You sit anxiously in your doctor’s office. The waiting room is full.

Your nerves are on edge as you think about the upcoming exam.

You are here for what will amount to your first check ever for screening — screening for prostate cancer.

You try to get your thoughts together to ask the questions you’ve had over the past few weeks.

Is it necessary to check your PSA every year because you are now 50? Do you have to have a rectal exam? What does it mean if your PSA is elevated? What happens if it is? Does a biopsy always show if you have cancer? Does it hurt? What are the complications of the biopsy?

And then you really start to get anxious …

What if cancer is found?

These are all real and legitimate questions to ask your primary care physician.

No screening is without risk. There is always the possibility your blood test will be normal and you still have cancer. Or, your blood test shows elevated levels, but no cancer is found.

This scenario leads to a biopsy. Biopsies aren’t without complications — infection, bleeding and pain.

If your biopsy report returns with a positive diagnosis, the question of treatment arises.

Recently, a panel has made recommendations that PSA screening not be done. The panel felt the risks of the biopsy and subsequent treatment did not warrant screening.

Unfortunately, the panel did not have a single urologist, medical oncologist or radiation oncologist on it.

The American Cancer Society has recommended that men over 50 with no family history of prostate cancer have a PSA drawn yearly if it is anticipated that they will live 10 years or more.

If there is a family history of prostate cancer, screening should start at age 40 and should be performed yearly.

Dr. Kris Gast is a board certified radiation oncologist. She has been in practice for 21 years, the last 13 at Fort Smith Radiation Oncology in Fort Smith. Her column, Cancer Demystified, appears the first Wednesday of every month in the Times Record. Send questions to