Your prostate and earlier detection of prostate cancer

The prostate is a gland found at only in men. Male hormones or androgens, including testosterone, make the prostate grow to full size. The prostate is part of a man's reproductive system.The gland makes and stores some of the fluid that goes into the man's semen.

A healthy prostate is around an inch and a half in diameter and shaped like a plum. It's wedged in the pelvic cavity with the fatter end below the urinary bladder, on top of the base of the penis and in front of the rectum. The urethra, the tube that carries urine from the bladder down the penis, runs through it.

The prostate has a base, an apex, an anterior, a posterior and two lateral surfaces. The base (the fat end) touches the lower surface of the bladder. The apex is directed downward, and is in contact with the fibrous tissue network between the skin and the underlying structure of muscle and bone of the urogenital diaphragm.

Urologists divide the prostate into zones -- the transition zone, central zone and peripheral zone. The peripheral zone can be felt through the rectum, especially when enlarged.

Benign Prostatic Hypertrophy is the abnormal enlargement of non-cancerous cells within the transition zone of the prostate.

Most cancers of the prostate start in the peripheral zone.

Do I Need a PSA Test?

The PSA test is a simple blood test to measure how much PSA (prostate specific antigen) a man has in his bloodstream at a given time. The PSA test is the most effective test currently available for the early detection of prostate cancer.

University of Pittsburgh Cancer Institute says PSA testing and the digital rectal examination (DRE) "are crucial in detecting prostate cancer in its early stages, when it usually produces no physical symptoms."

Since the PSA test came into use in the United States, the death rate for prostate cancer has fallen.

Many US guidelines for prostate cancer screening recommend annual PSA and digital rectal exam (DRE)

• At age 40 for African American men and all men with family history of prostate cancer or a mother with breast cancer. Many survivor advocates urge testing from age 35 up for men at high risk.
• At age 50 - 70 for all men.
• Men in their seventies and eighties may or may not wish to continue annual testing to protect themselves against advanced prostate cancer in their final years.
• The choice of what to do about prostate cancer is separate from finding out if you have it. Questions to keep in mind at any age are Is this a threat to my life or health and well-being? Which treatment, if any, offers good chance of cure or can minimize any threat prostate cancer presents to my health, and do that with minimum reduction of my overall quality of life?

Another recommended approach is to ask for a test by age 40, with biopsy if PSA is 2.5 ng/mL; if you have no special risk, retest every two years.

Two ways of using the PSA test are laid out in our CHECK UP FLOWCHART 1 and CHART #2 USING "free" PSA. Also see October 2003 report on "complexed" or "cPSA."

What is PSA, anyway?

The prostate in men, like the breast in a woman, is a gland that produces and secretes fluid. Cells lining the prostate gland make some of the semen that comes out of the penis at the time of sexual climax (orgasm).

Prostate-specific antigen (PSA) helps to keep the semen in its liquid form. It is an enzyme in the form of a glycoprotein produced primarily by the epithelial cells lining the acini and ducts of the prostate gland.

"PSA is concentrated in prostatic tissue, and serum PSA levels are normally very low. Disruption of the normal prostatic architecture, such as by prostatic disease, allows greater amounts of PSA to enter the general circulation." From Prostate-Specific Antigen (PSA) Best Practice Policy, Oncology Vol 14, No 2 (February 2000), American Urological Association.

High PSA levels in the blood may be a sign of any prostate problem. PSA rise may indicate infection. It may indicate benign growth or swelling of the prostate. Or it may indicate prostate cancer.

PSA may go up and down, or fluctuate. One elevated reading does not necessarily justify a biopsy. Researchers at Memorial Sloan Kettering Cancer Hospital found "natural variations" in PSA levels.

Aside from prostate problems, some physical events and procedures can affect PSA levels. Sexual ejaculation, prostate digital examination and biopsy can raise the PSA. The blood test should not be taken sooner than 24 hours after orgasm, and should be taken before rectal exam or biopsy.

Digital rectal exam (DRE)

A urologist examines the prostate by feeling (palpating) it with a lubricated, gloved finger inserted into the man's rectum. This is called digital rectal exam (DRE). It takes only a few moments and should not be painful at all (if it hurts, say so).

If your doctor does a hasty or rough examination, find a better doctor. The more experienced the urologist, the more he can tell from a DRE.

Don't rely on the PSA test alone. The DRE is an essential follow up to PSA test. According to urologist Patrick Walsh M.D., about 25 per cent of men who have prostate cancer,have a low PSA.

The exam is to feel for "suspicious" places on the prostate. As mentioned above, most prostate cancer occurs in the peripheral zone. Fortunately, this is the area most likely to be felt during a rectal exam. Nonetheless, as you can see from the illustration, the front and top parts of the prostate cannot be felt by DRE. Since prostate cancer may occur there and some prostate cancer in the peripheral zone is not detectable by feel, the PSA test is essential too. Find out more about DRE from University of Pittsburgh Medical Center

Information above is not intended as medical advice nor to be taken as such. Consult qualified physicians specializing in the treatment of prostate cancer. Neither the editors nor the publisher accepts any responsibility for the accuracy of the information or consequences from the use or misuse of the information contained on this website.

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