Contents
It is a simple, cheap and generally available test – the PSA test is offered by virtually every laboratory in Poland. It does not prejudge the tumor, but we start the diagnosis of prostate cancer with it …
PSA, which is what?
PSA (Prostate Specific Antigen) is a glycoprotein produced by the epithelial cells of the prostate tubules, regardless of their clinical condition. In patients with prostate cancer, the process of antigen release from cells is significantly intensified, therefore the determination of PSA concentration has been used as a tumor marker in screening tests, monitoring the course and treatment of prostate cancer, as well as in post-treatment control for early detection.
The PSA test is simple, cheap and generally available – it is offered by most laboratories in Poland. It consists in collecting a small amount of blood from the patient into a vacuum tube. The material is usually taken from the most visible veins located at the ulnar fossa. The resulting sample is sent for analysis.
When it comes to preparing for the test, fasting is not required. However, during the 24 hours before blood sampling, in order to avoid elevated PSA levels, one should avoid ejaculation and prolonged exercise. A blood sample should also be taken prior to a rectal exam and before a prostate biopsy, or several weeks later.
Who should get a PSA test?
In diseases such as prostate cancer, age is a very important risk factor. The risk increases rapidly after age 50, affecting 6 out of 10 men aged 65 and over. Unfortunately, in recent years there has been an increase in the incidence of younger men, which is why it is so important to regularly perform health checks, including blood tests.
It is assumed that the PSA test should be performed by every man over the age of 45, but men who are carriers of the BRCA2 mutation, which increases the risk of prostate cancer, and who have a family history of prostate cancer, should perform the first PSA test after the age of 40 . The test should be repeated every year.
An elevated score is not always cancer!
Increased concentration of the PSA tumor marker in the serum cannot be regarded as an unequivocal symptom of prostate cancer. For this reason, the interpretation of the results of your test should be done by the doctor, not by you.
Apart from prostate cancer, an increased level of PSA may be found in the case of inflammation of this gland or its benign hyperplasia (BPH). Slightly to moderately elevated PSA levels may be found in African Americans, and all men have levels of antigen increasing with age.
Abnormal PSA result – what next?
The disturbing test result – over 4 ng / dl (or in the elderly over 6 ng / dl), is an indication for further diagnosis of prostate cancer, i.e. per rectum examination (with a finger through the anus). Although this is a procedure that is associated with discomfort, it is recommended as prophylaxis to anyone over 50 years of age.
If the PSA level is above the norm and the rectal examination (through the rectum) doctor detects abnormalities (hard areas can be felt), the patient is referred for a prostate biopsy. In this ultrasound-guided test, a small piece of prostate tissue is removed. The sample is subjected to histopathological analysis, as a result of which it is possible to detect neoplastic changes.
Importantly, even if the histopathological examination does not show any disturbing changes, the disease may still develop. This is because the neoplastic focus may be small enough to be missed during the biopsy. Only the excision of the entire gland makes it possible to 100 percent. Certainly, the presence of neoplasm is excluded.
Cancer is not a sentence
The diagnosis of prostate cancer does not mean the end of the world – early detection of the disease increases the chance of a cure and allows for less aggressive treatment, which translates directly into the patient’s quality of life.
In some cases, the development of prostate cancer is very slow and radical measures are not always needed. Many sufferers can “survive” cancer and die with it, not because of it. Sometimes it is enough to stop at observation and the so-called active surveillance, which includes regular PSA testing every three to six months and annual biopsy.
However, if it turns out that we have medium or high risk cancer, we will choose the treatment scenario together with the urologist. Modern medicine has a lot to offer even to patients with advanced prostate cancer. Therefore, it is not worth being afraid of prophylaxis, it allows us to heal ourselves without fear.