What He Needs To Know About Prostate Cancer

The men in your life have enough to think about as they hit that dreaded middle age. If you can somehow steer them away from that mid-life crisis, or even better, get them to their doctor for an annual physical, you have already accomplished a lot. Do you really have to think about another silly test that your doctor wants to talk about? In this case, you should probably give it some thought.

The prostate-specific antigen (PSA) test is a measurement of an enzyme made almost exclusively in the prostate gland.  Normally only small levels of PSA are present in the blood.  However, an abnormality of the prostate can disrupt the normal architecture of the gland and enable more PSA to pass into the bloodstream.  Therefore, high blood levels of PSA can indicate prostate problems, including cancer. Today, PSA blood tests are approved for prostate cancer detection and are widely used to screen men for the disease.  

Since the advent of routine screening in 1986, about one in six American men have been diagnosed with prostate cancer. If detected early, it is usually very curable. However, if detected at an advanced stage, it is usually incurable, and it can be devastating. It can lead to a cancerous bone fractures, the inability to urinate, and bleeding in the urine that can clot off the bladder. Advanced prostate cancer can be a slow and painful death. I cannot reiterate enough that the key to the ability to cure prostate cancer is catching it early.

Clinical studies have demonstrated the following benefits of PSA testing:

  1. An elevated PSA is the single best predictor of the presence of prostate cancer
  2. PSA testing detects prostate cancer about 5 to 10 years earlier than rectal exam
  3. Most prostate cancers detected with PSA testing are curable
  4. Regularly scheduled PSA testing virtually eliminates the diagnosis of advanced prostate cancer

It is not clear, however, whether PSA screening for prostate cancer reduces the overall rate of death from the disease.  Some of the cancers detected are so small or slow growing that they might never become life threatening.

Another drawback of PSA testing is that most men with an elevated PSA do not have prostate cancer.  Often times, the reason for a high PSA level is prostate enlargement (BPH), inflammation, or urinary tract infection.

There is no PSA level below which physicians can reassure a man that he does not have prostate cancer.  Therefore, it is not possible to define an absolute "normal" level.  In some younger men, it has been shown that PSA levels above 2.5 ng/mL can signal trouble.  For older men, levels above 3-4 ng/mL usually indicate the need for a prostate biopsy. Most urologists agree that PSA should be used in conjunction with other clinical information to assess the overall likelihood that cancer is present, and that a biopsy may be warranted.  This will be a thorough discussion between you and your urologist, and it will be tailored to your individual clinical situation.

The American Cancer Society and the American Urological Association recommend an annual PSA test beginning at age 50.  Men at increased risk for prostate cancer - black men and men with a family history of prostate cancer - should begin annual screening at age 40 or 45.

Other studies have concluded that men age 50 and older who have PSA levels below 2 ng/mL, do not need to be tested every year.  However, the testing schedule for a man should be more frequent if the PSA is rising but has not reached a threshold level where a biopsy would be recommended.

So where does that leave us? Get the PSA screening?  Skip it?   My thoughts are that knowledge usually equates to better decision making. The great thing about treating prostate cancer is that it often doesn't need to be treated at all. I typically encourage my patients to get a PSA test at the recommended age between 40 and 50. However, I make sure they know that an elevated PSA does not assure them of needing a biopsy. Additionally, I try to make it clear to them that even if we find prostate cancer, this often does not mean immediate treatment. Many cases of prostate cancer can simply be watched closely, and have a very low chance of progression.

Hopefully, all of this talk about PSA has become more clear now. Maybe it’s time to discuss this with the man in your life. Encourage him to discuss this with his physician at his next appointment. The urologists at The Jackson Clinic are always available for an appointment to discuss this in more detail. The department offers cutting edge therapy for prostate cancer, which now includes minimally invasive robotic assisted prostate surgery utilizing the da Vinci® robotic system.