Archive for March, 2010

Prostate-Specific Antigen (PSA) Test

Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in the blood. The doctor takes a blood sample, and the amount of PSA is measured in a laboratory.
Doctors often use the PSA test as prostate cancer screening tests; together, these tests can help doctors detect prostate cancer in men who have no symptoms of the disease.

Doctors’ recommendations for screening vary. Some encourage yearly screening for men over age 50, and some advise men who are at a higher risk for prostate cancer to begin screening at age 40 or 45. Others caution against routine screening. Although specific recommendations regarding PSA screening vary, there is general agreement that men should be informed about the potential risks and benefits of PSA screening before being tested.

Thus, there is no specific normal or abnormal PSA level. In addition, various factors, such as inflammation (e.g., prostatitis), can cause a man’s PSA level to fluctuate. It is also common for PSA values to vary somewhat from laboratory to laboratory. Consequently, one abnormal PSA test result does not necessarily indicate the need for a prostate biopsy.
A man should discuss an elevated PSA test result with his doctor. There can be different reasons for an elevated PSA level, including prostate cancer, benign prostate enlargement, inflammation, infection, age, and race. If no symptoms to suggest cancer are present, the doctor may recommend repeating DRE and PSA tests regularly to watch for any changes. If a man’s PSA level has been increasing or if a suspicious lump is detected during a DRE, the doctor may recommend other tests like urine test, imaging tests, CT Scan, MRI, ultrasound to determine if there is cancer or another problem in the prostate. If cancer is suspected, a biopsy is needed to determine whether cancer is present in the prostate.

Limitations of the PSA test

- Detecting tumors does not always mean saving lives : When used in screening, the PSA test can detect small tumors.
- False-positive tests : False-positive test results (also called false positives) occur when the PSA level is elevated but no cancer is actually present.
- False-negative tests : False-negative test results occur when the PSA level is in the normal range even though prostate cancer is actually present.

Need To Know

An elevated PSA does not automatically mean a man has prostate cancer. Conditions other than cancer, including an infection or a benign enlargement of the prostate, can result in higher-than-normal PSA levels.The PSA test is not foolproof.

Nice To Know

Recent studies have shown that a variation of the PSA test, called the percent-free PSA test, may be better at detecting prostate cancer.

The percent-free PSA looks at how much PSA circulates alone (free) in the blood and how much is clinging to other proteins. A low percentage of free PSA, even if the total PSA is not especially high, may mean that prostate cancer is more likely.
The percent-free PSA test is not available at all testing facilities.

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Different stages of Prostate Cancer

After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body. Prostate cancer grows locally within the prostate, often for many years. Eventually, prostate cancer extends outside the prostate. Prostate cancer can spread beyond the prostate in three ways:

- By growing into neighboring tissues (invasion).
- By spreading through the lymph system of lymph nodes and lymph vessels.
- By traveling to distant tissues through the blood (metastasis).

The TNM System for Prostate Cancer Stages

The prostate cancer stages are described using three different aspects of tumor growth and spread. It’s called the TNM system for tumor, nodes, and metastasis.
T : for tumor – describes the size of the main area of prostate cancer.
N : for nodes – describes whether prostate cancer has spread to any lymph nodes and to what extent.
M : for metastasis – means distant spread of prostate cancer, for example, to the bones or liver.

Prostate Cancer Stage I

In stage I, prostate cancer is found in the prostate only. Stage I prostate cancer is microscopic; it can’t be felt on a digital rectal exam (DRE), and it isn’t seen on imaging of the prostate.

Prostate Cancer Stage II

The cancer is more advanced than in stage I, but has not spread outside the prostate. The Gleason score can range from 2-10. Stage II prostate cancer may also be called stage A2, stage B1, or stage B2 prostate cancer.

Prostate Cancer Stage III

Stage III prostate cancer has spread outside the prostate, but only barely. Prostate cancer in stage III may involve nearby tissues, like the seminal vesicles.

Prostate Cancer Stage IV

cancer has metastasized (spread) to lymph nodes near or far from the prostate or to other parts of the body, such as the bladder, rectum, bones, liver, or lungs. Metastatic prostate cancer often spreads to the bones. The Gleason score can range from 2-10. Stage IV prostate cancer may also be called stage D1 or stage D2 prostate cancer.