Diagnosis and Screening

Should I Be Screened?

The American Cancer Society recommends that both the PSA and DRE should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy. Men at high risk, such as African American men and men with a strong family history of one or more first-degree relatives diagnosed at an early age should begin testing at age 45. However, all men over 40 should speak with their doctors at the time of their annual physicals and develop a proactive prostate health plan that is right for them based on their lifestyles and family history.

Overview

There is no unanimous opinion in the medical community regarding the benefits of prostate cancer screening. Those who advocate regular screening believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects. Those who recommend against regular screening note that because most prostate cancers grow very slowly, the side effects of treatment would likely outweigh any benefit that might be derived from detecting the cancer at a stage when it is unlikely to cause problems.

Because a decision of whether to be screened for prostate cancer is a personal decision, it’s important that each man talk with his doctor about whether prostate cancer screening is right for him.

Screening

Early stage prostate cancer often has no warning signs, making regular screening tests such as PSA and digital rectal exams critically important.

Men are more likely to detect prostate cancer early when they have two simple screening tests – a digital rectal exam (DRE) and a prostate-specific antigen (PSA) blood test. During the DRE, your physician will insert a gloved finger into your rectum to feel the size, shape and texture of your prostate. The PSA test determines the level of PSA in a blood sample; high levels may indicate prostate cancer, an enlarged prostate or prostate infection. Men with normal levels of PSA also may have prostate cancer.

These tests are recommended yearly for all Caucasian men starting at age 50; African American men and anyone with a family history should be tested yearly starting at age 40. Many urologists recommend that even men without risk factors get a baseline PSA at age 40 to 45.

Diagnosis

If further evaluation is needed after the screening tests, a prostate biopsy may be recommended. In this test, using a local anesthetic and ultrasound guidance, your urologist will insert a tiny needle into the prostate and withdraw small amounts of tissue to be examined in a laboratory. If prostate cancer is found during the biopsy, additional testing such as a bone scan or a CT scan may be recommended.

In its early stages (T1 and T2), prostate cancer is usually confined to the prostate itself. As the cancer advances, it may move outside the prostate to surrounding tissues, lymph nodes, bones or other parts of the body (Stage T3 or T4). Your tissues also will receive a “Gleason Score” that helps your doctor predict how the cancer may progress.

False PSA Results:

Scientists in the United States suggest a blood test widely used to screen for prostate cancer can be misleading in the case of men who are obese.The researchers at Duke Prostate Center, Duke University in North Carolina, say doctors reading the results of a blood test commonly used to screen for prostate cancer can be deceived into thinking obese men are disease-free. They say the test for a protein called prostate-specific antigen, or PSA, may in fact produce falsely reassuring results because obese people have more blood in their bodies and the concentration of the protein is diluted.

The prostate gland produces PSA and doctors use this to detect the presence of prostate tumors, if levels are higher it can be a sign of cancer; an enlarged prostate can also elevate PSA levels.The researchers found that men with a body mass index, or BMI, indicating obesity, had a higher blood volume and lower PSA concentrations.The most obese men had PSA concentrations 11 to 21 percent lower than those recorded in men of normal weight.Prostatitis:(This information is from Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer)Prostatitis hurts. This painful condition—an inflamed, swollen, and tender prostate—can be caused by a bacterial infection or by other factors. The major complaint in men with prostatitis is pain in the perineum (the area between the rectum and the testicles). They may also experience aches, pain in the joints or muscles and lower back, blood in the urine, pain or burning during urination, and painful ejaculation. In its own way, prostatitis is every bit as difficult and frustrating as BPH—not only because of the symptoms, but because there is not always an apparent cause. Prostatitis is a benign ailment—it is not cancer, and it does not lead to cancer. It is not always curable, but it is almost always treatable.

The National Center for Health Statistics estimates that about 25 percent of all men who see a doctor for urological problems have symptoms of prostatitis. An estimated half of all men will experience some of these symptoms during their lifetime. Prostatitis is the most common cause of urinary tract infections in men; in fact, American men make about two million trips to the doctor each year seeking help for the symptoms of prostatitis or its siblings, “irritative prostatic conditions.”

Update 07-01-09

TEST TRIALS–hope for the Future:

Researchers in the MAyo Clinic have found very positive results in trials for 108 men with advanced prostate cancer. Previously, for patients with advanced prostate cancer which has spread outside the prostate, surgery was no longer an option. Standard treatment for advanced prostate cancer is to use hormone therapy to try and shrink the cancer tumor

In the Mayo Clinic study, the researchers tested MDX-010 (Ipilimumab), a type of monoclonal antibody, to see if it will stimulate a strong immune response to attack the prostate cancer cells. The results, according to Dr. Eugene Kwon, were beyond expectations. It was found that in three (3) cases, the tumors had shrank so much that it was possible to surgically remove the tumor. Twenty (20) other tests subjects had also shown improvements. The researchers were so encouraged that they planned to expand the trial to test higher dosages of MDX-010 on a further thirty (30) prostate cancer patients, and beyond that, to expand to larger trials in many hospitals.

Here are more details about the “startling results”: Rodger Nelson was diagnosed with advanced prostate cancer. His tumor had spread beyond the prostate and the cancer was encroaching upon the abdoman. The prognosis for such a condition is usually death within a few months, and only palliative care would be given. However, after only one dose of Ipilmumab (MDX-010), Nelson’s tumor has shrunk so much, it could then be surgically removed. The surgeons described the tumors a “very hard to find”. Another patient in the study, Fructuoso Solano-Revuelta, had a tumor as large as a golf ball with a similiar prognisis. His tumor has also shrunk after an application of Ipilimumab (MDX-010) to the extent it became operable. Both men have since returned to work.

More information can be obtained from the Mayo Clinic web site.