Prostate cancer and cancer screening has become quite a controversial subject, even amongst doctors. Not every doctor is in favor of screening patients, particularly older ones, for prostate cancer at all, and leaving it up to patient preference. Most however feel differently, and prostate cancer screening by using PSA levels has become a part of routine age and amount requirements.
Prostate cancer is a slow growing disease, and usually not an immediate cause of mortality. Statistics from the National Institute of Health and from insurance experience show however that the prostate cancer death rate is dropping. In younger men who develop the disease, even delayed mortality can be significant. In even older men, a drop in immune system response or an already advanced stage of cancer can also cause premature death.
No major medical or scientific groups, even the American Cancer Society (ACS), recommend routine testing for prostate cancer at this time; rather they advise men to speak with their doctors about risks and benefits. However, the ACS does believe that PSA blood testing and a rectal examination of the prostate start at age 50 in most individual males. In fact, the association recommends testing even earlier (age 45) for what considers high risk individuals- those with a close relative (father, brother or son) who was diagnosed with prostate cancer before the age of 65, or in African Americans - beginning at age 45.
The PSA blood test screening consists of a laboratory measurement of a substance made in all male prostate glands. Some PSA is found in all men, but the level rises markedly in prostate cancer. A normal value is under 4 ng/ml. When the value rises between 4 and 10, the odds of prostate cancer occurring are 25%. When the value rises over 10ng/ml, the chances are close to 50%. While not everyone who has an increased PSA has prostate cancer (very large benign prostate glands or acute inflammation can cause an elevated value as well) the odds of it certainly increase dramatically.
PSA is also useful in following men as they age. The acceptable normal range increases somewhat as men get older. A measurable fraction of PSA called Free PSA is helpful; when Free PSA measurements are over 20% of the total the odds of a benign process are much higher. PSA velocity is another helpful factor in doctors following men for well health screening - a PSA that increases over 0.75ng/ml/year over three serial measurements is very suspicious for a cancerous process.
The insurance industry screens for prostate cancer using a PSA and may refer an applicant back to his physician for evaluation if the measurements point to prostate cancer as a viable possibility. Many times an insurance laboratory measurement can be the first clue that a dangerous disease is going on and it can actually be life prolonging for an applicant.
The PSA measurements are also helpful for following prostate cancer after treatment. The treatment can include radiation, surgery, cryotherapy, and brachytherapy just to name several. Generally, measurements of PSA drop well under 1.0 ng/ml after adequate treatment. A level that stays persistently elevated or that rises after treatment is often a sign that the cancer is either still present or has recurred. Prostate cancer can be metastatic and spread to bone and lymph nodes and while growth and eventual death prostate cancer is slower than with other malignancies, the shortening of life span is significant.
The information contained on this page is not intended to provide medical advice, which should be obtained directly from your physician.