New Test for Prostate Cancer
A new blood test is now available to help identify prostate cancer and avoid unnecessary prostate biopsies. The older Total PSA test measured the prostate specific antigen (PSA), which is a protein produced by the prostate gland. The prostate gland is a walnut sized sex gland in men that makes the fluid that carries the sperm. Higher Total PSA levels can indicate prostate cancer, but the levels can also rise due to non-cancerous conditions such as benign enlargement of the prostate gland and prostate gland infections. The greatest criticism of the Total PSA test has been that it was not specific enough to detect prostate cancer. Men with elevated PSA tests were subjected to prostate biopsies which is expensive and moderately uncomfortable and only 25% of men who have biopsies based on an elevated Total PSA will have prostate cancer.
How does the new Free PSA test work? The Total PSA measures all of the PSA released by prostate gland into the blood stream. The Total PSA is made up of two components: Free and Complexed PSA. The Complexed PSA is bound to circulating proteins in the blood and the Free-PSA is not attached or bound to any other substance or molecules. Researches have found that patients with prostate cancer have less Free PSA released by the prostate gland compared to men with benign enlargement of the prostate or men with prostate infections. Men with prostate cancer have a ratio of Free to Total PSA that is in less than 25%. Men with benign disease of the prostate gland have a ratio of Free to Total PSA that is usually greater than 25%. Men with Free to Total PSA less than 25% should probably be advised to have a prostate ultrasound exam and a biopsy. Those men with ratios greater than 25% can be followed with regular rectal examinations and PSA testing.
The new test or Free PSA test can help physicians more precisely detect prostate cancer
in its early stages. Prostate cancer is expected to cause the death of more than 40,000 Americans this year and nearly 250,000 men will be diagnosed with prostate cancer making it the most common cancer in older men. That's the bad news. The good news is that if the cancer is detected early while the cancer is still confined to the prostate gland, it is curable. Also, the new, Free PSA test detects 95% of prostate cancers making the test more specific than the Total PSA test.
The PSA test is not a replacement for the digital rectal examination. Men have to have both the rectal exam and the PSA test in order to detect early prostate cancer. When the PSA test and digital rectal examination are used together, they are more effective in detecting prostate cancer than when either test is used alone.
It is still possible, however, that some prostate cancers may be missed. This is because some cancers are too small to raise the PSA blood level or to be felt during a digital rectal examination. There is also the chance that a healthy man may be identified as possibly having prostate cancer.
If the PSA test result is higher than normal (greater than 4.0) or the digital rectal examination is suspicious, biopsy of the prostate is required before your doctor can make a definite diagnosis of cancer. Biopsy is the removal of a small amount of prostate tissue. This tissue is examined under a microscope to see if cancer is present.
If you are a man over the age of 50, see your physician once a year for prostate gland check up. If you are an African-American man or if you have a relative, father, brother, uncle, who had or has prostate cancer, then you need to begin testing after age 40 as there is an increased likelihood of prostate cancer in African-American men and in men with blood relatives who have prostate cancer.
Prostate cancer is not like a car and the attitude "if it ain't broke, don't fix it" does not apply. Prostate cancer in its earliest stages has no symptoms. By the time prostate cancer produces symptoms, it may have spread beyond the prostate and not be curable. No one needs to suffer the consequences of prostate cancer if they obtain a regular check up and a PSA test.
Dr. Neil Baum is a urologist and can be reached at 504.891.8454 or at his Web Site, www.neilbaum.com.
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