Prostate Cancer
 

Screening
 

A Decision Guide 

for African Americans 
This booklet was developed by the U.S. Department of 

Health and Human Services, Centers for Disease Control 

and Prevention (CDC). Published in October 2003. 
Is screening 


right for you?
 

The decision is yours. 

Some medical experts believe all 

men should be offered regular 

screening tests for prostate cancer. 

Other medical experts do not. 

To help you understand 

both sides of the issue, 

let’s begin with the basics. 

1 
2 

THE PROSTATE AND PROSTATE CANCER 
 

What is the prostate? 

The prostate is a walnut-sized gland that only men have. It is part of the 

reproductive system that makes the fluid that carries sperm. As you can 

see in the picture below, the prostate is located in front of the rectum and 

just below the bladder. The urethra (the tube that carries urine from the 

bladder to outside the body) runs through the center of the prostate. As 

men age, the prostate tends to increase in size. This can cause the urethra 

to narrow and decrease urine flow. 

bladder 

urethra 

rectum 

prostate 
What is prostate cancer? 

Prostate cancer is made up of cells that do not grow normally. The cells
 

divide and create new cells that the body does not need, forming a mass 


of tissue called a tumor. These abnormal cells sometimes spread to other
 

parts of the body, multiply, and cause death.
 

What causes prostate cancer? 

As with many types of cancers, medical experts do not know what causes
 

prostate cancer. They are studying several possible causes.
 

Can prostate cancer be prevented? 

Medical experts do not know how to prevent prostate cancer. But they are
 

studying many factors. They do know that not smoking, eating a healthy
 

diet, staying physically active, and seeing your doctor regularly contribute
 

to overall good health.
 

Prostate Facts 

3 
4 

THE PROSTATE AND PROSTATE CANCER
 

Are African American men at increased risk for prostate cancer? 

Yes. Though all men are at risk, African American men have higher rates 

of getting and dying from prostate cancer than men of other racial or 

ethnic groups in the United States. Scientists do not know why it is more 

common in African American men than in others. They are studying 

possible reasons, including culture, environment, and differences in the 

biology of the disease in African American men. 

Asian Pacific Islander 

Hispanic 

American Indian 

Alaska Native 

African American 

White 

All Races and

Ethnic Groups 

Prostate Cancer Death Rates by Race/Ethnicity 

in Men Aged 45 and Above 

159.7 

70.7 64.4 

47.6 

37.2 

26.4

Per 100,000 in the U.S. Standard PopulationSource: CDC, 1998 
 

What is the lifetime risk of prostate cancer in African American men? 

An African American man in his lifetime has about a: 

■ 19 percent chance (1 in 5) of being diagnosed with prostate cancer. 

■ 5 percent chance (1 in 20) of dying from prostate cancer. 

What else can increase the risk for prostate cancer? 

Besides race and ethnicity, other factors that can increase risk are: 

■ Family history. Men with a father, brother, or son who has had
 

prostate cancer are at greater risk for developing it themselves.
 

■ Age. The older a man is, the greater his risk for getting prostate
 

cancer. See the chart below.
 

5 

Risk of Being Diagnosed with Prostate Cancer by Age:
 

African American Men
 

Age 45 ......................................................................................1 in 1,111
 

Age 50 .........................................................................................1 in 204
 

Age 55 ...........................................................................................1 in 66
 

Age 60 ...........................................................................................1 in 26
 

Age 65 ...........................................................................................1 in 13
 

Age 70 .............................................................................................1 in 9
 

Age 75 .............................................................................................1 in 7


 Ever .............................................................................................1 in 5
 
6 

THE PROSTATE AND PROSTATE CANCER
 

Is prostate cancer serious? 

Some prostate cancers become a serious threat to health by growing 

quickly, spreading beyond the prostate gland to other parts of the body, 

and causing death. Yet other prostate cancers grow slowly and never 

become a serious health threat or affect how long a man lives. Doctors 

can’t always be sure what type of cancer is present in your particular case. 

How serious is prostate cancer in African American men? 

Among the 10 leading causes of cancer death in African American men, 

prostate cancer is second, behind lung cancer. When compared to all 

causes of death, prostate cancer is the fourth leading cause of death among 

African American men over age 45. 

Stroke 

Diabetes 

Colorectal Cancer 

Emphysema 

Unintentional and 

Intentional Injuries 

Kidney Disease 

Pneumonia 

Prostate Cancer 

Heart Disea

Lung Cancer 

se 

Top Ten Causes of Death among African American Men over Age 45 

30.8% 

8.3% 6.8% 5.3% 3.9% 3.8% 2.7% 2.7% 2.5% 2.4% 
What are the symptoms of prostate cancer?
 

