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Prostate
Cancer Diagnosis What You Should Know 
Source:
prostatedoctor.com/diagnosis_prostate.html
Prostate
Cancer Diagnosis: What you should know.
The American
Urological Association advises the following regarding the use of the PSA test:
- Men should begin
yearly PSA testing at age 50, or sooner if they have a strong family history
of prostate cancer. African American men, or men with a strong family
history should begin screening at age 40.
- Your physician
should consider doing a PSA test if; PSA is 4.0 ng/mL or higher, if the
level significantly increases from one PSA test to the next, or if the
digital rectal exam is negative. -JAMA 3.22.00 p. 1557
- PSA makes it
possible to diagnose up to 80 % of prostate cancers while the are still
confined to the gland. Prior to PSA testing only approximately 30% were
diagnosed early.
- PSA is a protein
found in the prostate gland. It is manufactured by the gland to
liquefy the seminal fluids.
- PSA that a blood
test measures is produced by both normal and diseased prostate
tissue.
- Other reasons PSA
can be elevated are the following: urinary retention, prostatitis
(infection/inflammation ), prostate massage, and ejaculation. PSA testing
should be delayed for as long as 6 weeks following one of these to allow for
more accurate measure.
- The drug
Finasteride (Propecia or Proscar) artificially lowers PSA.
- The positive
predictive value of the combination of PSA and Digital rectal exam in
identifying prostate cancer is approximately 60%.
- When a suspicious
DRE and PSA test are obtained, the diagnostic procedure of choice is a
transrectal ultrasound. This takes place with the placement a
ultrasound probe across the rectum.
- Prostate biopsies
are taken in a pattern referred to as a sextant. This method utilizes
a grid to obtain one specimen from each area of the prostate, the apex,
middle, and posterior base. The biopsy occurs with an 18 gauge needle
very similar to the size of a needle utilized to draw your blood, just
longer. The needle is guided into each grid sector by utilizing the
ultrasound to guide it into the proper area.
- A single set of
biopsies has at least a 25 % chance of being a false negative. What
does this mean? This means that for a biopsy set, with at least one
biopsy sample from each of the three areas, these samples may have no
visible sign of cancer on microscopic evaluation, leading to a report of
negative. However, 25 % of the time these samples may have missed the
cancerous tissue. For this reason, researchers are recommending that
additional biopsies be taken. However, patients should know that the
additional biopsies can lead to additional discomfort and risk.
- PSA levels of 4.0
ng/mL are considered the upper limit of normal. However, 20% of those
with prostate cancer have a number below 4.0 ng/mL
- Researchers are
trying to develop additional criteria to accurately predict prostate cancer.
Much debate surrounds issues such as adjusting the PSA normal limits for age
and race. No consensus has been reached on these issues.
- PSA Velocity:
This is a measure of the rate of rise of PSA over a period of time. This
partially eliminates the variability that can occur in multiple PSA readings
that can occur from day to day. Some studies have shown a 15-20% day
to day variation. Experts don't yet agree on the value of this calculation,
and it appears to lose value for PSA values over 4.0 ng/mL.
- PSA Density: This
is a calculation that utilizes PSA level divided by prostate volume.
The prostate volume is estimated by utilizing ultrasound. It is
important the remember that ultrasound results are dependant on the quality
of the technique that the ultrasound technician has. The value
of this test is of much debate, because of daily variations is PSA level (up
to 20%) and prostate volume (10%-30%).
- Free PSA (percent
free PSA): Substances that circulate in the blood stream sometimes are
connected to other substances. This is referred to as binding.
This binding is determined by complex chemical properties that all
substances have. Some substances are more "sticky" and are found
bound to other substances in the blood or body tissues. Binding is the
means in which many vitamins and drugs circulate around the body. It is like
having an escort.
- PSA normally
circulates with an escort in the bound fashion. There is a small
portion of PSA that circulated free, or unbound. For some unexplained
reason, researchers have shown that when this free PSA is measured, it
appears to be lower in mean with prostate cancer. This measurement
when compared with the total PSA level, can increase the value of the
measurements, and eliminate up to 20% of "unnecessary"
biopsies.
- However, the
current free PSA studies were utilized with the single sextant set of
biopsies. Remember, that the single sextant set had a 25 % false negative
result. Therefore, it is believed that free PSA is a tool for
physicians to use in deciding whether to perform 2nd biopsies in men with
normal digital rectal exam and PSA between 4 ng/mL and 10ng/mL.
 Aloha From Hawaii!
Prostate
Cancer Diagnosis What You Should Know
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(Thanks)!
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Prostate
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