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EVERY MAN SHOULD KNOW ABOUT PROSTATE CANCER
By Stephen B. Strum, MD, FACP and
Donna Pogliano, co-authors of
"A Primer on Prostate Cancer, The Empowered Patient's Guide"
cancer often has no symptoms. This is why screening is so important for all men
starting as young as age 40, particularly if they are at high risk due to family
history or racial background. Black men have the highest incidence of prostate
cancer, followed by Hispanics. Many current guidelines specify that screening
for all men should begin at age 50.
Any persistent increase in PSA over
time at any level, even within the normal range, should be investigated to rule
out prostate cancer. If patients and doctors were to keep a PSA record or a graph,
noting any changes and noting the trend over time in PSA values, countless lives
would be saved. The quality of life for many men diagnosed with prostate cancer
is better preserved with early detection of the disease versus diagnosis with
advanced disease. Prostate cancer detected early provides many options for disease
management while prostate cancer detected only after it has metastasized provides
for only a few palliative treatments with no known curative treatment at the present
Screening consists of two parts -
The PSA blood test for prostate specific antigen. Some experts believe that a
PSA value of 2.0 and over should be investigated to rule out prostate cancer,
although the U.K> National Cancer Programme guidelines establish 3.0 as the point
where further investigation is appropriate.
The DRE or digital rectal examination. This test takes less than a minute and
can save lives, so if a DRE is not offered as part of screening, patients need
to point out that the DRE is an important part of the lifesaving potential that
screening has to prevent diagnoses of prostate cancer at stages beyond the window
of opportunity for cure.
In the event that screening produces a result
that requires further investigation to rule out prostate cancer, first steps should
of the free PSA percentage. Over 25% free PSA is associated with a low risk of
prostate cancer, while a free PSA percentage of 15% or less is associated with
a higher risk.
Prostatitis can cause an elevated PSA and a correspondingly low free PSA. Four
to six weeks of treatment with an antibiotic such as ciprofloxacin can help sort
out cases in which PSA elevation is due to benign causes.
Benign prostate hyperplasia (BPH) is another possible cause of an elevated PSA,
but BPH, unlike prostatitis, does not result in a low free PSA percentage. An
estimate of gland volume by DRE or better still, by transrectal ultrasound of
the prostate (a non-invasive procedure) can help to determine how much PSA a non-cancerous
gland might produce. Since PSA is produced by healthy prostate tissue as well
as by malignant prostate cancer tissue, it helps to know that the gland volume
multiplied by 0.066 will equal the amount of benign-related PSA.