Prostate Cancer Early Detection Guidelines

Early Detection Guidelines

EARLY DETECTION OF PROSTATE CANCER
Prostate Cancer Canada (PCC) advises men and their doctors take the time to discuss the merits of prostate specific antigen (PSA) blood testing followed by a digital rectal examination (DRE) for the early detection of prostate cancer
We also strongly recommend that, beginning at age 40 men consider the following schedule for prostate cancer monitoring using the PSA blood test

AGE 40: Establish a baseline PSA value. While the threat of prostate cancer is minimal at this age, it also precedes the onset of benign prostatic hyperplasia (BPH), the natural enlargement of the prostate that commonly occurs with age. The onset of BPH often results in rising PSA levels over time, and can be confused with the onset of prostate cancer.
Unless your resulting baseline PSA score is of concern to your doctor, the PSA test need only be repeated every 5 years until age 50
Men at higher risk of prostate cancer (i.e. Men whose father and/or brother developed prostate cancer and/or those of African or Caribbean descent) should begin annual PSA and DRE monitoring at age 40

AGE 50:All men should begin annual or semiannual PSA monitoring if they have not yet done so
A minimal increase in PSA levels against your baseline score often requires no further action until your next annual test
A significant increase should prompt a discussion with your doctor or urologist about follow up PSA blood tests
The PSA blood test not only helps to diagnose prostate cancer, but also helps monitor for recurrence of prostate cancer after treatment
The PSA blood test allows a patient and his doctor to monitor if cancer is suspected, if lifestyle changes have had an impact or if cancer has regressed or spread
Combining the results of a PSA blood test with a DRE increases both the diagnostic power and the accuracy of these early detection methods

PSA DISCUSSION
Like most cancer diagnostic tools, the PSA blood test comes with its pros and cons
However, men deserve the right to make their own informed decisions regarding the state of their health – even if that decision is to forego or delay treatment
Regular PSA blood tests and digital rectal examinations (DRE) are required to assess the likelihood of cancer
The PSA blood test is neither a test for prostate cancer nor an indicator of the type of prostate cancer. PSA levels in the blood increase when the size of the prostate or the number of prostate cells increases

PSA DISCUSSION
When deciding whether to take the test, men should consider the pros and cons and take into account age, risk factors and general health
Pros
Research has shown that a rapid rise in PSA levels over months or years is a very strong sign of aggressive prostate cancer
By the time a man develops advanced prostate cancer, his PSA is almost always very high
Widespread testing results in early diagnosis – at the stage when the chances of a cure are good, with more options for treatment
The test may not be foolproof but it is the best early detection tool we currently have

PSA DISCUSSION
Cons
Sometimes increased PSA blood levels are present when clinically insignificant prostate cancers exist
These tumors may never become life threatening
A high PSA level can also signify non-cancerous conditions
Biopsying these men and treating their cancers may in some cases cause more harm than good
Normal PSA levels are arbitrary
Sometimes PSA levels may be below normal levels even when cancer is present

WHAT DO THE NUMBERS MEAN?
The PSA blood test checks the blood for minute quantities of an enzyme called prostate specific antigen or PSA
A higher than normal amount of PSA in the blood is a possible indicator of prostate cancer
Although other conditions of the prostate, such as benign prostatic hyperplasia and prostatitis can also elevate PSA levels
The general guidelines for PSA values are:
PSA level in nanograms per millilitre (usual description for average man)
0 to 4 ng/ml Within the normal range
4 to 10 ng/ml Elevated
10 to 20 ng/ml Moderately elevated
Greater than 20 ng/ml Highly elevated

WHAT DO THE NUMBERS MEAN?
A high PSA reading does not necessarily mean that you have prostate cancer
Many factors can contribute to an abnormally high level of PSA in the blood, and the general guidelines presented are usually adjusted for some of these factors:
Age
Aging increases the amount of PSA in the blood, so normal PSA levels are adjusted for age
Race
A man's race affects his risk of developing prostate cancer and the amount of prostate specific antigen that is within the normal range

RELIABILITY OF THE PSA BLOOD TEST
The PSA blood test, especially when combined with a digital rectal examination (DRE), is a good indicator of the possibility of prostate cancer
The PSA blood test does not predict either the presence or absence of prostate cancer, but it does alert men and their physicians to the possibility of the presence of an early-stage cancer in the prostate
Still, there is considerable controversy over the value of the PSA blood test

