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Prostate cancer and PSA testing |
The prostate gland is part of the male reproductive system and makes a fluid that mixes with sperm and other fluids during ejaculation. A normal prostate is about the size of a walnut.
Prostate cancer can be aggressive, which means it grows quickly and spreads to other parts of the body especially the bones or it may be slow growing and stay in the prostate, causing few if any problems. Three out of four cases of prostate cancer are of the slow-growing type that is relatively harmless.
Prostate cancer is a very common type of cancer. Although men of any age can get prostate cancer, it is found most often in men over the age of 50. It has been shown that almost all men will develop prostate cancer if they live long enough but most of these men will die from causes unrelated to their prostate cancer.
Men with a family history of prostate cancer are at higher risk. Family history means that your father or a brother had prostate cancer. Men need to be aware that, over an average lifetime, their risk of experiencing prostate cancer is one in ten. Put another way, men have a nine out of ten chance they will never develop prostate cancer.
Your doctor may examine your prostate by putting a gloved, lubricated finger a few inches into your back passage to feel your prostate gland. A normal prostate feels firm. If there are hard spots on the prostate, your doctor may suspect cancer. Prostate cancer in its curable stage rarely has symptoms and is usually not detectable at rectal examination.
Another way to check for prostate cancer is with a blood test called the PSA test. PSA is short for prostate-specific antigen. Men who have prostate cancer may have a higher level of PSA in their blood. However, the PSA level can also be high because of other, less serious causes such as infection.
Screening means looking for cancer before it causes symptoms. Doctors don't agree on whether screening is needed. The issues are complex but there is now evidence to suggest that PSA testing of asymptomatic men can allow early detection and treatment of prostate cancer in its early curable stages. Early treatment of prostate cancer reduces the risk of dying from prostate cancer; unfortunately to date there is no evidence that early treatment of prostate cancer reduces over all death rates. You would need to perform curative surgery on seventeen men to prevent one death over eight years. This surgery has frequent complications that include impotence (85%) and urinary leakage (49%)
There is no clear consensus at this time that screening of the population for prostate cancer using PSA testing can be justified. However, men with a family history of prostate cancer should be tested annually from the age of 40 years. If we are to screen the greatest benefit will accrue between 50–70 years of age. Testing before or after this age is not likely to be effective, except in cases of family history of the disease.
To reduce the risk of death, we must detect and treat the disease early, while it is still confined to the prostate. At present, only PSA testing is likely to detect the disease early enough for cure. However screening by PSA testing does lead to a need to perform a large number of what are ultimately shown to be unnecessary prostate biopsies. These biopsies are not without there own risks. Biopsy caries the risk of bleeding and infection sometimes the infection can be very serious indeed.
There is no right or wrong answer on the issue of screening with a PSA. The test is available and the decision to screen is one to make having talked with your doctor. Think about whether you really would want to know if you have cancer. Since many cases of prostate cancer don't cause problems or shorten a man's life, some men would rather not have the worry of knowing they have cancer.
If you think you would want to know if you have prostate cancer, ask yourself whether you would want treatment. Talk to your doctor about the known risks and uncertain benefits of treatment.
If you want to know if you have prostate cancer and you would consider early treatment then maybe it is time to think about a PSA test.
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