Early detection and screening

Prostate cancer is typically slow growing. High PSA levels can occur five to ten years before the onset of prostate cancer symptoms and early prostate cancer often has no symptoms. The PSA test can help to detect cancer at this early stage.

At present, however, health authorities do not recommend widespread ‘screening’ for prostate cancer. While we have some evidence that regular testing may prevent prostate cancer deaths, there are concerns that many men may be diagnosed and treated unnecessarily as a result of being screened, with a high cost to their health and quality of life.

Discuss testing with your doctor

Most authorities suggest that a man makes his own choice about whether or not to be screened for prostate cancer. This should be done in discussion with your doctor, after considering the benefits and uncertainties of testing and your own risk from the disease.

The Urological Society of Australia and New Zealand has suggested that a single test at the age of 40 years or more may be the best way of assessing a man’s risk of prostate cancer over the following 15–20 years. Men with a father or brother who were diagnosed with prostate cancer at an early age are also at higher risk.

In Australia, Medicare covers an annual check, but this may not be necessary for all men who choose to be screened. The frequency with which you should be checked will be influenced by your first test result. If a man chooses to be tested for prostate cancer, both a PSA test and DRE are recommended to give the best chance of detecting the cancer.

How are PSA test results reported?

PSA test results show the level of PSA detected in the blood. These results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood. In the past, most doctors considered a PSA level below 4.0 ng/mL as normal. In one large study, however, prostate cancer was diagnosed in 15.2 percent of men with a PSA level at or below 4.0 ng/mL (2). Fifteen percent of these men, or approximately 2.3 percent overall, had high-grade cancers (2). In another study, 25 to 35 percent of men who had a PSA level between 4.1 and 9.9 ng/mL and who underwent a prostate biopsy were found to have prostate cancer, meaning that 65 to 75 percent of the remaining men did not have prostate cancer (3).

Thus, there is no specific normal or abnormal PSA level. In addition, various factors, such as inflammation (e.g., prostatitis), can cause a man’s PSA level to fluctuate. It is also common for PSA values to vary somewhat from laboratory to laboratory. Consequently, one abnormal PSA test result does not necessarily indicate the need for a prostate biopsy. In general, however, the higher a man’s PSA level, the more likely it is that cancer is present. Furthermore, if a man’s PSA level continues to rise over time, other tests may be needed.

Because PSA levels tend to increase with age, the use of age-specific PSA reference ranges has been suggested as a way of increasing the accuracy of PSA tests. However, age-specific reference ranges have not been generally favored because their use may lead to missing or delaying the detection of prostate cancer in as many as 20 percent of men in their 60s and 60 percent of men in their 70s. Another complicating factor is that studies to establish the normal range of PSA values have been conducted primarily in white men. Although expert opinions vary, there is no clear consensus on the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group.

# What if the screening test results show an elevated PSA level?

A man should discuss an elevated PSA test result with his doctor. There can be different reasons for an elevated PSA level, including prostate cancer, benign prostate enlargement, inflammation, infection, age, and race.

If no symptoms to suggest cancer are present, the doctor may recommend repeating DRE and PSA tests regularly to watch for any changes. If a man’s PSA level has been increasing or if a suspicious lump is detected during a DRE, the doctor may recommend other tests to determine if there is cancer or another problem in the prostate. A urine test may be used to detect a urinary tract infection or blood in the urine. The doctor may recommend imaging tests, such as a transrectal ultrasound (a test in which high-frequency sound waves are used to obtain images of the rectum and nearby structures, including the prostate), x-rays, or cystoscopy (a procedure in which a doctor looks into the urethra and the bladder through a thin, lighted tube that is inserted through the end of the penis; this can help determine whether urinary blockage is caused by an enlarged prostate). Medicine or surgery may be recommended if the problem is BPH or an infection.

If cancer is suspected, a biopsy is needed to determine whether cancer is present in the prostate. During a biopsy, samples of prostate tissue are removed, usually with a needle, and viewed under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to tell if cancer is present.

How a Prostate Cancer Test Can Save your Life

Although prostate cancer is considered a disease of the elderly man, it has been known to inflict its damage on men in their early 30s. Heredity seems to play a factor especially in younger patients.

If you're a man over 50, you should consider a yearly Prostate cancer PSA (Prostate Specific Antigen) test. It's a simple a blood test that can help doctors catch the very early cases of prostate cancer. This is a great way to protect yourself from this potentially deadly disease that afflicts men in their later years.

