• Home

PSA

It is estimated that about 30,000 men in the United States die as a direct result of metastatic prostate cancer each year. The American Cancer society estimates that about 200,000 new cases of prostate cancer are diagnosed each year. Prostate cancer is the most commonly diagnosed cancer in men and the second leading cause of cancer death for American men. Even in very elderly men with prostate cancer, if left untreated 13% to 20% will die from prostate cancer. Cure is only possible when the cancer is early in its course and is confined to the prostate gland. There is at this date no cure for advanced (metastatic) prostate cancer; advanced prostate cancer may be controlled with drugs but not cured.

Articles in both the medical and lay press have focused on prostate cancer and PSA testing. The American Cancer Society recommends routine PSA testing once a year starting at age 50, and at age 40 for all African-American men and all men with a family history of prostate cancer. Many prostate cancer experts recommend starting PSA testing at age 40 in all men. The most common symptoms associated with prostate cancer are identical to the symptoms of benign prostate disease. Some of the more common symptoms of both prostate cancer and benign prostate disease include low back pain, rectal and genital discomfort, urinary symptoms such as slowing or change in the urinary flow, awakening more often at night to urinate and discomfort with urination. Therefore, it is critical to distinguish between benign prostate problems and prostate cancer. The PSA, along with a digital rectal exam, helps to do this.

PSA and PROSTATE CANCER FACTS

1. What is PSA? PSA is a protease enzyme produced by the lining of the prostate gland and is secreted in high concentration in the seminal fluid (ejaculate). The standard PSA test measures the total amount of PSA.
2. PSA has the highest validity of any circulating cancer screening marker discovered thus far. Not all men with an elevated PSA have prostate cancer, however cancers detected using PSA are clinically significant (85% are moderately or poorly differentiated and therefore aggressive cancers).
3. PSA in combination with the digital rectal exam (DRE) is the best method for detecting prostate cancer when the disease is localized and potentially curable.
4. PSA is the most sensitive indicator of prostate cancer activity after any form of treatment for prostate cancer.
5. What can change the PSA level in the blood? Prostate surgery, prostate biopsy, prostate infection, prostate massage, radiation therapy, hormonal treatment of prostate cancer, antibiotics, the drugs Proscar (finasteride) and Avodart and some dietary and nutritional supplements.
6. What elevates the PSA? Normally the PSA is found in very low concentrations in the blood. PSA gain access to the blood circulation when something alters the cellular barriers that keep PSA within the ductal system of the prostate. Thus, PSA can be abnormally elevated by prostatitis (prostate infection), urinary infection, incomplete bladder emptying, benign prostate enlargement (BPH) as well as prostate cancer.
   
7. The drug Proscar (finasteride) and Avodart will both lower the PSA by about 50%. Therefore, in men who take these drugs the PSA result must be doubled (multiplied by 2) to get the true PSA value.
8. What PSA values are normal and abnormal? The range of normal for the PSA is generally from 0.0 to 4.0. PSA values should be lower in younger men. The following are “age adjusted” PSA reference ranges:
   • Age 40 to 50: PSA value less than 2.5.
   • Age 50 to 60: PSA value less than 3.5.
   • Over age 60: PSA value less than 4.0.
9. Can the PSA value tell when prostate cancer is about the escape the prostate and metastasize? No.
10. When should a man be evaluated by a urologist? When the PSA is noted to be abnormally elevated (see age adjusted values above).
11. Indications for PSA testing and prostate exam:
    • Men over age 40 with signs and symptoms referable to the prostate
    • All African-American men yearly starting at age 40
    • Starting at age 50 all men with a life expectancy of greater than 10 years.
12. At what age is PSA testing no longer necessary? Age should not be an absolute limit. However, when a man over age 80 requests a PSA exam it must be done with the understanding that if the test is abnormal a biopsy may be recommended. Therefore the test should not be done out of curiosity.

Home :: About us :: For Patients :: For Physicians :: Services :: Urology News :: Urology Links :: Contact Us
Designed By eLink Design, Inc. and Hosted By Intelliwire, Inc.
© 2008 Commonwealth Urology. All Rights Reserved.