Glenn Ellis

*For such a small gland (it’s roughly the size of a walnut), the prostate has a very important job. If a man didn’t have a prostate, the sperm couldn’t survive. The main purpose of the prostate is to produce fluid and other compounds that help support sperm survival.

Prostate cancer affects many men each year. Screening includes a digital rectal exam, tests for prostate-specific antigen (PSA), and transrectal ultrasonography (TRUS).      Each of these tests takes less than half an hour to perform.

The age-old question is, “Are they effective”?

New Mayo Clinic research studied the association between prostate-specific antigen (PSA) levels and prostate size and found that routine annual evaluation of prostate growth is not necessarily a predictor for the development of prostate cancer. However the study suggests that if a man’s PSA level is rising quickly, a prostate biopsy is reasonable to determine if he has prostate cancer. Researchers are working on developing effective methods to screen for prostate cancer. However, it has not yet been shown that screening for prostate cancer decreases the chances of dying from prostate cancer.

Prostate cancer is the most common type of cancer found in American men, other than skin cancer. The American Cancer Society estimates that there will be about 179,300 new cases of prostate cancer in the United States this year, and about 37,000 men will die of this disease. For an American man, the lifetime risk of dying from prostate cancer is 3.4%.

Although men of any age can get prostate cancer, it is found most often in men over age 50. In fact, more than 8 of 10 men with prostate cancer are over the age of 65.

African-American men are at higher risk than Caucasian men. Men with a family history of prostate cancer are at higher risk too. Family history means that your father or a brother had prostate cancer.

The prostate gland is part of the male reproductive system. The prostate makes a fluid that mixes with sperm and other fluids during ejaculation. A normal prostate is about the size of a walnut.

Your doctor may examine your prostate by putting a gloved, lubricated finger a few inches into your rectum to feel your prostate gland. This is called a digital rectal exam. A normal prostate feels firm. If there are hard spots on the prostate, your doctor may suspect cancer. A more sensitive test measures prostate-specific antigen, or PSA, a protein manufactured by the prostate gland. An elevated level indicates an abnormality of the prostate.

An elevated PSA can be due to benign prostatic hypertrophy (an enlarged prostate), which affects nearly all men as they grow old. It can also signal prostatitis, an inflammation of the prostate. Both conditions may or may not warrant treatment, depending on the severity of symptoms. Neither problem is potentially fatal. But a high PSA level could indicate cancer.

An abnormal PSA test often leads to a biopsy to determine if cancer is present. In recent years, health professionals have questioned whether the PSA test is an effective way of detecting prostate cancer. Does it miss too many cancers? Does it lead to too many unnecessary biopsies? Is there a better way to screen for prostate cancer?

Although the PSA test is not perfect, it is the best currently available test for early detection of prostate cancer. Prostate Specific Antigen (PSA) is a protein made in the prostate. Normally, very little should be found in the blood. Rising levels of PSA in the blood indicate a problem with the prostate, which could be cancer but could also be an enlarged prostate (BPH).

While the PSA test is considered a major advance in diagnosing early-stage prostate cancer, it has some drawbacks. For 100 men over 50 at average risk for prostate cancer, the following would be found if they all had a PSA test:

  • Ten of the 100 men would have a PSA level higher than normal (over 4.0). The 10 men would need further testing to clarify their abnormal levels.
  • Three of the 10 men would be found to have prostate cancer.
  • Seven of the 10 men would be found not to have prostate cancer. They would have an elevated PSA for other reasons—most likely an enlarged prostate (BPH).
  • Ninety of the 100 men would have PSA levels in the normal range (less than 4.0).
  • One or 2 of these 90 men would be found to have significant prostate cancer that becomes life threatening.

This shows that the PSA test is moderately sensitive. Of 100 men with prostate cancer, it will detect only about 70 of them. But the positive predictive value of the PSA test is low. Only 3 out of 10 positive results were cancer. And 7 out of 10 positive PSA results (i.e., greater than 4.0) are false-positive results; this means that 2 out of 3 men who are told that they may have cancer after taking the PSA test actually do not have it. When the PSA is greater than 10.0, the test is more accurate. There is about a 50-50 chance of having cancer at this level of PSA!

Other things you and your doctor may want to consider:

Your age. Doctors may use Age-adjusted PSA ranges to account for the natural increase in PSA with age when considering further testing.

The size of your prostate. PSA Density is a measure that relates your PSA level to the size of your prostate, to account for the increase in PSA caused by prostate enlargement.

Your weight. Body Mass Index, a measure of obesity, may also be a factor. The relationship between obesity and lower PSA levels may cause doctors to miss early prostate cancer cases in overweight men.

Ejaculation within 48 hours before taking a PSA test can also cause a higher reading of your PSA level.

Refinements of the PSA test have been developed to reduce the number of false positive results. If your PSA is found to be high, ask your primary healthcare practitioner to discuss your cancer risk and the possible use of other evaluations of PSA before having a biopsy. Men should be counseled about the benefits and risks of detecting and treating an indolent tumor (this cancer may not have caused symptoms). The treatment may cause urinary and sexual problems.

Keep in mind that the ultimate goal of the PSA test is not to decide who should be biopsied and who should not. It is to save lives.

 

Remember, I’m not a doctor. I just sound like one.

 

Take good care of yourself and live the best life possible!

Glenn Ellis, author of Which Doctor?, is a health columnist and radio commentator who lectures around the country on health issues relevant to the African-American community.

E-mail me at [email protected]

For good health information, visit: www.glennellis.com