Screening for Prostate Cancer. Tests to Get and Tests to Avoid

The PSA is a popular blood test that is notorious for providing shady results, sometimes missing the cancer and other times worrying men with results that signal prostate cancer even when there is none to be found. In this article we will discuss the various tests such as the PSA, biopsies, ultrasound, digital rectal exam and more. You will learn…
What are the symptoms of prostate cancer
What tests are used to screen for prostate cancer
Why the PSA test is useless in most men
A improved version of the PSA test
How to improve the accuracy of the PSA test
Why prostate biopsies can kill you
Why prostate cancer may not be something to fear
A combination of tests that may prevent the need for prostate biopsies

Prostate cancer typically occurs without symptoms, however, occasionally people will note symptoms such as:

Blood in the urine
Difficulty urinating
Pain or burning while urinating
Lower back pain or pain in the upper thighs
Weak urine flow

Many of these symptoms can occur for other reasons such as infection, prostatitis (inflammation of the prostate) or benign prostate enlargement. For this reason, you should be assessed by a physician whenever you have any symptoms with the urinary tract. The likely is that these symptoms will turn out to be benign, however, it is best to be sure.

What tests are involved to diagnose prostate cancer?

The most common tests are the digital rectal exam and the standard PSA, which stands for prostate specific antigen. The digital rectal exams involves the doctor feeling the prostate for enlargement and abnormalities. The PSA is a blood test that is widely used to screen men for prostate cancer, unfortunately PSA can be elevated for many non-cancerous reasons and can cause unnecessary alarm and biopsy. A PSA is considered normal by the medical establishment as long as it stays below 4 dl/ml, however, some doctors prefer to see it below 2.5 dl/ml. PSA that are excessively elevated may signal more aggressive cancer.

To demonstrate how misleading the PSA can be, it is estimated that the standard PSA misses 82% of prostate cancers in men under the age of 60 and misses 65% of cancers in men over the age of 60. It has been noted that up to 1 in 6 men with a normal PSA actually have prostate cancer and in men who have a PSA score between 4 and 10 only 20-25 percent actually have cancer.

The PSA has an alarming rate of signaling prostate cancer in men without the disease. This can cause fear and panic in many healthy men. According to the research, the PSA test can signal cancer in 12 out of 15 men without cancer. This is an unacceptably high rate of false positives and it is very common for men who have an elevated PSA test to see those numbers drop to normal within a year. With this information it is a good idea to have PSA reassessed a couple months later before you subject yourself to biopsy.

To increase the accuracy of the PSA test, be sure to follow these guidelines:

Abstain from sex or ejaculation for at least 48 hours as ejaculation artificially elevates the PSA.
Make sure that you have the PSA test before the digital rectal exam as prostate manipulation increases PSA
Do not take part in physical activity, especially bike riding, for at least 48 hours before the test as this can artificially elevate PSA.
Stressed people are 3 times as likely to have an artificially elevated PSA than non –stressed men. So take part in some stress relieving activities.
Certain medications can artificially lower PSA. These medications are Proscar, Propecia and Avodart.
Saw Palmetto does not artificially loser PSA
The Bottom Line: The PSA is not an ideal tool for screening for prostate cancer. In fact, the doctor who attributed as being the father of the PSA test no longer recommends the PSA saying that the PSA is no longer a useful marker for detecting prostate cancer. In men who are 75 years and older the PSA question is more cut and dry as the U.S. Preventative Services Task Force recently advised that men who are 75 years old or older no longer get the PSA test. Men in this age group are highly unlikely to die of prostate related problems The fact is, even if they did develop a prostate tumor they are likely to die of other causes well before the tumor would claim their life.

Other Tests for Prostate Cancer Screening

There are a number of other tests that may help to screen for prostate cancer, however, none of them are completely accurate and only a few are reasonably accurate.

Free PSA – PSA is a protein that exists in two forms in the blood, bound and unbound. Approximately 85% of the prostate specific antigen is bound to protein, the remaining 15% is free floating. The higher the amount of the free floating PSA, the lower your risk of cancer is. The main benefit of this test is the low number of false positives (men diagnosed with prostate cancer who do not have it).
Transrectal Ultrasound – This test can visualize prostate size and abnormalities in the shape of the prostate that may indicate prostate cancer.
Prostate Biopsies – Inaccurate and Possibly Dangerous

Biopsies are not a controversial matter in medicine…but they should be! First, it is important to note that most biopsies are performed because of an elevated PSA, one of the most inaccurate cancer screenings in the medical world. In fact, one study in 1500 men who underwent biopsies found only 10% actually had prostate cancer. Given the discomfort and subsequent risk of prostate inflammation or infection, perhaps we should reevaluate the standards for sending a man in for a prostate biopsy.

Okay, so you might argue that 165 men out of 1500 had cancer and now they can receive “life-saving” treatment. Not necessarily…you see, most prostate cancer is not going to result in death. In one study of men over the age of 70 who had passed from other causes not related to prostate cancer, over 80% had prostate cancer. The truth is most men will develop prostate cancer in their lifetime and will not be bothered by it, they will live their lives ignorant to the fact that they have abnormal cells and will end up succumbing to something else.

Prostate biopsies can be dangerous because of the traumatic way in which the cell samples are taken. Remember, localized cancer is far less dangerous than metastasized cancer (cancer that has moved to other areas of the body). A biopsy involves taking numerous needle punches of the prostate tissue in hopes that a needle will catch some abnormal cells. It is fairly common that the luck of the draw misses the abnormal cells and results in a false negative result. If the doctor gets lucky and punctures an area with abnormal cells then you may run the risk of sending some of the abnormal cells into circulation where they can result in metastases.

According to one study, the best approach for prostate cancer screening is:

Digital Rectal Exam to feel for abnormal shape, nodules or size.
An ultrasound done rectally to visualize nodules or cancerous areas
PSA in relation to prostate size. If the prostate is enlarged, then PSA is not as good of a predictor and should not be used as a primary screening tool.
By following this procedure, it is estimated that we could avoid over 200,000 unnecessary biopsies annually.

Article Written by: Ray Hinish, Pharm.D.,CN,C.P.T.

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