• On one hand, there are several conditions that cause the same symptoms as prostate cancer.
• On the other hand, in its earliest stages, prostate cancer may not cause any symptoms at all.

Given these facts about risk factors and symptoms, it makes sense to see your doctor or a urologist if you have any of the symptoms, especially if you have one or more of the risk factors. 

You should also think seriously about having an annual prostate cancer screening, even if you have no symptoms at all, if you're over 50, and/or have any of the risk factors mentioned above.

There are several ways to screen for prostate cancer.  The two simplest and most common are:

• Digital rectal exam (DRE): Wearing a lubricated rubber glove, the doctor inserts a finger into the rectum and feels the prostate through the rectal wall (the separation between the rectum and the prostate) to check for abnormalities, lumps and hard areas.
• Blood test for prostate-specific antigen (PSA): In a blood test, a small amount of blood is taken from the patient and sent to the lab for analysis.  In this test, the lab measures the amount of  PSA in the blood stream.
• PSA is a protein produced by the prostate and usually found in semen.  However, a small amount does circulate through the blood stream.  A larger than normal amount in the blood may indicate some problem in the prostate, such as BPH, prostatitis, or cancer.
• PSA test results are usually reported as nanograms of PSA per milliliter of blood (ng/ml). According to the National Cancer Institute, in the past most doctors considered PSA values below 4.0 ng/ml as "normal." However, recent research found prostate cancer in men with PSA levels below 4.0 ng/ml.  Many doctors are now using the following ranges, with some variation:
• 0 to 2.5 ng/ml is low
• 2.6 to 10 ng/ml is slightly to moderately elevated
• 10 to 19.9 ng/ml is moderately elevated
• 20 ng/ml or more is significantly elevated
• There is no specific "normal" PSA level, but the higher the level, the more likely that cancer is present. But many things can cause PSA levels to change. So one elevated PSA test does not necessarily mean you need other diagnostic tests. If PSA levels continue to rise over time, then you may need them.
• A portion of the PSA enzyme is bound in the bloodstream to other chemicals.  In patients who have prostate cancer almost all the enzyme is in the form that's bound, so there's very little that's unbound or "free."  For people who have benign enlargement of the prostate (the most common scenario) a higher proportion of the enzyme is in the free form.  So, if it's a high PSA number with a low "free" number there's a better chance it's cancer.
• In general, early detection of cancer is beneficial.  But the National Cancer Institute does point out that we don't yet know if the PSA test actually saves lives or if its benefits outweigh the risks of follow-up diagnostic tests and cancer treatments.  For more information about the pros and cons of PSA testing, go to The National Cancer Institute

A third way to screen for prostate problems is a urine test.  The patient provides a small sample of urine which is sent to the lab for analysis.  The lab can detect blood in the urine and other signs of infection or abnormalities.

Note that none of these tests is conclusive for prostate cancer.  That is, they can reveal the presence of a prostate problem, but they can't show whether its cause is cancer or another condition.  If these tests do indicate a prostate problem, the doctor may ask for further tests to find the cause.  (For information about these tests, go to Prostate Cancer Key Point # 2)