Screening

Prostate Cancer

for Men with Medicare

A Decision Guide
This booklet was developed by the U.S. Department of

Health and Human Services, Centers for Disease Control 

and Prevention (CDC) and Centers for Medicare &

Medicaid Services (CMS). Published in June 2003.

Medicare covers prostate cancer screening.

For more information, go to pages 16 and 17.
1

To help you decide, 

let’s begin with the basics.

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 

recommend screening.
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.

2

THE PROSTATE AND PROSTATE CANCER

bladder

urethra

rectum

prostate
3

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
4

How common is prostate cancer?

For the general population, a man in his lifetime has about a:

■ 16 percent chance (1 in 6) of being diagnosed with prostate cancer.

■ 3 percent chance (1 in 33) of dying from prostate cancer.

The older you are, the greater the risk for getting and being diagnosed

with prostate cancer. See the chart below.

THE PROSTATE AND PROSTATE CANCER

Age 45 .....................................................................................1 in 2,500

Age 50 ........................................................................................1 in 476

Age 55 ........................................................................................1 in 120

Age 60 ..........................................................................................1 in 43

Age 65 ..........................................................................................1 in 21

Age 70 ..........................................................................................1 in 13

Age 75 ............................................................................................1 in 9

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

Risk of Being Diagnosed with Prostate Cancer by Age
5

Who is at increased risk for prostate cancer?

While all men are at risk for prostate cancer, some factors increase risk:

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

prostate cancer are at greater risk for developing it themselves.

■ Race. Prostate cancer is more common in some racial and ethnic

groups than in others, but medical experts do not know why.

Prostate cancer is more common in African-American men than in

white men. It is less common in Hispanic, Asian, Pacific Islander, and

Native American men than in white men.

Prostate Facts
6

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 threat to health or affect how long a man lives. Doctors

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

Among the leading causes of cancer death in men, prostate cancer is 

second, behind lung cancer. When compared with all causes of death 

in men over age 45, prostate cancer ranks fifth.

THE PROSTATE AND PROSTATE CANCER

Heart Disease

Lung Cancer

Stroke 

Emphysema

Pneumonia

Prostate Cancer 

Diabetes

Colorectal Cancer

Liver Disease

33.2%

7.8% 6.4% 6.0%

3.3% 2.7%

Unintentional Injuries

2.9% 2.5% 2.5% 1.7%

Top Ten Causes of Death in Men Over Age 45
7

What are the symptoms of prostate cancer?

Many men with prostate cancer often 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 the 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 are also caused by other prostate 

problems that are not cancer, such as an infection or an enlarged prostate.

Prostate Facts
8

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 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.

PROSTATE CANCER SCREENING

DRE:

digital rectal exam

Prostate Cancer Tests

PSA test:

prostate specific antigen test
9

What is the PSA test?

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

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, such as age and race, can affect PSA

levels. Some prostate glands produce more PSA than others. PSA levels

can also be affected by:

■ certain medical procedures;

■ an enlarged prostate;

■ a prostate infection.

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

to interpret your PSA test results.

Screening Tools
10

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 help suggest cancers in men with

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

usually performed.

If 100 men over age 50 take the PSA test:

■ 85 will have a normal PSA level (though a small number of these

men will have a cancer that was missed by the PSA test).

■ 15 will have a higher than normal PSA level and require further

tests. After further testing, results will show:

— 12 do not have prostate cancer.

— 3 have prostate cancer.

PROSTATE CANCER SCREENING

“I want to know more so I can ask my 

doctor questions.”
11

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

about 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

all men who have a life expectancy of at least 10 years should be offered the

PSA test and DRE annually beginning at age 50. They also recommend

offering screening tests earlier to African-American men, and men who

have a father or brother with prostate cancer.

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

screening decision.
12

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. Results are expected 

in five to 10 years. They should help experts know if screening for prostate

cancer saves lives. 

PROSTATE CANCER SCREENING

“I want all the facts before I get 

a screening test.”
13

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 will take the screening tests because they will give me peace of mind. 

It 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

“I will not take the screening tests until medical experts agree that finding

and treating prostate cancer in its early stages reduce 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.”

“There is more to screening than 

I realized.”
14

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 or DRE test.

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.

FOLLOW-UP TESTING 
15

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.

TREATING PROSTATE CANCER
16

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 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.

Does Medicare cover prostate cancer screening, and if so, 

who is covered?

Medicare covers both a DRE and the PSA test once every 12 months. All

men with Medicare age 50 and older are covered (coverage begins the day

after your 50th birthday). 

What do men with Medicare pay for prostate cancer screening?

You pay nothing for the PSA test. For the DRE, what you pay may be 

different depending on the type of Medicare health plan you have.

Generally, you will pay no more than 20% of the Medicare-approved

amount after the yearly Part B deductible.

TREATING PROSTATE CANCER
17

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.

“The right decision is the

one that is right for me.”

Medicare Information

1-800-MEDICARE 

(1-800-633-4227)

TTY: 1-877-486-2048

www.medicare.gov

National Cancer Institute’s 

Cancer Information Service

1-800-4-CANCER 

(1-800-422-6237)

TTY: 1-800-332-8615

Government and Nonprofit Health Information

www.healthfinder.gov and

type in “prostate cancer”

For more information about prostate cancer and Medicare, call or visit the following:
1-800-MEDICARE (1-800-633-4227)

TTY: 1-877-486-2048

www.medicare.gov 

CMS Publication # 11042, June 2003