EARLY DETECTION & PREVENTION

Early detection of prostate cancer gives a better chance of survival and cure. The patient’s risk increases when it is left undetected for a long period. Early detection is only possible in healthy patients.

The exact cause of prostate cancer is unknown. Current risk factors for prostate cancer include:

Age:

The risk of prostate cancer increases with age.

Race:

African American men are more than twice as likely to be diagnosed with prostate cancer and to die from the disease.

Family History:

Men with a family history of prostate, breast, ovarian, colon or pancreatic cancers may be at an increased risk of prostate cancer.

Genetic Mutations:

Inherited mutations of the BRCA1 or BRCA2 genes raise the risk of breast, ovarian and prostate cancer in some families.

Diet and Lifestyle:

Studies indicate there may be a link between diet and lifestyle, and the cause or prevention of prostate cancer.

Chemical Exposure:

Exposure to certain chemicals such as pesticides and herbicides may have higher than average rates of prostate cancer.  Veterans who were exposed to the defoliate Agent Orange are 49% more likely than non-exposed veterans to be diagnosed with prostate cancer.

Firefighters:

Recent studies show that firefighters are at a 28% greater risk to develop prostate cancer compared to the general population.

Screening

Because there are no early warning signs for prostate cancer men may choose to undergo screening for the disease. Screening does not provide a diagnosis but offers valuable information that can help detect prostate cancer early. Screening commonly involves two tests: the prostate specific antigen (PSA) blood test and the digital rectal exam (DRE).

A referral to a urologist is usually prompted by an abnormal DRE finding, such as a lump or firmness of the prostate, or an elevation in the PSA blood test.

New tests or markers under development may also aid in the detection of prostate cancer. A biomarker is a biological molecule found in blood, body fluids, or tissues that can indicate normal or abnormal processes in the body. Biomarkers can also be used to monitor how the body responds to a treatment.

Click Here for Screening Guidelines

Prostate Specific Antigen (PSA) Test

PSA is a prostate specific blood test, but it is not prostate cancer specific. PSA is a protein produced by prostate cells, both cancerous and non cancerous, that can be measured in the blood.

Increased PSA levels do not always mean cancer, but a rising PSA increases the risk. There is no PSA level that completely eliminates the chance of prostate cancer. Even men with low PSA levels can have detectable cancer on biopsy. PSA levels between four and ten within standard units correspond to about an eighteen percent chance of cancer, while levels above ten correspond to roughly a sixty seven percent likelihood according to NCCN guidelines. Any abnormal result should be repeated to confirm the value.

Factors that may affect PSA level include:

• Age
• Race
• Other health conditions
• Prostate size
• Infection
• Medicines, supplements, or herbals
• Sexual activity
• Vigorous exercise

Early detection efforts in the past resulted in overtreatment, especially in men with low risk cancers that were not likely to be life threatening. PSA testing can also produce false positives and false negatives. False positives may lead to anxiety, additional testing, and biopsy. To balance these risks, the United States Preventive Services Task Force recommends that men aged seventy five and older should not undergo routine PSA testing, and that men aged fifty five to sixty nine should engage in individualized decision making with their physician.

The National Comprehensive Cancer Network recommends a baseline PSA and DRE at age forty for men at increased risk, including those with a strong family history or African American men. If the baseline PSA is less than or equal to three with average or high risk, repeat testing every one to two years is appropriate. If the PSA is less than one with average risk, repeat testing every two to four years may be considered. In men older than seventy five with PSA less than four, testing every one to two years is suggested only for otherwise healthy individuals.

Percent Free PSA Ratio

The percent free PSA ratio helps determine whether an elevated PSA is more likely caused by prostate cancer or benign prostate enlargement.

How the test is performed:

• A routine blood sample is taken.
• The laboratory measures total PSA and free PSA.
• The ratio is calculated:

Percent Free PSA = (Free PSA ÷ Total PSA) × 100

Example:
Total PSA = six
Free PSA = one point two
Percent Free PSA = twenty percent

Interpreting results:

• Greater than twenty five percent suggests lower likelihood of prostate cancer.
• Ten percent or lower suggests higher risk and may prompt consideration of biopsy.

PSA Density

PSA density is another tool used to understand whether an elevated PSA level is more likely due to prostate cancer or other conditions such as prostate enlargement. PSA density compares the PSA level to the size of the prostate.

To calculate PSA density, two pieces of information are needed:

• The PSA level from a blood test
• The prostate volume, measured most often by ultrasound or MRI

PSA Density = PSA Level ÷ Prostate Volume

Example:
PSA = six
Prostate volume = sixty cubic centimeters
PSA Density = zero point ten

Interpreting PSA Density

• A PSA density lower than zero point fifteen is generally considered lower risk.
• A PSA density equal to or greater than zero point fifteen suggests a higher risk of prostate cancer.

PSA density is especially helpful when the PSA is borderline or when the prostate is enlarged, since larger prostates naturally produce more PSA. A higher PSA density may prompt further evaluation with MRI or biopsy, while a low PSA density may help avoid an unnecessary biopsy. It is one of several tools used to gain a clearer understanding of prostate health.

There are also additional Biomarker tests available that your physician may recommend:

Available Biomarker Tests