Prostate Cancer (and PSA Prostate Testing)

About Prostate Cancer Prostate cancer is the most commonly diagnosed non-skin cancer in the United States. One in six American men will develop prostate cancer in the course of his lifetime. A little-known fact is that a man is 33% more likely to develop prostate cancer than an American woman is to get breast cancer.

These and other sobering facts are the driving forces of the Prostate Cancer Foundation, whose mission is to support research into better treatments and a cure for recurrent prostate cancer. The PCF is the world's largest source of philanthropic support for prostate cancer research. The PCF has raised more than $230 million to fund over 1,200 research projects, all with the goal of finding better treatments and a cure as soon as possible.

Every man diagnosed with prostate cancer begins a deeply personal journey for himself and his loved ones in determining the appropriate therapy for the disease. Receiving a diagnosis of cancer is always very difficult. Prostate cancer is particularly complicated due to the variety of treatment options and the lack of knowledge, in certain cases, as to the most appropriate treatment. However, learning more about the disease, understanding the treatment options and their risks and benefits, and discovering the diet and lifestyle changes that may improve the prognosis all can help empower patients. It lets them participate more actively in their care and helps in making informed choices about treatment options.

Screening & Diagnosis
Screening for prostate cancer can be performed quickly and easily in a physician’s office using two simple tests: the prostate specific antigen (PSA) blood test, and the digital rectal exam (DRE).

About The PSA Test
PSA is an enzyme produced in the prostate that is found in the seminal fluid and the bloodstream. An elevated PSA level in the bloodstream does not necessarily indicate prostate cancer, since PSA can also be raised by infection or other prostate conditions such as BPH. Many men with an elevated PSA do not have prostate cancer.

Nonetheless, a PSA level greater than 4.0 nanograms per milliliter of serum was established initially as the cutoff where the sensitivity for detecting prostate cancer was the highest and the specificity for detecting non-cancerous conditions was the lowest. A PSA level above 4.0 ng per milliliter of serum may trigger a prostate biopsy to search for cancer. Recently, experts have argued that men with a PSA level greater than 2.5 should obtain biopsies to increase the likelihood that prostate cancer might be detected earlier in a more curable form of the disease. This issue is not yet scientifically resolved, and the topic remains controversial.

It is important to note that the PSA test is an imperfect screening tool. A man can have prostate cancer and still have a PSA level in the “normal” range. Approximately 25% of men who are diagnosed with prostate cancer have a PSA level below 4.0. In addition, only 25% of men with a PSA level of 4–10 are found to have prostate cancer. With a PSA level exceeding 10, this rate jumps to approximately 65%.

More sophisticated forms of the PSA blood test can be used to further improve the precision of the test. It should be noted that the standard PSA test remains the most widely used screening assay for prostate cancer and that the newer methods are just starting to be adopted by the medical community. Learn more about additiontal diagnostic tests.

About The Digital Rectal Exam
The digital rectal exam should be performed along with the PSA test. The DRE is performed by a physician who will insert a gloved finger into the rectum to feel the peripheral zone of the prostate where most prostate cancers occur. The physician will be checking for hardness of the prostate or for irregular shapes or bumps extending from the prostate – all of which may indicate a problem. The DRE is particularly useful because the PSA test may miss up to 25% of cancers, and the DRE may catch some of these.