Many men with prostate cancer have no symptoms. If symptoms appear, 

they can include: 

■ blood in the urine; 

■ the need to urinate frequently, especially at night; 

■ weak or interrupted urine flow; 

■ pain or burning feeling while urinating; 

■ the inability to urinate; 

■ constant pain in lower back, pelvis, or upper thighs. 

If you have any of these symptoms, see your doctor as soon as possible. 

Keep in mind that these symptoms may also be caused by other problems 

common to older men that are not cancer, such as an infection or an 

enlarged prostate. 

Prostate Facts


7 
8 

PROSTATE CANCER SCREENING
 

What does “screening” mean? 

Screening means looking for signs of disease in people who have no 

symptoms. So screening for prostate cancer is looking for early-stage 

disease when treatment may be more effective. The main screening tools 

for prostate cancer are the digital rectal examination (DRE) and the 

prostate specific antigen (PSA) test. The DRE and the PSA test cannot 

tell if you have cancer; they can only suggest the need for further tests. 

What is the DRE? 

The DRE or digital (finger) rectal examination is a quick exam for checking 

the health of the prostate. For this test, the doctor inserts a gloved and 

lubricated finger into the rectum. This allows the doctor to feel the back 

portion of the prostate for size and any irregular or abnormally firm areas. 

“I like getting more information so I can ask 

my doctor questions.” 
What is the PSA test? 

PSA stands for “prostate specific antigen.” PSA is a substance produced
 

only by cells from the prostate gland and released into the blood. The
 

PSA test measures the PSA level in the blood. A small amount of blood is
 

drawn from the arm. The doctor checks the blood to see if the PSA level
 

is normal. The doctor may also use this test to check for any change in
 

your PSA level compared to your last PSA test. 


As a rule, the higher the PSA level in the blood, the more likely a prostate 

problem is present. But many factors can affect PSA levels. Some prostate 

glands produce more PSA than others. PSA levels tend to increase with 9 

age. In addition, PSA levels tend to be higher in African American men 

than in others. PSA levels can also be affected by: 

■ certain medical tests or procedures; 

■ an enlarged prostate; and/or 

■ a prostate infection. 

Since many factors can affect PSA levels, your doctor is the best person to
 

interpret your test result.
 

Screening Tools 
10 

PROSTATE CANCER SCREENING
 

How accurate are the screening tests? 

No test is right all the time and that is true of the PSA test and DRE. The 

PSA test is better at suggesting that small cancers are present, especially 

those toward the front or sides of the prostate gland, or deep within it. 

But the DRE can sometimes suggest cancers in men with normal PSA 

levels. That is why both the PSA test and the DRE are usually performed. 

In a large study, it was found that if 100 African American men 

over age 50 take the PSA test: 

■ 

■ 

87 will have a normal PSA level (though a small number 

of these men will have cancer that was missed by the test). 

13 will have a higher than normal PSA level and require 

further tests. After further testing, results will show: 

– 8 do not have prostate cancer. 

– 5 do have prostate cancer. 

“We like to discuss health matters together.”
 
What do medical experts say about screening? 

Medical experts agree that every man needs balanced information on the 

pros and cons of prostate cancer screening to help him make an informed 

decision. Balanced information is important because medical experts 

disagree whether men should be screened regularly for prostate cancer. 

Medical experts who encourage regular screening believe current scientific 

evidence shows that finding and treating prostate cancer early, when 

treatment might be more effective, may save lives. They recommend that 

African American men, and men who have a father, brother, or son with 

prostate cancer, should discuss with their doctor the need for an annual 

DRE and PSA test starting in their 40s. For all others, they recommend 

informing men of the benefits and limitations of prostate cancer screening, 

and offering the screening tests annually beginning at age 50. All of these 

recommendations apply to men with a life expectancy of at least 10 years. 

11 

Medical experts who do not recommend regular screening want convincing 

evidence that finding early-stage prostate cancer through screening, and 

treating it, saves lives. They believe some of these cancers may never affect a 

man’s health and treating them could cause temporary or long-lasting side 

effects like impotence (inability to keep an erection) and incontinence 

(inability to control the urine flow, resulting in leakage or dribbling). Since 

they believe it is unclear if the potential benefits of screening outweigh the 

known side effects of treatment, they recommend that all men be given 

information on the pros and cons of screening before making their own 

decision. 
PROSTATE CANCER SCREENING
 

When will medical experts know more? 

Medical experts are working together on major research studies to get 

answers. These studies are called clinical trials. They will help determine 

whether a man who gets screened regularly is less likely to die of prostate 

cancer than a man who does not get screened. Clinical trials involve 

thousands of male volunteers and take a long time. Extra efforts are being 

made to recruit African American men into these studies. These clinical 

trials will also help experts understand how prostate cancer may be different 

for African American men. Results are expected in five to 10 years. They 

should help experts know if screening saves lives. 

