Tread carefully when deciding to undergo PSA test
Q: A friend of mine was diagnosed with prostate cancer recently and it made me think about my own risk. I am active and eat well.How would I know I have a problem with my prostate? I've heard there is a blood test to check it. Is this worth having done?
Dr Nina replies: The prostate gland is found below the bladder surrounding the urethra which is the tube in which urine and semen pass out of the body. A normal prostate is the size of a walnut. The prostate gland produces fluid which mixes with sperm to make semen.
If the prostate gland enlarges it can press on the urethra causing a number of different symptoms. These include passing urine more often, having to get up at night to pass urine, and difficulty starting or stopping the passage of urine. The stream of urine may seem weaker than usual or dribbling may occur at the end of the stream. You may also feel that you haven't completely emptied your bladder.
Other symptoms can include pain or discomfort passing urine or blood in the urine or semen.
Prostatitis is the most common urinary problem in men under the age of 50. It is usually associated with pain in the lower abdomen, genitals or back and pain or difficulty passing urine. There may be pain or discomfort during or after ejaculation. If an infection is present there may also be fever, chills or nausea.
The prostate does enlarge as men age and Benign Prostate Hypertrophy (BPH) is thought to affect 50pc of men aged 51 to 60 and 90pc of men over the age of 80.
Prostate cancer is the second most common male cancer in Ireland. One in nine men will be diagnosed with it in their lifetime. Although many men are diagnosed with this condition most do not die from it and it can be treated or controlled in the majority of cases. The risk of prostate cancer increases as you age and most cases are diagnosed in men over 50. The risk is higher if you have a family history of prostate cancer especially if it was diagnosed under the age of 60. Those of Afro-Caribbean descent also have an increased risk. Eating a diet high in processed foods or a sedentary lifestyle are also thought to play a role.
If the prostate gland is enlarged it may produce higher levels of a hormone called the prostate specific antigen (PSA). However as the PSA level may go up with prostate infections or benign swelling of the prostate a raised PSA does not mean you have cancer.
Screening means testing for a condition when you have no symptoms at all. Screening for prostate cancer is controversial and it isn't certain whether this can reduce the risk of death from this disease. The decision to have a PSA done should be considered carefully and in consultation with your doctor.
You may consider discussing screening with your doctor if you are aged over 45 and you are of Afro-Caribbean descent or have one first degree relative who was diagnosed at a young age.
If you are over the age of 50 and you are expected to live longer than 10 more years it may be worth considering screening. Screening is not routinely recommended if you are over the age of 75.
Screening involves checking the PSA levels in the blood and should also involve a digital rectal exam (DRE).This allows the doctor to feel the prostate to see if it is enlarged or irregular.
If your PSA and rectal exam are normal you will be reassured. If your PSA is raised and your DRE is normal the PSA should be repeated six weeks later. If your PSA is normal and your DRE abnormal or your repeat PSA is raised you should be referred to a specialist.
Once you have been referred to a specialist you will need to undergo a prostate biopsy. The advantage of a biopsy is it may pick up early cancer and help a doctor decide the best treatment options. The disadvantage is that a biopsy may miss the area containing cancer or may pick up a very slow growing cancer that wouldn't have caused any problems at all.
To sum it up the advantages of PSA testing are that it may pick up early disease, it can be used to monitor your prostate if you are at risk of cancer, and if it is normal it may be very reassuring.
The disadvantages are that about two thirds of men with a raised PSA do not have cancer and may end up having unnecessary tests. It may pick up a slow growing cancer which wouldn't necessarily cause you any problems but may cause anxiety once you know you have it. A normal result does not mean you won't get prostate cancer in the future.
Health & Living