Screening for prostate cancer can reduce prostate cancer mortality.

According to the Council for Medical Schemes (CMS) guideline for the management of prostate cancer:

• Prostate cancer is the second most frequent cancer, after lung cancer, in men.
• It is estimated that over 1,4 million new cases of prostate cancer are reported annually in the world.
• Men of African origin are at high risk of developing a more aggressive type of prostate cancer.
• In sub-Saharan Africa, prostate cancer is the leading cause of cancer deaths among men.
• Nigeria and South Africa combined, have the highest cumulative risk incidence of prostate cancer in Africa.
• One out of nineteen men in South Africa will develop prostate cancer in their lifetime.

Men who are 40 years and older are at risk, and the risk increases rapidly after 50 years.  Other risk factors are positive family history of prostate and/or breast cancer.  Certain gene mutations (BRCA1 and BRCA2) increase the risk of prostate cancer.  BRCA1 has been associated with an increased risk of periodic incidences of prostate cancer, however, the risk increases 5-fold in males with BRCA2 mutations.  Lifestyle and environmental factors such as smoking, alcohol intake, obesity, and poor diet (increased red meat and fatty food consumption) may increase the risk of developing prostate cancer.

Cancer in its early stages rarely produces symptoms.  Symptoms of urinary obstruction usually occur in advanced stages of cancer.  There may be blood in the urine or semen, painful ejaculation, urinary retention, difficulty and frequency of urination, and decreased size and force of the urinary stream.  Cancer may sometimes spread to lymph nodes and bones.  Symptoms of metastasis (spread) include backache, hip pain, perineal and rectal discomfort, anaemia, weight loss, weakness, decreased urine output and spontaneous pathological fractures.

Screening is aimed at detecting cancer before the symptoms appear.  This includes a Prostate Specific Antigen (PSA) blood test and a digital rectal exam (DRE).

PSA blood test: blood is tested for a protein, Prostate Specific Antigen (PSA, produced by the prostate.  High PSA high levels may indicate inflammation of the prostate or cancer.

DRE – is the examination of the prostate through the rectum to check for any prostate abnormalities.

The Council for Medical Schemes (CMS) recently updated their prostate cancer (PCa) prescribed minimum benefit (PMB) guideline.  The CMS recommends medically informed patient-based screening as PMB level of care in males with a life expectancy of more than 10 years based on the following criteria:

• From the age of 40 in Black African patients and in those with a positive family history of PCa and/or breast cancer in a first-degree relative.
• From the age of 45 years in all other males.
• Patients with a history of lower urinary tract symptoms and/or clinical suspicion of PCa regardless of age group.