Let me caution you that an elevated PSA result can be caused by a variety of factors and does not necessarily indicate prostate cancer. These other causes include BPH or benign hypertrophy or enlargment of the prostate, and also elevate the PSA test results. Even Prostatitis and Lower Urinary Tract symptoms can show elevated levels of PSA.

The prostate specific antigen test is like any other simple blood test. Blood is drawn by a phlebotomist and sent to the lab for analysis. A normal result from a PSA test, doesn't guarantee that your free from cancer, nor does a higher than normal result mean you DO have cancer

A PSA Count of between 0 - 3.9 nanograms per milliliter of blood is generally considered normal. Levels higher than a 3.9 ng count may indicate there may be a prostate problem which could be anything from a swelling or inflammation, infection or cancer.

It's critical that you follow your doctor's lead in regard to dealing with the Prostate Specific Antigen test results. The results are an indication that something may be happening only. To complicate matters even more, PSA levels can also increase with age. Oh and the relative size of your prostate also plays a factor in interpreting the results.

The point of this is the strongly encourage you to have an annual prostate exam and PSA blood test.

Please do not assume a high PSA reading means that you have prostate cancer. All a high PSI level reading indicates is that there "may" be a problem. Two out of three people with elevated the PSA readings DO NOT have a malignancy. So don't panic!

Here's a few very good reasons why you should consider getting an annual PSA blood test

a. Your doctor is much better able to detect potential prostate cancer even though you have no symptoms.

2. Early detection means a much higher chance of successful treatment and cure

3. The PSA blood test is simple and is recognized as a major contributing factor in the continued drop of prostate cancer deaths

So what we know as patients about the PSA test is that it's not perfect and cannot clearly identified the presence of prostate cancer. All the tests provides is an indicator of a potential benign or cancerous prostate problem

We also know that the term 'normal" in dealing with the PSA test result is subject to interpretation due to many factors. This is why it's critical that your doctor interpret the results.

The PSA test indicated a normal antigen level in about 20% of the cases in men who had early prostate melanoma.

Even with an imperfect test however, it's recognized that the PSA is a good indicator and tool in our arsenal to fight this deadly disease. Note that a Harvard study done in 2005 indicated that those men having a yearly PSA test and monitoring of PSA levels were almost 3 times less likely to die for prostate cancer than those who didn't bother with the PSA

Finally, according to the Centers for Disease Control ( CDC ), is the introduction 20 years ago of any use of the PSA test, deaths from prostate cancer have fallen by one third. Prostate cancer if caught in its early stages is treatable and curable. Don't wait until it is too late to have this important test done

Accuracy of PSA tests

PSaA is measured in nano-grams per millilitre and is normally in the range of 0.1 to 4. There are two forms of PSA present in the bloodstream, those bound to alpha antichymotrypsin, which are the most abundant form, and free PSA. It is generally considered that by analyzing the percentage of free PSA together with total PSA (defined as percent-free PSA) will lead to more accurate diagnostics of the chance of a patient having prostate cancer.

Patients with PSA test results of between 4 and 10 are normally considered borderline patients; the level of percent free PSA well then determine if a biopsy is required. If percent-free PSA numbers are 10% or less then the chance of having cancer is about 50%. Normally a doctor will recommend a patient has a biopsy if percent-free PSA readings are less than 25%.

It is recommended that both a digital rectal examination and a Protein specific antigen test are carried out together. This is because of the nature of detection of specific cancers, has been reported that if a digital rectal exam alone is taken that 60 percent of the detected cancers are advanced whereas when a PSA test is also performed this level reduces to 33%.

Biopsy of the prostate

If your PSA level is raised, you may be referred to a specialist for a prostate biopsy. This is because a definite diagnosis of prostate cancer can only be made by taking cells from the prostate and then looking at them under a microscope. A biopsy involves using an ultrasound scanner to guide a metal probe into the rectum. This test can be uncomfortable, and sometimes painful.

The biopsy is not without risks. For example, there is a small risk of introducing infection into the prostate during the procedure, which can sometimes be serious. Some men bleed quite a bit following the procedure.

Also, the biopsy itself is not foolproof and 100% accurate. If the biopsy does not show any cancer cells, that doesn't completely rule out an early cancer. Of every 100 men who have cancer of the prostate, the biopsy will miss the cancer in about 20 of them.