Your Best Chance – Spot It Early

Health Alert 105

With the help of some recent refinements in a common blood test, you can increase your chances of a long healthy life to spend with your family and friends.

Over 30,000 mature American men die of prostate cancer annually. You don’t have to become another notch in prostate cancer’s staff. How do you survive prostate cancer? The most important factor is simple: early detection.

In this letter, I’ll tell you about the vastly improved PSA testing for early detection of prostate cancer, and how it could save your life.

* It’s Only Getting Better *

Prostate-specific antigen or PSA is a protein produced by the prostate gland. We can measure it in your blood. An elevation or dramatic change in the PSA in your blood can indicate prostate cancer.

We’ve been using PSA tests for almost 20 years as an early detector of prostate cancer. But several new refinements have made PSA testing more accurate than ever before. You can use four types of PSA testing.

Total PSA: Total PSA tests are the most common and traditional of the PSA tests. The method measures the total amount of PSA in the blood. PSA levels become elevated when cancer is present.

But Total PSA tests are not completely accurate. A number of other factors can also cause a man’s PSA levels to rise. Benign prostatic hyperplasia (BPH), urological difficulties, bacterial infections, and even recent ejaculation can cause PSA levels to rise.

Luckily Total PSA tests aren’t the only tool in your doctor’s detection kit. Total PSA is very useful when used alongside other, more accurate types of PSA tests.

PSA Density: PSA Density is a test used to differentiate between BPH (swelling of the prostate) and cancer. We simply divide Total PSA levels by the prostate volume to find PSA Density. Cancer causes greater levels of PSA as compared to the volume of the prostate itself. Therefore cancer will usually have a much higher PSA density than benign enlargement will.

PSA Velocity: PSA velocity measures how PSA rises over time. The more rapid the rise in PSA, the greater chance of cancer. We need to test at least 3 times in two years to see PSA Velocity.

Free PSA and Complexed PSA Testing: These tests indicate the ratio of unbound PSA to bound (attached to another protein) PSA. Men with prostate cancer usually have lower levels of unbound or free PSA.

These tests are more accurate than Total PSA tests. In fact a recent study found that, when used together, these tests are was 67% more “specific” than Total PSA tests. “Specificity” refers to the avoidance of “false positives”. 1 In other words, an abnormal test is 67% more likely to indicate an actual cancer instead of some other cause. This avoids unnecessary alarm and procedures such as biopsy.

* Be the Early Bird *

The earlier we spot prostate cancer, the more benign the treatment options and the greater chance you have to live a long and healthy life. Here are some tips so that you can utilize PSA testing to it’s fullest potential.

• All men need to begin PSA testing at the age of 50.

• Men with an elevated risk for prostate cancer need to begin PSA testing at the age of 40. (You are at elevated risk if a family member has prostate cancer, or if you are African American.)

• All men need to test PSA at least once a year.

• DRE (digital rectal exams) are useful. They’re not the most enjoyable tests, but they only take a moment. There is no additional charge to get one with your annual check-up.

• Ask your doctor to use all four of the PSA tests in this letter to get the most accurate evaluation.

• PSA tests are inexpensive and covered by insurance. Information about the state of your health is generally a good thing. It puts you more in charge regardless of how you decide to use the information. And, I’ve never heard a convincing reason not to test.

Al Sears, MD

1 Cheli C., et al. Final results of a multicenter prospective evaluation of complexed PSA for early detection of prostate cancer. American Urological Society Annual Meeting Orlando, Florida May 25, 2002. Abstract ID 834