The medical community calls a higher than normal PSA level with no evidence of prostate cancer a “false positive”
Some researchers estimate that 20% of prostate cancers would be missed if doctors relied only on PSA blood test results
In other words, one out of every five men tested would have prostate cancer and a normal PSA level
A PSA level in the normal range with the presence of prostate cancer is called a “false negative”
There is also a misconception that the PSA blood test is not accurate

The PSA value is not diagnostic for prostate cancer
It should be used in conjunction with clinical evaluation, digital rectal examination and other laboratory tests or imaging techniques
If the PSA value is inconsistent with clinical evidence, additional testing is suggested to confirm the result
Confirmation of prostate cancer can only be determined by prostatic biopsy

REFINEMENTS
Physicians have made refinements to the PSA blood test and to the analysis of PSA blood test results to improve its reliability as an indicator of prostate cancer
Doctors now consider the speed at which PSA levels rise
How quickly PSA levels double in amount (PSA doubling time)
The sort of prostate-specific antigen in the blood (free versus total PSA)
The amount of PSA in relation to the size of a man's prostate (PSA density)
PSA doubling time
PSA doubling time relates PSA levels to a specific period of time
It measures the time it takes for your PSA value to double
Sometimes, PSA doubling time is helpful in prebiopsy guesses about whether a man has cancer and whether this cancer is likely to be aggressive or to have spread

REFINEMENTS
Percentage of Free to Total PSA (% of PSA)
This measurement is a ratio comparing the amount of free PSA to the total amount of PSA in the blood
Free PSA travels alone in the blood; it is not bound to any other blood proteins
This unbound or free PSA comes from BPH, not prostate cancer
The higher a man's percentage of free PSA, the less likely it is that prostate cancer is to blame
Testing for free PSA (called % of PSA in some medical reports) is useful for men whose PSA level falls between 4 and 10 - the grey area in which BPH could be the culprit
Readings of greater than 25 per cent free PSA (25 % of PSA) indicate that much of the elevated PSA is caused by BPH

REFINEMENTS
A reading of under 10% suggests that prostate cancer is causing this elevation and that this cancer is probably large and in need of immediate treatment
PSA density (PSAD)
This measurement compares the size of a man's prostate, which is determined by a transrectal ultrasound (TRUS), with his PSA level
The doctor simply divides the PSA value by the size (or mass) of the prostate. For example, if your PSA level is 4 and the size of your prostate in grams is 32, you would divide 4 by 32 to get a PSA density of 0.125
Usually, a PSA density under 0.07 is considered fairly safe, (depending on age and ethnicity) one between 0.07 and 0.15 could be attributable to either BPH or prostate cancer, and one above 0.15 indicates an increased likelihood that cancer is present. Prostate volume measurements, and thus PSA densities, are subject to TRUS operator/interpreter variability

OTHER CONDITIONS OF THE PROSTATE
Benign prostatic hyperplasia (BPH) and prostatitis can also increase the amount of PSA found in a man's blood
BPH, a non-cancerous enlargement of the prostate, can elevate PSA levels because a larger prostate manufactures more prostate-specific antigen
Also, any prostate condition can weaken the tissues in the prostate gland, allowing more PSA to leak into the blood
Usually, PSA levels caused by BPH do not go as high as those caused by prostate cancer, nor do the levels tend to rise as quickly
However, most likely, if you have a higher than normal PSA level or one that is steadily rising, your doctor will discuss the value of having a prostate biopsy to determine whether cancer or some other condition is to blame

OTHER CONDITIONS OF THE PROSTATE
Prostatitis, an inflammation of the prostate, can also affect PSA levels
Because this inflammation can break down tissues in the prostate gland, it can enable quite a bit of prostate-specific antigen to escape fairly quickly into the blood
An acutely inflamed or infected prostate can increase a man's PSA level to 100 nanograms per millilitre (ng/ml) or higher
After treatment for prostatitis, it can take up to six months for PSA levels to return to normal

Early Detection is key!
To protect yourself, discuss your prostate health and benefits of early detection with your doctor.

Prostate Cancer Early Detection Guidelines

by Prostate Cancer Canada

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