|
|
|
Stephan L. Werner, M.D., F.A.C.S. Prostate Cancer, (PCa), is the most common cancer in men in the US today. In 1997 there were 240,000 newly discovered cases and about 40,000 deaths. These numbers have started to drop as the result of the development of a screening test, PSA, and much improved public awareness of the importance of seeking evaluation on a regular schedule. Prostate Cancer is much more common in the developed world, especially in western Europe and the Americas. The causes are unknown but are probably related to lifestyle and dietary factors. Heredity and race play roles in causation as there are families with a high incidence of prostate cancer, and it is much more frequently found in African Americans than Caucasians. The disease is rare in Africa and Asia, but occurs more frequently in later immigrant generations. The disease is rare before age 40. The incidence rises with age, and by age 80, 70+% of men will have prostate cancer, although the aggressiveness of the disease decreases with late age of onset.
Prostate cancer usually exists without symptoms!!! Some patients may have symptoms of having to urinate frequently or slowly, or have urinary burning or blockage or bleeding. These symptoms usually come from other conditions such as infection or inflammation or overgrowth, but may be associated with prostate cancer. When these symptoms occur the patient should seek urologic evaluation. When the cancer has spread, bone pain is a common symptom. Who Should be Examined for Prostate Cancer? All men over 50 and below 80 should have an annual prostate cancer examination. All men over 40 with strong family histories, (fathers, brothers or any two close relatives), and all African-American men over 40 should have an annual exam. In those few families with multiple males having had prostate cancer screening might be considered at an earlier age. Prostate cancer is very common in men over 80, but is usually a slow growing, non life threatening disease. Men over 80 should have an annual DRE for prostate and colorectal examination, and if the prostate is abnormal a PSA may be obtained. (See below under treatment). The prostate examination consists of two parts, a digital rectal examination, (DRE), and a blood test, the PSA or, prostate specific antigen. The combination of the two examinations significantly increases the detection of prostate cancer over either test alone. PSA or Prostate Specific Antigen, is a blood test that helps detect prostate cancer. PSA is a fuzzy test and cannot diagnose prostate cancer by itself!. Many other conditions such as prostate infection or inflammation, or urinary tract infection may raise the PSA. A high PSA does not mean cancer is present and a normal PSA does not rule out the presence of prostate cancer The normal values for PSA are 0 to 4. Borderline levels are 4 to 10 and when it is over 10 it is considered high. Prostatitis may artificially elevate PSA, a a rapid rise in PSA should usually be treated for several weeks with appropriate antibiotics and then repeated . The use of Proscar or Propecia as well as many of the proprietary "prostate medicines" sold over the counter, which include saw palmetto will artificially lower PSA levels. For patients on any of these drugs, the normal upper limit of PSA is reduced to 2-2.5. Patients using any of these medications should inform their doctors!!When the PSA levels are between 4 and 10 a second fuzzy blood test, the Total vs. Free PSA ratio may be helpful. While high ratios, over 25%, suggest benign disease, and low ratios, under 15%, suggest cancer, there are many false positive and negative results, and the evaluation of the results are best left to a urologist. This test is not valid for PSA's less than 4 nor greater than 10. A third indicator is PSA velocity. If the PSA is rising more than 0.7 per year it is considered suspicious and should be taken into the consideration for biopsy Sometimes when the PSA is borderline or elevated, or a nodule is present, and there are symptoms suggestive of infection or inflammation, the urologist, (this decision is best left to an expert), may decide to treat the condition with antibiotics for 2 to 4 weeks and repeat both the PSA and the examination. If both examinations return to normal, cancer is usually not present, and a repeat examination in 3 to 6 months is indicated. Rev: 09/04 |
|
[Home] Werner - Francis Urology Associates llc - Mid Atlantic Urology Associates llc Greenbelt - Bowie - Laurel Maryland (301) 441-8900 Fax (301) 982 0453 7500 Hanover Parkway Suite 206 Greenbelt, MD 20770
Rev:03/08 |
