Prostate cancer screening/abnormal PSA
What is it?
PSA stands for prostate specific androgen and is a protein that is secreted solely by the prostate, a small organ located below the bladder. A PSA blood test may be checked by your urologist or primary physician as part of a normal yearly check-up or if your physician is concerned that you might have a problem with your prostate. In addition, the PSA test is one way that men are evaluated for possible cancer that can develop in the prostate.
Why is my PSA abnormal?
PSA is not a test specific to prostate cancer and an abnormal or elevated value does not necessarily indicate prostate cancer. The PSA can be elevated in several benign problems of the prostate:
- Benign prostate enlargement
- Infection (prostatitis, bacterial cystitis/bladder infection)
- Manipulation/trauma-recent prostate surgery, cycling, trauma to groin
- Ejaculation within a few days of the test
- Age-there is a normal increase of PSA with age
How do I know if I have prostate cancer?
In the past, prostate cancer was diagnosed after the patient had significant urinary symptoms or blood in the urine. However, these symptoms are not specific to prostate cancer and can also be a sign of benign prostate enlargement. Your urologist or primary physician may suggest they perform a prostate cancer screening examination which consists of a digital rectal examination to assess the prostate for any abnormal features-nodules, firmness, or asymmetry.
The Facts About Prostate Cancer Screening
Early Detection of Prostate Cancer Saves Lives
The U.S. Preventive Services Task Force has recommended healthy men should no longer receive prostate specific antigen (PSA) blood test as part of routine cancer screening.
This decision is being made by a panel that does not include urologists or oncologists. No new research has been cited that would call for this drastic change in prostate cancer testing recommendations since the USPSTF considered this issue in 2009
In 2009, this same task force tried unsuccessfully to eliminate mammograms for women ages 40-49 and recommended against teaching women to do breast self-exams, which Congress rejected after public outcry.
Advanced Urology Center of New York (AUCNY, www.aucofny.com), the largest urology group in the United States, strongly disagrees with the task force's latest findings. This recommendation needlessly puts into harm's way all the men who are at most risk: those who are underinsured, live in rural areas where health care is not readily available, have a family history of prostate cancer, and particularly African American men. AUCNY supports current recommendations endorsing PSA screening for well-informed men who wish to pursue early diagnoses.
The largest prostate cancer screening study, the European Randomized Study of Screeening for Prostate Cancer (ERSPC), updates March 2012, found that with prostate cancer screening, death by prostate cancer dropped 38%, compared to those who did not undergo prostate cancer screening.
Early detection is critical to the success of prostate cancer treatments and over 90% of prostatc cancers detected by screening are organ confined (not metastatic). Men should have an opportunity to make an informed decision about prostate cancer screening. A decision on how best to test for and treat prostate cancer should be between a man and his doctor.
How is it diagnosed?
After careful discussion of your prostate cancer risk factors, your urologist may suggest a prostate biopsy, the only way to diagnose prostate cancer and obtain a biopsy of prostate tissue. This is typically done in the office. In addition, your physician may obtain additional imaging like an MRI to help focus the biopsy or suggest an MRI Fusion biopsy.
How is it treated?
If you are diagnosed with prostate cancer, your physician can help guide you through your various treatments options.