September is National Prostate Health Month. FPG Urologist Dr. Robert I. Carey writes about Prostate Specific Antigen and what that means for a patient’s individual health:
The PSA test (Prostate Specific Antigen) is useful as a marker of prostate conditions. If used properly, it can lead to the early detection of significant, life-threatening prostate cancer and allow for a complete cure. Your primary care physician and urologist— a physician who specializes in prostate cancer and prostate diseases– will guide the proper management of your PSA test.
Having an elevated PSA does not mean that you have prostate cancer. There are many reasons why a patient may have an elevated PSA test. Some causes are benign such as prostatitis, urinary tract infection, urinary retention or benign prostatic hyperplasia (enlargement of the prostate).
A normal PSA should be less than 2.5. For all patients who have a total PSA between 2.5 and 10, there is a roughly 20% chance prostate cancer will be found on biopsy. If the PSA is greater than 10, the risk of having prostate cancer goes up. Patients with a PSA less than 2.5 rarely have prostate cancer.
Your total PSA is only part of the picture. Some patients have an elevated PSA for years and do not have cancer. Your doctor was will make an assessment of your total PSA in the context of your overall health and multiple other findings, including:
- Total PSA
- PSA/free PSA ratio (should be greater than 25% in patients without cancer)
- PSA progression (evidence or absence of rise of PSA over time)
- Family History (father and brothers, did mother or sisters have breast cancer?)
- Digital rectal exam
- Assessment of prostatitis, urinary retention, urinary tract infection
- Urinary urgency, frequency, nocturia, bladder or kidney stones
- Consideration of the Select MDx test or other genomic screening tests
- Age, overall health, and life expectancy of the patient
MRI Fusion Biopsy. For some patients an MRI is an appropriate test that can assist in the localization of a prostate cancer within the prostate. At Sarasota Memorial, we offer state-of-the-art MRI Fusion technology. A transrectal ultrasound guided biopsy of the prostate is often more appropriate in certain patients, particularly those patients with small prostates and palpable nodules on prostate exam.
Personalized medicine and your PSA. You are unique. Only through a complete assessment of the patient can rational decisions be made regarding who needs an immediate prostate biopsy versus who needs further assessment of their elevated PSA with MRI imaging, Genomic testing or simply continued PSA surveillance. Your physician will determine which imaging (MRI, CT scans, ultrasound, bone scans etc.) may be helpful in locating and staging prostate cancer.
Having a diagnosis of prostate cancer does not mandate treatment. Only life-threatening, aggressive, high grade prostate cancers need to be treated. Many patients are diagnosed and placed into active surveillance where they live for years without progressing to treatment.
Robert I. Carey, MD, PhD serves patients as Medical Director of First Physicians Group Urology in Sarasota. He specializes in minimally invasive robotic surgery for the treatment of urologic cancers.