Interest increases in early detection of Prostate Cancer

Cancer of the prostate is a health concern for both middle-aged and older men. However, many men do not seek diagnosis because they fear the treatment, or what they perceive to be the treatment, as much as the disease itself. If the treatment does not appear threatening, the side effects from the therapy may. For years, men have heard about prostate surgery, castration, and use of female hormones for treating prostate cancer. With the variety of treatments available for different stages of the disease, many men are confused about which therapies they might receive.

The confusion can be minimised if the patient has some basic knowledge. Once a man understands the various available therapies, he can discuss them with his doctor and participate in the choice of treatment.

So what is the prostate? The prostate is a walnut-sized male sex gland, encircling the upper end of the urethra, the tube that carries urine from the bladder during urination. The prostate gland produces semen, the fluid that transports sperm from a man's body during orgasm.

Cancer is a disease of the body's cells. Normal cells reproduce themselves by dividing in an orderly fashion to replace worn-out or damaged tissue. Cancer is characterised by uncontrolled growth and spread of abnormal cells. These cells grow into a tissue mass known as a tumour. Some tumours are benign, or noncancerous, and others are malignant, or cancerous. Benign tumours can interfere with body functions, but they do not invade other tissues, and they are generally not life-threatening. On the other hand, malignant tumours will spread, or metastasise, to other parts of the body. Sometimes cancer grows and spreads rapidly, and sometimes the process is slow.

Prostate cancer is a slow-growing malignant tumour that starts in the prostate gland. The tumour can be present but not noticed for years. Often, it is first diagnosed when a man seeks medical attention for painful or frequent urination or aches and pains in the bones or joints. A disease of older men, this form of cancer is rare in men under age 55. The rate of occurrence increases with each decade of life.

The chances of surviving this form of cancer are better today than ever before, and the quality of life for those who have it has been dramatically improved. The key to fighting prostate cancer is to detect and treat the condition in its early curable stages, before it spreads. A man can protect his health by learning the warning signs of prostate cancer and having regular check-ups.

Interest in testing men at risk of prostate cancer has increased with the development of the prostate specific antigen (PSA) blood test. In many patients an abnormal result of a PSA is the first sign of prostate cancer. There are a number of different PSA tests carried out in the hospital laboratories in the UK, manufactured by different diagnostics companies. Standardisation of the methodologies has resulted in an upper limit of normal of 4.0 units. Along with prostate cancer, benign conditions such as prostatic hypertrophy and inflammation of the prostate can also cause increases in PSA results. PSA values in the 4 to 10 units range are said to be borderline, and may be evaluated with the ‘free PSA’ test. This test, in conjunction with the ‘Total PSA’ test, evaluates the ratio between the PSA which is free in the blood, and the PSA that is bound to proteins in the blood. When the free PSA is less than 15% of the total, there is a higher risk that the patient has prostate cancer. The PSA test must be evaluated in conjunction with the patient's history, physical examination, and other tests such as ultrasound to complete the diagnosis.

In the United States, it is clear that patients are now diagnosed at an earlier stage of disease than before the introduction of PSA. The American Cancer Society currently recommends an annual PSA and physical examination for men 50 years and older who have at least a 10 year life expectancy, and also for younger men who are of African-American descent or men with two or more first-degree relatives affected by prostate cancer.