Prostate Cancer

Lesson 1: Prostate Basics

The PSA Test

The PSA is a blood test used to detect changes in the prostate. PSA stands for "Prostate-Specific Antigen". This antigen, a protein, is made only in the prostate. Each man has a PSA level that is normal for him, and this level will normally rise each year: as men age, the prostate grows slowly, and more PSA is made. This is known as "PSA Velocity". However, if the PSA level is very high, or much higher than a previous level, then you and your doctor should start thinking about what might cause an increase in PSA. It’s important to note that any kind of irritation in the prostate can cause the cells to release more PSA than normal. This includes an infection, passing a hard stool or even a recent digital rectal examination. However, an elevated PSA level can be an indicator of Prostate Cancer. But remember: The PSA test does not diagnose Prostate Cancer. Rather, an elevated PSA test is an indicator that further testing is needed to make a definitive diagnosis.

PSA FACTS:

• PSA levels of less than 4 ng/ml (nanograms per milliliter) are considered normal.
• PSA levels of 10 ng/ml or greater are considered high.
• PSA levels between 4-10 ng/ml may indicate a problem, either cancer or a benign condition.
• A PSA level greater than 4 ng/ml warrants a referral to an Urologist for further testing.

About 4 years ago my doctor, Wendy, advised me that my PSA level had spiked up from 2.6 ng/ml to 6.2 ng/ml and that the test should be done again. The reason for the spike could be as little as passing a hard stool or an infection. Worst-case scenario: it could be cancer. My second PSA level was 6.9 ng/ml. I was starting to take notice of what the PSA test results were all about. An appointment was set for a Urologist in two weeks time. The Urologist wanted a third PSA test done before we met. The third test was 8.0 ng/ml. Neither Wendy nor the urologist, Dr. Zack could feel anything unusual about my prostate but my PSA numbers were on the move. Dr. Zack suggested that, for safety’s sake, I have a biopsy of my prostate. A biopsy is a small sampling of cells, which are examined for the presence of cancer. The biopsy was set for about 3 weeks from my visit with Dr. Zack. The biopsy report showed that I had cancer in all six samples.

The biopsy is carried out in a hospital or clinic. The procedure takes about 30 minutes and is more uncomfortable than painful. A probe is inserted into the rectum and with the aid of computer imagery the rectum walls are pierced and samples of tissue are taken from the Prostate. Eight samples (they have moved from 6 to 8 samples since my biopsy) are taken and analyzed. The biopsy is the only way to confirm if you have cancer and how active the cancer is. Depending on the treatment you choose you may have a follow up biopsy done 2 to 3 years after your treatment.

The next lesson will deal with Prostate Cancer itself: what it is, how it’s measured, and tips on coping with your diagnosis of Prostate Cancer.

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