Prostate Cancer: PSA Test (Part I)

Fred Cicetti

Date: 14 October 2010 Time: 10:22 AM ET

Question: I’m in my sixties and I just had a blood test. My PSA went up from 2 to 3. My doctor told me to see a urologist to get my prostate checked. How worried should I be about cancer at this point?

When older men gather, they exchange PSA stories as often as they once shared stories about girls. PSA test results are horribly confusing and often terrifying. I have personal experience with both the confusion and the terror.

PSA is the cause of so much concern to my male readers—-and their loved ones—-that I’m going to cover this topic in a three-part series, which begins today.

The prostate is a walnut-size gland that surrounds the urethra, a tube that carries urine from the bladder. The urethra also transmits semen, which is a combination of sperm plus a fluid the prostate adds.

Cancer of the prostate is one of the most common types of cancer among American men, and also one of the most complex. More than 6 in 10 cases of prostate cancer cases occur in men 65 and older. By age 85, more than 75 percent of men have prostate cancer; many have lived with the disease for more than a decade. The disease is usually not fatal.

Treatment for prostate cancer works best when the disease is found early.

In a physical exam, the doctor feels the prostate through the rectal wall. This is called a Digital Rectal Exam (DRE). Hard or lumpy areas may mean that cancer is present.

Doctors also may suggest a blood test to check your PSA level. PSA levels may be high in men who have an enlarged prostate gland or prostate cancer. PSA tests are useful for early cancer diagnosis. But PSA test results alone do not always tell whether or not cancer is present.

When doctors suspect cancer from indications found through a blood test or DRE, they may perform a biopsy. Doctors can remove samples of the prostate with a needle and look at them under a microscope.

There are many options for treating prostate cancer:

Observation. If the cancer is growing slowly, you may decide to wait and watch.

Hormone therapy. This stops cancer cells from growing.

Surgery. There are several surgical options. These include radical prostatectomy or removal of the entire prostate, cryosurgery that kills the cancer by freezing it, radiation therapy to shrink tumors, and implant radiation that places radioactive seeds into the prostate. Surgery can lead to impotence and incontinence. Improvements in surgery now make it possible for some men to keep their sexual function.

Benign prostatic hyperplasia (BPH) is the term used to describe an enlarged prostate, which is common in men 50 and older. Some men with prostate cancer also have BPH, but that doesn't mean that the two conditions are always linked.

Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. The PSA test measures the level of this protein in the blood. It can be detected at a low level in the blood of all adult men. It should be noted that it is common for PSA ranges to vary among laboratories.

A fundamental problem with the PSA test is that, while elevated levels can indicate the presence of cancer, they can also be caused by:

* Benign prostatic hyperplasia.

* Urinary tract infections

* Prostatitis, inflammation of the prostate

* A digital rectal exam

* Recent ejaculation

* Recent bowel movement

* Recent urinary catheterization

* Recent urinary tract operation

* Large doses of medicines, such as methotrexate for cancer treatment.

* The medicine finasteride, which is used to treat BPH.