Prostate cancer is a common cancer among men over the age of 50. Fortunately, in addition to annual physical examinations of the prostate, there is a simple blood test that can be done to screen for prostate cancer. This blood test is called a PSA test, which stands for prostate specific antigen. PSA is released in to the blood stream in response to changes in the prostate. The amount of PSA in the blood normally increases at a gradual rate as a man’s prostate enlarges with age. Changes in PSA can be also be caused by benign things like trauma or inflammation but also can occur because of cancer. The PSA test is an extremely valuable screening tool because, while prostate cancer may not be detected on physical examination due to the inherent limitations of the exam, it may be suggested in a routine PSA test result.
Early detection is key in our community’s fight against all cancers. That is specially so with prostate cancer where, if diagnosed early enough, ones chances to avoid the complications of surgery to remove the prostate and death from the disease are significantly better. Below is a cautionary story about a man who did not get the benefits afforded by early detection.
In his early 60’s, “John” saw his urologist at regular intervals for urinary complaints. As part of his work up, John’s urologist performed PSA tests. In an 8-month interval, John’s PSA level rose significantly from 3.2 to 4.1 (4.0 being the upper limit of normal). Despite this sharp increase in a relatively short amount of time, John’s doctor did not perform any tests, like a biopsy, to rule out prostate cancer. Instead, John’s doctor ordered a repeat PSA test in 6 months. The repeat PSA test came back even more elevated at 4.8. Although John was concerned about these above-normal levels, he believed his doctor when he told him that a biopsy was not necessary because his PSA levels were not too elevated for a man of his age and he did not feel anything abnormal on physical examination.
About a year later, John’s PSA level rose to 6.55 and he was shortly thereafter diagnosed with an aggressive prostate cancer after undergoing a prostate biopsy. By the time of his ultimate diagnosis, John’s disease had spread outside his prostate and metastasized to his bones making his prognosis for survival and/or cure far worse than it would have been had he been diagnosed earlier. John underwent a complicated and debilitating surgery to remove his prostate and rigorous chemotherapy treatments.
John’s story is vitally important on many levels. While the importance of early detection through vigilant screening is paramount, what is also critical, and cannot be underestimated, is the value of another medical opinion. Whenever one is concerned about their health and an explanation given by their doctor, a second, or maybe even third opinion, can be a life-saver.