Sections:

• Prostate Cancer
• Screening for prostate cancer by Prostate Specific Antigen (PSA)
• Screening for Prostate Cancer by Digital Rectal Exam (DRE)
• What happens if the PSA is elevated or the Digital Rectal Exam (DRE) is abnormal?
• What happens to men who get prostate cancer?
• How is prostate cancer treated?
• So should I get a PSA screening?
• Where can I get more information?

Prostate Cancer

This year, up to 30,000 men will die from prostate cancer. It is the second leading cause of cancer deaths in men after lung cancer, especially among older men. The good news is that most prostate cancer is slow growing - only 30 percent of men diagnosed with prostate cancer will die from the disease.

Prostate cancer occurs in the prostate gland, which rests below the bladder in males. There are no known ways to prevent prostate cancer. However, here are some screening tests that your physician can perform to screen for the presence of prostate cancer, although these tests pose challenges because of false positive results (abnormal test results when cancer is not present) and false negative results (normal results when cancer is present). In addition, the benefits of current treatment have not been firmly established. Long-term studies to be completed in 2008 may help answer questions regarding testing and treatment options.


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Screening for prostate cancer by Prostate Specific Antigen (PSA)

PSA is a protein produced by the prostate gland. This protein is used to screen for prostate cancer. A simple blood test can measure PSA levels, which may rise in the presence of prostate cancer. However, up to 30 percent of men with prostate cancer have a normal PSA blood test and up to 75 percent of men with an high PSA blood test do not have prostate cancer. Additionally, the PSA blood test cannot determine if the cancer is a slow-growing or aggressive cancer.


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Screening for Prostate Cancer by Digital Rectal Exam (DRE)

Physicians often recommend a digital rectal exam, using a gloved finger to feel the prostate for irregularities or lumps. Fifteen percent of prostate cancers are detected through this exam, but many men with abnormal digital rectal exams do not have cancer.


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What happens if the PSA is elevated or the Digital Rectal Exam (DRE) is abnormal?

Some prostate cancers are detected first by DRE, others by an elevated PSA blood test. Each test may detect a cancer missed by the other. If either test is abnormal, some type of evaluation is appropriate. The PSA may be repeated once or several times. Ultrasound of the prostate can search for suspicious areas. Finally, a prostate biopsy may be performed.

A biopsy is done using a needle inserted into the prostate through the rectum. A small piece of tissue is obtained and examined under the microscope. A biopsy is the only test that can positively detect whether cancer cells are present.


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What happens to men who get prostate cancer?

Most men who get prostate cancer do not die of the disease, and many prostate cancers grow slowly without causing symptoms. A smaller number of prostate cancers are more aggressive. The aggressiveness of the cancer is determined by the degree of abnormality of the cells.


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How is prostate cancer treated?

Below are the four generally available treatment options.

1. Watchful waiting does not involve treatment. Depending on a man's health, age, and aggressiveness of the cancer, this may be appropriate.

2. Radiation therapy may cure prostate cancer, but research does not confirm that it lengthens life expectancy. Potential complications include impotence, rectal injury or loss of bladder control.

3. Prostatectomy is the surgical removal of the prostate gland. Prostatectomy may cure prostate cancer, but research does not confirm that it lengthens life expectancy. Potential complications include impotence, loss of bladder control, narrowing of the urethra (tube leading urine from bladder through the penis) or rectal injury.

4. Hormone therapy is not given to cure the cancer, but to slow tumor growth and reduce symptoms. Side effects include breast enlargement and tenderness, hot flashes and loss of bone density.


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So should I get a PSA screening?

This is a highly personal decision. Discuss your questions and concerns with your physician.

Given the uncertainties about the benefits of treatment compared to the risks, routine PSA screening for men at average risk for prostate cancer is considered optional by PAMF and the National Cancer Institute. The U.S. Preventive Services Task Force does not recommend PSA screening. However, the American Cancer Society and American Urological Association both recommend offering PSA screening to men ages 50 to 70 at average risk of developing prostate cancer, after discussing the pros and cons of testing.

Men at higher risk of prostate cancer include those of African-American descent or those with a family history of developing prostate cancer before 70 years of age. These men should discuss appropriate prostate cancer screening with their physician.


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Where can I get more information?

1. Your physician or PAMF's Community Health Resource Centers in Fremont and Palo Alto.

2. PAMF's Prostate Cancer Care Web site

3. Clinical articles:

• What should men know about prostate-specific-antigen screening before giving informed consent? Chan ECY, Sulmasy DP. American Journal of Medicine 105: 266-274, 1998.
  
  
• Prostate-specific-antigen testing for early diagnosis of prostate cancer. Barry MJ. New England Journal of Medicine 344:1373-1377, 2001.
  
  
• Early detection of prostate cancer Part II: Estimating the Risks, Benefits, and Costs. Coley CM, Barry MJ, Fleming C, Fahs MC, Mulley AG. Annals of Internal Medicine 126:468-479, 1997.
  
  
• Prostate Specific Antigen (PSA) Best Practice Policy. Oncology 14(2): 267-286, 2000.
  
  
• Screening for Prostate Cancer. American College of Physicians. Annals of Internal Medicine 1997; 126:468-479.

4. Other Web sites:

• Prostate Cancer, National Cancer Institute. Accesssed November 2007.
  
  
• Learn About Prostate Cancer, American Cancer Society. Accessed November 2007.

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