Facing fears of prostate cancer

Posted on: 11 September 2013 by 50connect editorial

Advice and information every man should know about screening for prostate cancer.

Prostate cancer Q&AScreening for prostate cancer is crucial, since the disease often exhibits no symptoms, and is most effectively treated when caught early. Below, medical experts Dr Daniel Shasha and Dr Robert Salant review the two most important tests used for prostate screening-and describe what to expect when you go see your doctor.

What is the function of the prostate? 

Robert Salant: The prostate is located just under the urinary bladder. It surrounds a tube called the urethra, which is how urine travels out of the bladder. The prostate's function is to supply some fluid to the semen that nurtures the sperm when a man ejaculates. Therefore, the prostate is necessary to the production of fertile semen. However, once a man turns 40, the prostate starts to grow-and when it grows, there is a possibility it can become cancerous.

How do you perform the digital rectal exam? 

Robert Salant: The prostate is located just in front of the rectum. As a rectal exam is done, a gloved, lubricated finger is inserted into the rectum, and the surface of the prostate is easily felt with the examiner's finger. What you're looking for during the examination is both a rough estimate of the size of the prostate, but more importantly, any abnormal nodules or masses in the prostate.

How effective PSA blood test? 

Robert Salant: The PSA blood test is a measure of a chemical that is produced by prostate tissue: both normal prostate tissue and abnormal prostate tissue. Prostate cancers tend to produce a higher level of PSA than does normal prostate tissue. As the prostate grows, the PSA level may rise a little, but if there's a prostate cancer in that gland, very often the PSA rises to a higher level than what is considered normal.

It's just a regular blood test? 

Robert Salant: That's right, it is just like any other blood test. As a matter of fact, it's usually obtained as part of a battery of the more standard blood tests.

PSA results: What's normal, what's abnormal? 

Robert Salant: Every lab has different ranges of normal versus abnormal. For the most part around the United States, most laboratories have 0 to 4.0 as the normal range of PSA. What's important about PSA is not only the magnitude of the number, but also how it might have changed. So for example, if a 53-year-old man had a PSA of 2.5 two years ago and now comes in and has 3.8, even though that 3.8 is still in the "normal" range, it's a marked elevation from where it was previously. That change would make a physician more suspicious that there may be something abnormal going on.

Is the PSA test a reliable indicator of prostate abnormalities? 

Daniel Shasha: Well, a number of countries, institutions and organizations have looked at the PSA test as a screening tool. We know a few things about it. We know that it is by far the most sensitive means of detecting prostate cancer, although it is by no means a substitute for the digital rectal exam. The test really is a complement. There are prostate cancers that will be diagnosed on the basis of an abnormal digital rectal examination, but will have a normal PSA. And the reverse is also true.

I think everybody would agree that the PSA test enables us to diagnose cancers in younger men.

When is a biopsy done? How painful is it? Does it offer definitive information about cancer?

Daniel Shasha: A biopsy is a test that's generally done at the discretion of the urologist. It may be ordered after an abnormal digital rectal examination or an elevation in PSA.

Robert Salant: The way the biopsies are done really depend upon the clinical situation. For example, if a nodule is felt on digital rectal examination, a thin needle is inserted into the prostate, and a small core of tissue is removed-less that a millimeter in width, and perhaps an inch in length.

However, in men who have a normal-feeling prostate and have an elevated PSA, we use a prostate sonogram as a guide. We actually obtain several biopsy specimens from the prostate to get a fair representation of the entire volume of the prostate.

The average standard is to obtain six cores of tissue. Does that pick up all of the prostate cancers? No. It probably does about 90 to 95 percent. There has been a trend towards doing more biopsies, 10, 12, and sometimes even 14 to increase your yield. But even that is not a hundred percent. It does a very good job, but it's not perfect.

What percentage of prostate cancers cannot be detected definitively by the digital rectal exam and the PSA?

Robert Salant: There are probably many men walking around with a completely normal digital rectal examination and a normal PSA, who do have small areas of prostate cancer within their glands. Many of these men won't be diagnosed, and many of these men won't die from prostate cancer. However, that does not mean that men should not be concerned about prostate cancer, and be screened.


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