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Three things you should know about prostate cancer screening

Let’s face it: If you want a sex life, you need a healthy prostate. Heck, if you want a life at all you need a cancer-free prostate. You’ve probably heard it’s a good idea to get your gland an annual checkup. What you may not know is that it’s not always enough.

We asked some of the country’s top urologists to tell us what they’d insist on if it were their prostates on the line. Their advice: go beyond the standard routines the average doc’s likely to suggest. Here’s what you should know about when it comes to getting tested for prostate cancer:

The standard routine: Once you turn 50, you undergo a digital rectal exam (the finger) and a PSA (prostate-specific antigen) test each year. If your total PSA reading is 4 nanograms per milliliter of blood (ng/ml) or greater—a high count that suggests that cancerous cells may be producing PSA—your doctor might refer you to a specialist for a prostate biopsy.

A better strategy: Start getting PSA tests at age 40 if you have a family history of prostate cancer. Be certain your doctor performs a “percent free” PSA test, which measures both free-floating PSA and those bound to other molecules, known as “complex” PSA. The test has been around for 3 years, but not all urologists use it. Cancerous prostate cells seem to produce more complex PSA. Your doctor should send your blood sample to a university medical center that performs the percent-free test.

Also, ask your doctor if your PSA reading is normal for your age and race. Asian men produce the least PSA, white men produce slightly more, and black men have the highest natural PSA counts. Most urologists would ignore a PSA reading of 3.3 ng/ml in a 52-year-old black man, but if you’re Japanese, that’s high enough to suggest cancer.

The standard routine: Your prostate biopsy takes six tissue sample.

A better strategy: Double the take. “The standard six-sample prostate biopsy can miss cancer,” says Jonathan Epstein, M.D., a urologist at Johns Hopkins University in Maryland. “That’s why we take 12 core samples and include more outer regions of the prostate.” This is called an extended-sextant biopsy, and it scans a wider field to spot malignant cells. It won’t cause any more pain than the usual biopsy, says Dr. Epstein.

The standard routine: Your doctor sends your bipsy to a nearby hospital for analysis.

A better strategy: Cut the error margin. “f it were me, I’d have it sent to one of the best prostate-cancer centers for analysis. It doesn’t cost a penny more,” says Dr. Epstein. Your urologist should know the leading institutions. Most important, demand that at least two pathologists review your biopsy results and agree on exactly how aggressive your tumor is (its grade). “At least 15 percent of prostate-cancer cases are graded wrong, and grading determines what kind of treatment you get,” says Dr. Epstein. A combination of tests, such as CAT scans, bone scans, and MRIs, can help determine the grade of your cancer.