Prostate cancer and PSA test results
Prostate cancer and PSA test results – The PSA test is a commonly performed blood test. Prostate specific antigen is a protein made purely by the prostate gland for reproductive purposes and leaks into the bloodstream by accident. It does however get into the bloodstream in higher quantities when the vascular supply of the prostate gland is abnormal such as when it is infected or inflamed or in prostate cancer.
However, it can also leak into the bloodstream in higher quantities when the prostate is simply enlarged in a benign fashion which is common as men get older and also it can go up slightly when there has been recent sexual activity or strenuous cycling. It’s important to do the PSA test when middle-aged or elderly men come to the doctor complaining of symptoms of urinary bladder voiding or if prostate cancer is suspected.
There isn’t a screening programme for prostate cancer, so PSA won’t be done automatically by most doctors and it’s very important to rule out urinary infection before the PSA test is taken. No, the PSA test is not entirely reliable. In fact, about 10% of cancers can be found in men with a normal PSA test and up to three-quarters of men who have an abnormal test do not have cancer.
When a patient comes to see me who has an abnormal PSA according to his age, I want to perform an examination called a digital rectal examination which enables me to feel the back surface of the prostate just inside the rectum. It is a bit uncomfortable and takes about 30 seconds to do.
I will be wanting to see if the prostate gland feels very large, whether it is tender to suggest inflammation, or whether it might contain hard areas or nodules. After that, and assuming there is no urinary infection, I will probably recommend a dedicated prostate MRI scan and then will consider a prostate biopsy once the scan has been done. A prostate biopsy is a procedure where we take small snippets of prostate tissue to send to a pathologist in the laboratory to look at down the microscope to decide whether or not cancer is present.
The procedure is usually done under local anaesthetic, takes about five minutes and it is a bit uncomfortable. Most people find this because an ultrasound device, it has to be put into the back passage to image the prostate during the collection of the biopsy samples. We need to give antibiotics to guard against infection and we usually want to stop anticoagulants to make sure there isn’t any excessive bleeding as a result of the biopsies.
The result of the biopsy usually takes one to two weeks to come back and it will tell us whether or not there is cancer in the samples and it will tell us how much cancer and the grading or aggressiveness of the disease. Something we use commonly as a Gleason score. Well, we don’t use x-rays much in the detection of prostate cancer, but a dedicated prostate MRI scan is extremely useful in pinpointing regions of interest within the prostate and outside the prostate that may be relevant.
If we see something in the prostate on an MRI scan that looks suspicious, it can be targeted with a biopsy. Not all suspicious areas turn out to be cancer and in about one in six cases, there can be significant cancer found even when the MRI appears to be normal. So, some patients will choose to have an MRI scan followed by a biopsy regardless of whether the MRI pinpoints an abnormality or not, whereas others will take the chance and avoid a biopsy if the MRI looks normal.
Following a diagnosis of prostate cancer by biopsy, then it’s important to decide whether or not treatment is necessary. And I say this because some very small, non-aggressive prostate cancers grow extremely slowly and there is no threat from them during the following 10 or 20 years. So we manage these with what we call active surveillance: PSA testing, occasional repeat MRIs and biopsies, and the beauty of this is that it avoids the side effects of treatment for a lot of men.
However, if the disease has a slightly bulkier or higher grade or aggressiveness to it, then curative treatment would be necessary should it be within the prostate gland, and we can offer surgical removal of the prostate which is called a radical prostatectomy or radiotherapy delivered with either external beam or implant of brachytherapy seeds.
However, if it has spread away from the prostate: gone to bones, lymphatic glands, liver, lungs which is uncommon, but then we can’t treat it with surgery or radiotherapy. We have to offer drug treatments with chemotherapy, hormonal therapy to suppress it.