12 

In addition, experts are conducting studies to find the gene or genes that 

may cause hereditary (inherited) prostate cancer, which is believed to be 

responsible for 5-10% of prostate cancers in all men. These studies may 

one day lead to simple genetic tests that can identify men at higher risk for 

the disease. Medical experts are also conducting the first large national 

study of hereditary prostate cancer in African American families. 

“Screening means more than 

just getting tested.” 
FOLLOW-UP TESTING 


What if the results of your screening tests indicate that you might need 

further testing? 

Do not panic. Most men who go for further testing do not have cancer. 

If your PSA test or DRE suggests a problem, your doctor most likely will 

refer you to a urologist (a doctor who has special training in prostate-related 

problems). Additional testing is necessary to determine if the problem is 

cancer or something else. 

The urologist may perform a transrectal ultrasound — a small probe 

inserted into the rectum that bounces sound waves off the prostate, 

producing a video image. Transrectal ultrasound does not provide enough 

specific information to make it a good screening tool by itself, but some 

doctors find it useful as a follow up to a suspicious PSA test or DRE. 

13 

If the urologist suspects cancer, tiny samples of the prostate may be 

removed with a needle. This is called a biopsy. A biopsy is usually 

performed in the urologist’s office. The samples are examined under a 

microscope to determine if cancer cells are present. 
14 

TREATING PROSTATE CANCER
 

What happens if prostate cancer is found? 

No two men with prostate cancer are the same. Many factors affect the 

decision whether or not to treat the disease: the patient’s age, whether 

the cancer has spread, the presence of other medical conditions, and the 

patient’s overall health. 

When prostate cancer has been found in its early stages and has not spread 

beyond the prostate, a doctor and his patient may decide upon: 

■ watchful waiting — monitoring the patient’s prostate cancer by 

performing the PSA test and DRE regularly, and treating it only if and 

when the prostate cancer causes symptoms or shows signs of growing; 

■ surgery (radical prostatectomy) — removing the prostate; 

■ external radiation therapy — destroying cancer cells by directing 

radiation at the prostate; 

■ internal radiation therapy (brachytherapy) — surgically placing small 

radioactive pellets inside or near the cancer to destroy cancer cells; 

■ hormone therapy — giving certain hormones to keep prostate cancer 

cells from growing; 

■ cryotherapy — placing a special probe inside or near the prostate 

cancer to freeze and destroy the cancer cells. 

More advanced prostate cancers that have spread beyond the prostate can 

be complex to treat and may be incurable. Patients should discuss with 

their doctor the best course of action. 
15 

Do these treatments have side effects? 

Side effects from prostate cancer treatment depend mainly on the type of 

treatment, the patient’s age, and his overall health. Men can experience 

pain, discomfort, and other mild to severe side effects that may be 

temporary or may last a long time. Two important side effects from 

treatment are impotence and incontinence. When a doctor explains the 

treatment options, he or she can discuss how mild or severe side effects 

might be, and how long they might last. Also, a doctor may be able to 

perform surgery or prescribe drugs to relieve some side effects. 

“There is more to screening than I realized.”
 
16 

Should I be screened for prostate cancer? 

The decision is up to you and your doctor. Know your risk factors for 

prostate cancer and the pros and cons of screening: 

Pros 

I’m taking the screening tests because they will give me peace of mind. As an 

African American man, I am at higher risk for getting and dying from 

prostate cancer. I understand that taking the screening tests could mean 

finding a problem, taking further tests, and treating a potentially serious 

prostate cancer. And since there’s no way to tell if the prostate cancer will 

cause problems in the future, I want it found early when treatments might 

be more effective. 

Cons 

Although I’m an African American man, I will hold off and not take the 

screening tests until medical experts agree that finding prostate cancer 

through screening, and treating it in its early stages, reduces the chance of 

dying from it. Screening tests could lead to further tests and treatment of a 

prostate cancer that may never cause problems. And treatment can have 

serious side effects. 
17 

“The right decision is the 

one that is right for me.” 

Thank you for reading this booklet. We hope it helped you understand 

the prostate, prostate cancer, and the different opinions on screening. 

To decide whether screening is right for you, discuss the pros and cons 

of screening with your doctor and the people important in your life. 

For more information on prostate cancer testing, treatments, and 

studies, talk with a cancer information specialist at 1-800-4-CANCER 

(1-800-422-6237), or visit the Web site: www.healthfinder.gov and 

type in the words “prostate cancer.” 
CDC Publication #99-7692 

October 2003