PSA
What are the risk factors for prostate cancer?
The strongest risk factors for prostate cancer are:
• Age: being 50 years or older;
• Diet: notably one high in red meat and low in fibre,
• Family History of prostate cancer;
• African ancestry.
What are the tests available today?
1. A digital rectal exam (DRE), during which your health care provider inserts a finger into your rectum to feel one side of your prostate for any abnormality. A normal prostate feels smooth and
rubbery. • Cancers are often missed by this examination so even if your health care provider finds nothing, you may still have cancer. Some health care providers have stopped doing this test as the chance of finding cancer is low.
2. A prostate specific antigen (PSA) test is a blood test that measures the amount of a substance (PSA) in the blood. • PSA is produced by the prostate and is normally present in a man’s blood in very small amounts. High levels of PSA may indicate the presence of cancer although high levels can be caused by a large prostate and/or other prostate problem.
What is my chance of getting the disease and then dying from it?
Other cancers are more deadly but prostate cancer is the most common cancer diagnosed in Canadian men. On average, a 50 year old man has a 15% chance of being diagnosed with prostate cancer by age 80. However, his chance of dying from prostate cancer over this 30 year period is only 1.4%.
What is the current recommendation?
All men over the age of 50 should discuss with their health care provider the potential benefits and risks of prostate cancer testing so they can make informed decisions about the use of the
tests available today.
TO TEST OR NOT TO TEST?
The results of PSA testing vary significantly with men of different age groups. As you age, your risk of developing prostate cancer increases but so does your chance of getting a false-positive result on a PSA test. Given the stress and anxiety associated with a potential diagnosis of cancer, men in the older age group (70-80) may opt out of testing for prostate cancer.
The PSA test is probably the most controversial of all the cancer tests and, because of this, it is difficult to make a clear recommendation on testing. Review the following information before making your decision
Here are the key issues that impact the decision to test:
• The PSA test is not as accurate as we would like.
• 2 out of 3 men who have a high PSA will NOT have prostate cancer. They will usually require ultrasounds and biopsies to prove this. • Up to 25%of men with low PSA actually have prostate cancer, particularly men over the age of 70.
• There are no definitive research results that can tell us whether testing for prostate cancer does, or does not, save lives.
• There are ongoing trials now but they won’t give us answers for a few years.
• It is difficult to generalize about what usually happens to men with prostate cancer.
• Most men diagnosed with prostate cancer will have slow growing cancer which probably won’t kill them. A much smaller group will have more aggressive prostate cancer that needs
to be treated. • Those with fast growing cancer will benefit from the test but the majority (those with slow growing cancer) will not benefit and may have more stress and health complications from invasive testing.
• Finding prostate cancer, especially in older men, may not increase lifespan.
• Studies of men over the age of 70 who had their prostates removed because of prostate cancer showed that they had a poorer quality of life and no difference in lifespan than those with prostate cancer who did not have surgery. Because of this, for many older men with prostate cancer, the prescribed strategy will not be removal of the prostate or other treatments but “active surveillance” (assessing the prostate at periodic intervals).
