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Prostate Cancer Diagnosis
Estimates report that prostate cancer is very common and up to 1 out
of 6 men will develop prostate cancer. Why is that the case? It seems
to be more common as for all cancers. As long as heart disease doesn’t
take us in our 60s, we frequently go on to develop all the tumors that
occur with aging. The chance that a man living in the United States will
develop cancer at some point is now 45% and prostate cancer is the #1
cancer in men.
Improved testing is playing a role. The prostate specific antigen is a
tumor marker which enables us to diagnosis prostate cancer at a much earlier
and more curable stage. What exactly is PSA? PSA is an enzyme, in this case
a glycoprotein, and is made is highest concentration of any protein in the
prostate. When semen is ejaculated it coagulates. Prostate specific antigen,
or PSA, breaks down the coagulant. Under certain conditions, the PSA enzyme
can leak into the blood. One reason is enlargement called benign prostate
hyperplasia or BPH. The second reason could be an infection, or it could
be malignancy. PSA increases in cancer because the ducts that form PSA
are blind ending and it has nowhere else to go.
Doctors are frequently asked what a normal value of PSA is. Is the actual
PSA amount important or is it the year to year change? We originally said
that a PSA of more than 4 is abnormal. Then we said more than 2.5. We now
know that there is no single PSA measurement above 0.1 that says you are
free of cancer and free from an aggressive tumor. One way to judge what
you should do is to see how your PSA changes from year to year. If a
man’s PSA is less than 4 it should not go up more than 0.4 per year.
At an early curable stage, prostate cancer produces no symptoms. But
men also need a digital rectal examination because the PSA will not be
elevated in 25% of men with prostate cancer. Twenty-five years ago before
we had PSA, virtually everyone came in because they either had symptoms,
problems with urination, or bone pain because the prostate cancer had
metastasized to their bones.
Over the past decade, deaths from prostate cancer have fallen 33% which
is more than any other cancer in men or women. The reason is that very few
men who were diagnosed thirty years ago were curable and those that were
curable weren’t offered intervention with techniques such as we have today.
Once PSA came along, we could diagnose men when they were curable.
How is prostate cancer diagnosed?
The diagnosis of prostate cancer can be confirmed only by a biopsy. A
biopsy is the surgical removal of tissue samples, while under local anesthesia,
drugs or substances that cause a loss of feeling or awareness, in a doctor’s
office. The biopsy is done by a urologist, a doctor who specializes in
diseases of the sex organs and urinary tract, the organs of the body that
produce and discharge urine. Then a pathologist, a doctor who identifies
diseases by studying tissues under a microscope, checks the patient’s
tissue for signs of cancer.
With prostate cancer becoming the most prevalent form of cancer
in men in the United States, more emphasis has been placed on
early diagnosis. An estimated 39,200 American men will die annually of
prostate cancer. With increased attention focused on the growing prevalence
and monetary cost of prostate cancer, advancements in diagnosis and treatments
are evolving and should continue to do so over the coming years. The cost
of medical treatment for prostate cancer patients is estimated to be $3
billion annually. Much like the breast cancer awareness movement, a similar
effort has been mounted against prostate cancer over the last five years.
This has influenced research, development, detection and treatment.
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