Prostate Cancer Screening

What you should know… 

Accord­ing to the Amer­i­can Can­cer Soci­ety, 1 in 9 men will be diag­nosed with prostate can­cer in their life­time. If detect­ed ear­ly, it is one of the most cur­able types of can­cer. To ensure ear­ly detec­tion, Duly Health and Care (Duly) doc­tors recommend:

  • A year­ly prostate spe­cif­ic anti­gen (PSA) blood test
  • A year­ly dig­i­tal rec­tal exam (DRE)
  • Begin test­ing at age 50 (if African-Amer­i­can or have any fam­i­ly his­to­ry, begin test­ing at age 40)

What is a PSA?

Prostate spe­cif­ic anti­gen (PSA) is an enzyme pro­duced by the prostate which all men have in their blood­stream. The PSA is a blood test which mea­sures the amount of prostate spe­cif­ic anti­gen in a man’s bloodstream. 

What does the PSA num­ber mean? 

In gen­er­al, a healthy PSA lev­el range is between 0 – 4. Patients should seek fur­ther test­ing when the PSA lev­el is above this — or increas­es between tests. PSA test­ing is very indi­vid­u­al­ized and what is con­sid­ered abnor­mal for one man may be nor­mal for another. 

What does it mean when my PSA num­ber is in the nor­mal range, but the num­ber has rapid­ly increased?

The rate of rise of the PSA over time is called PSA veloc­i­ty. A change in PSA of more than 0.5 ng/​ml per year may indi­cate a pres­ence of prostate cancer. 

For exam­ple, a man goes for his rou­tine screen­ing PSA test and it comes back at 2.0 ng/​mL. He is oth­er­wise healthy and his physi­cian is uncon­cerned by the result since 2.0 is in the nor­mal” range of 0 – 4 ng/​mL. But last year his PSA lev­el was 1.0 ng/​mL and the year before it was 0.5 ng/​mL. Due to the rate of rise (dou­bling each year), this indi­cates fur­ther eval­u­a­tion may be necessary. 

The vast major­i­ty of men (80%) with ele­vat­ed PSA have serum lev­els in the range of 4.0 to 10.0 ng/​ml. How­ev­er, numer­ous stud­ies have now shown that a high PSA veloc­i­ty may sig­nal a rapid­ly grow­ing can­cer regard­less of how high the absolute PSA lev­el is.

Prostate Can­cer Risk Factors

FAM­I­LY HIS­TO­RY: High­er risk for men whose fathers or broth­ers have had prostate can­cer.
AGE: Men over 50 have a high­er risk than younger men.
RACE: More com­mon in African-Amer­i­can men.
DIET: Diets high in ani­mal fat or red meat may increase risk; a diet rich in fruits and veg­eta­bles may low­er risk.

What do I do if my PSA is out of nor­mal range?

It is impor­tant to seek addi­tion­al med­ical advice as soon as pos­si­ble. Your physi­cian may rec­om­mend a repeat test or biop­sy which involves tak­ing a small amount of tis­sue that is ana­lyzed under a micro­scope. The sam­ple is then giv­en a Glea­son Score which deter­mines the exis­tence or sever­i­ty of cancer. 

What is a Glea­son Score? 

When review­ing a biop­sy, a pathol­o­gist exam­ines cells under a micro­scope and the degree to which they appear dif­fer­ent from nor­mal cells. This is what deter­mines the can­cer grade. The Glea­son grad­ing sys­tem ranges from 1 — 5, with 1 rep­re­sent­ing cells that do not look like nor­mal prostate cells at all. A pri­ma­ry Glea­son grade is giv­en to the most com­mon pat­tern and sec­ondary grade to the next most com­mon pat­tern. The sum is what deter­mines a Glea­son score. 

Do I need a dig­i­tal rec­tal exam (DRE)?

Yes, it is very pos­si­ble to have a nor­mal PSA test, but an abnor­mal prostate on the rec­tal exam. A tumor in the prostate often feels like a hard lump that is dis­cov­ered when the physi­cian per­forms the DRE. Sim­i­lar­ly, a man may have a nor­mal DRE, but have an ele­vat­ed PSA. Prostate can­cer is a pos­si­bil­i­ty with either an abnor­mal DRE or an ele­vat­ed PSA, and some­times both. For this rea­son, the PSA blood test, togeth­er with the DRE, is impor­tant for ear­ly detec­tion of prostate cancer. 

What if my PSA con­tin­ues to be out of nor­mal range but the office biop­sy did not find any cancer?

Duly physi­cians have devel­oped Stereo­tac­tic Transper­ineal Prostate Biop­sy (STPB), the most com­pre­hen­sive, sophis­ti­cat­ed prostate biop­sy tech­nique avail­able. The out­pa­tient test diag­noses 40% more can­cer than the stan­dard office biop­sy. It is per­formed through the per­ineum, under gen­er­al anes­the­sia and sys­tem­at­i­cal­ly sam­ples every part of the prostate gland. More patients are choos­ing this option as their first choice. 

If you would like to sched­ule a PSA test, DRE or STPB, sched­ule an appoint­ment with our Brachyther­a­py provider today.

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