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The Straight Poop on the PSA Test for Prostate Cancer

Did you know that nearly 30,000 men die each year from prostate cancer. That's half the capacity of the Superdome. That's the bad news. The good news is that if men would obtain a digital rectal exam and a prostate specific antigen (PSA) blood test, most of those death could be prevented.

The detection of prostate cancer by rectal exam alone is inaccurate as it only detects 30% of patients with prostate cancer. When the rectal exam is combined with the PSA blood test the detection rate approaches 75%.

The American Urologic society and the American Cancer Association recommends that all men between the ages of 50-73 and who have a life expectancy of more than ten years have an annual prostate examination and a PSA test. If you are more than 73 years of age, then only a digital rectal examination is necessary. The reason is that prostate cancer is a slow growing tumor and if you are over the age of 73 you are more likely to die with prostate cancer than from it.

However if you are Afro-American or if you have a family member that has prostate cancer, then you need the rectal examination and the PSA blood test beginning at age 40. Because African Americans are statistically more likely to develop an aggressive type of prostate cancer at a younger age, black men are advised to begin obtaining routine screening every year after age 40.

Because men with a strong family history (on their father's or mother's side) of prostate cancer are more likely to carry genes that predispose them to it, they should also begin screening at age 40.

Interpreting the PSA test

If the PSA is 0 - 2.5 and the rectal exam in normal, then you can breathe a sigh of relief and return again next year for your exam and blood test. If the PSA is 2.5 - 10, then you may have three conditions that are contributing to the elevated PSA: benign enlargement of the prostate gland, prostate gland infection, or prostate cancer. Now a new test is available that can help distinguish between benign enlargement and cancer of the prostate gland. This new test, ratio of free and total PSA, is also a blood test that compares the amount of PSA bound to protein in the blood stream to the PSA that is free or not attached to the protein in the blood. If more than 25% of your total PSA is of the free variety, then you more than likely have benign enlargement of the prostate gland. This condition is not related or a precursor to prostate cancer but does cause difficulty with urination. This condition can be treated with medication or relieved with surgery.

If the PSA is greater than 10 or if less than 25% of the total PSA is of the free variety, you will need to be referred to a urologist. The urologist will perform an ultrasound examination of the prostate and a prostate biopsy. This consists of the placement of a tiny needle into the prostate gland and remove a small amount of prostate tissue from different parts of the prostate gland. This tissue will be examined under a microscope for prostate cancer.

How to improve the accuracy of the PSA test

The PSA test is far from foolproof. The PSA value can change by 15-20% depending on how and when the test is administered. In order to improve your score, follow these suggestions: Abstain from sex 24 hours before the PSA test is taken. Intercourse can artificially raise the level. To ensure accurate results, avoid sex and even masturbation for at least a day before your blood is drawn.

Inform your doctor if you are taking drugs or herbs that are known to lower the score. This includes Proscar and saw palmetto. These drugs can artificially lower your PSA level and lull you into a false sense of security. If you are taking these medications, your physician can make adjustments in your score that will reflect the true level of the PSA test.

Find out about the method of determining the PSA level. The only assay that is approved by the Federal Drug Administration is the Hybertech assay. If you doctor doesn't use the Hybertech assay, make sure he uses the same assay each time in order to have a consistency of the test.

Obtain the PSA before the rectal exam. A PSA test after the rectal exam can also artificially elevate the level by releasing additional PSA into the blood stream.

Prostate cancer is a deadly disease that can be prevented by early detection. Early detection consists of a PSA blood test and a rectal exam. If it ain't broke, don't fix it does not apply to this common medical problem.

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Reprinted with permission from Neil Baum, neilbaum.com

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