If you are a white male over the age of 50 or a black male over the age of 40, chances are your doctor has recommended that you have a PSA test.

The reason for this is that a PSA “score” of higher than 4 can indicate that you may have prostate cancer.

What is PSA?

PSA or prostate specific antigens are proteins produced by the tissue in your prostate. Under normal conditions, some of these will get into your bloodstream, causing you to have a low (less than 4) PSA level. However, both malignant (cancerous) prostate and benign (non-cancerous) tissue will produce more PSA than normal prostate cells – thus elevating your PSA level.

How A PSA Test Is Performed

A PSA test is a very simple procedure. Your doctor or a phlebotomist (a person specially trained to draw blood) will draw blood, probably from either the inside of your elbow or the back of your hand. This blood will then be sent to a laboratory for analysis. In most cases, your doctor will have the results of this test in just a few days.

What A PSA Test Can Tell You

If you have a PSA level of 4 (ng/ml), the odds are that you don’t have prostate cancer. The reason for this is that studies have shown that men who have a prostate gland that feels normal in a digital rectal exam (DRE) and a PSA level of 4 or less, have only about a 15% chance of having prostate cancer. However, if your PSA is 5 to 10, the risk factor goes up to 25%, and if it’s above 10, there’s a 67% chance you have prostate cancer.

The PSA Test Is Not Perfect

A PSA test alone will not provide enough accurate information for your doctor to say that you do or do not have prostate cancer. An elevated PSA can mean prostate cancer or it can mean you have what’s called a benign (non-cancerous) condition such as benign prostatic hyperplasia (BPH) or prostatitis. There also have been many cases where the test returned a false positive, meaning that there was an elevated PSA but no prostate cancer – leading to unnecessary treatments.

There have also been cases of a false negative – men who had a PSA lower than 4 but did have prostate cancer.

How Else Will Your Doctor Diagnose Prostate Cancer?

Your doctor will most certainly perform a procedure called a digital rectal exam or DRE. In this procedure, he or she inserts a finger into your rectum and feels your prostate. If the prostate feels normal – not inflamed and with no lumps – it is most likely that you do not have prostate cancer. On the other hand, if it is inflamed or has a lump, your doctor will most likely order more tests.

These tests can include x-rays, a urine test, a transrectal ultrasound, a cystoscopy or even a biopsy. If the biopsy comes back positive, the bad news is that you do have prostate cancer.

Your doctor will look at other factors in evaluating your PSA, such as:

  • The size of your prostate
  • When you last ejaculated (you should not have ejaculated for two days before the test)
  • Your age
  • Whether you are taking other medications that can affect your PSA measurement such as Propecia, Proscar or Avodart.
  • How quickly your PSA levels are changing – either up or down

Prostate Cancer

If it turns out that you do have prostate cancer there are several different treatments that have proven effective. Your doctor will choose a treatment based on the stage of the cancer.

If your cancer is diagnosed as Stage 1, the simplest treatment is called Watchful Waiting. This means your doctor will closely monitor your condition but withhold treatment until symptoms appear or change.

Another treatment for Stage 1 prostate cancer is called implant radiation therapy or brachytherapy where radioactive material sealed in needles, wires or catheters are placed directly into or near your tumor. There is also a procedure called external beam radiation therapy, a process called radical prostatectomy where a surgeon removes your entire prostate and several clinical trials including one of high-intensity, focused ultrasound.

Treatment options for Stage 2 prostate cancer include most of the treatments cited above, plus several clinical trials, including ultrasound-guided cryosurgery and a clinical trial of hormone therapy followed by a radical prostatectomy.

Stages 3 and 4 of prostate cancer usually include more radical treatments such as a radical prostatectomy, usually with pelvic lymphaderectomy, external beam radiation without hormone therapy, and radiation therapy or transurethral resection of the prostate as palliative therapy to relieve the symptoms caused by the cancer.

The news that your PSA test has indicated that you may have prostate cancer can’t be good. However, take heart because your level may be a false positive. And even if it isn't, there are many treatment alternatives available that can help you beat the disease.

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