Earlier Detection
Finding Prostate Cancer

Location of the Prostate. Male reproductive system. From: The Atlas of the Human Body, The American Medical Association, 1998.

The Prostate

The prostate is a gland found only in men. It makes fluid that goes into the man's semen. Normally the prostate is about an inch and a half in diameter—the size of a plum or a golf-ball. The prostate is in the lower abdomen at the base of the penis below the urinary bladder and in front of the rectum. It wraps around the urethra, the tube that carries urine from the bladder down the penis.

Do I Need a PSA Test?

You do if you want to increase your chance of avoiding death from prostate cancer. Men who have a yearly PSA blood test are nearly three times less likely to die from prostate cancer than those who don't have annual screenings, according to a study presented in October 2005.

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, plus a biopsy if PSA is 2.5 ng/mL. If the tests are negative and 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 liquid. 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. Men often ask whether bike riding (or exercise bike) affects PSA. Studies show that bike riding does not have an effect. 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)

Your urologist examines your prostate by feeling (palpating) it with a lubricated, gloved finger inserted into the 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.

Why not rely on PSA test alone? The DRE is important because 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. 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 above, the front and top parts of the prostate cannot be felt from the rectum. Since prostate cancer may occur there and some prostate cancer in the peripheral zone cannot be felt, the PSA test is essential too. Find out more about DRE from University of Pittsburgh Medical Center

The choice of what to do about prostate cancer is separate from finding out if you have it. Questions to keep in mind include

Is this a threat to my life and/or health and well-being?
Which treatments offer me my best chance of cure or can minimize any threat prostate cancer presents to my health?
Which treatments do this with minimum reduction of my overall quality of life?

PSA Velocity and Doubling Time Better Predictors for Outcomes After Radical Prostatectomy Mayo, November 10, 2005

Annual Prostate Cancer Screening Test Appears to Save Lives Oct 2005

Regular PSA tests from age 35 recommended to track velocity (speed of change) Jul 2004

Brothers at high risk for prostate cancer. Sept 2, 2004

New drug aimed at men diagnosed with High Grade PIN Oct 19 2004

Aspirin or other NSAIDs use increases survival for men with prostate cancer. Oct 2004

Heavy Smoking Doubles Risk of Aggressive Prostate Cancer August 1, 2003.

PSA Test Reduces Prostate Cancer Deaths in Blacks and Whites National Cancer Institute August 2003

Links

Prostate Cancer Treatment Guidelines for Patients
Version III, October 2002 The national Comprehensive Cancer Network

Cáncer de la próstata
Guías de la NCCN para el tratamiento de los pacientes
Transferencia directa aquí
1-800-ACS-2435
1-888-909-NCCN

This page made by J. Strax, last edited April 14, 2006.

Information on this website 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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