The PSA test and its role in Movember

“Lookin’ ah dah man mustash remind meh I haf to go by d doctor and get meh PSA check…” Mo

 

What is Movember?

The Movember foundation is a global charity which raises funds and awareness to address health issues facing men and allow them to live longer healthier lives. (1)  

 

What is prostate cancer?

Prostate cancer is the most cancer in men. The prostate is a small gland surrounding the tube which allows men to pee and makes part of the fluid in semen. It is normally the size of a walnut (~1 inch in size) however it enlarges with prostate cancer. However, it can also enlarge with other many other conditions like “benign prostatic hyperplasia” (BPH) which is very common as you age.

The exact cause of prostate cancer is unknown but it is common in persons older than 55, someone with a family history of the condition, and someone who eats a lot of fat.

What symptoms could I have?

Prostate cancer can present as a person peeing a lot, or having difficulty with starting to pee, difficulty maintaining a constant flow of pee or dribbling after peeing. In addition to this, men may have other symptoms such as difficulty keeping an erection, blood in urine, painful peeing, and pain elsewhere including back.

Many of these symptoms could also be caused by prostate infections and BPH.

Should I go by my doctor?

If you have any of the symptoms above YES. You should go speak to a doctor and he/she may decide whether or not to do additional tests and/or give medication to help stop the problem.

What is the PSA and is it a good test?

The PSA does identify problems with your prostate but it is not necessarily a good test for identifying prostate cancer.

There are complex methods of deciding whether or not a test is a good one, and whether or not PSA is useful is debatable. There is limited evidence to support the view that the PSA reduces the risk of someone dying. (2,3) Further, the PSA test is raised in many conditions including BPH and studies have found that as many as one in eight men being falsely identified as having the illness but not actually having it. (4) As a consequence of this the test can cause unnecessary anxiety, false results, and potential for subsequent harms of treatment (effect on urinary function, bowel function, or sexual function).

Because of this, many groups including the American Cancer Society do not recommend using it to identify persons with prostate cancer and the UK does not use it as part of a national screening programme. (5-7)

What is a digital rectal exam and does it hurt?

A digital rectal exam or PR exam, may form part of the assessment to identify whether or not your symptoms are the result of prostate cancer. It involves the doctor inserting one gloved lubricated finger into your back passage and identifying your prostate. It should not take longer than a minute or two and is generally not painful but a bit uncomfortable. While studies have proposed that the PSA is a better screening tool than the digital rectal exam, the combination of symptoms, the PSA and the examination should help your doctor determine whether or not you have cancer. (8)

What happens if I do have prostate cancer though?

It depends on how the disease has spread and/or if its fast growing. There are lots of medical and surgical options which the doctor may offer. However, for most men with prostate cancer, he is likely to die from something else (not the cancer). As a result, many old men, with other health problems are likely to get conservative management and the doctor is likely to use “watchful waiting” treatment.

How to prevent prostate cancer?

Eat a healthy diet rich in fruits and vegetables.

 

Conclusion

Prostate cancer is a very important condition which needs greater awareness. Men are more likely to die younger than their female counterparts and this gender divide is worth addressing. (9) However, it must be underscored that the PSA is not a very good test to screen for prostate cancer and as a result of this, it is not routinely used in many parts of the world. Further information could be found at:  Link 1, Link 2, Link 3

References

1. The Movember Foundation. Link at: http://uk.movember.com/about/foundation Acessed on 16/11/15
2. Andriole, Gerald L., et al. “Mortality results from a randomized prostate-cancer screening trial.” New England Journal of Medicine 360.13 (2009): 1310-1319.
3. Hugosson, Jonas, et al. “Mortality results from the Göteborg randomised population-based prostate-cancer screening trial.” The lancet oncology 11.8 (2010): 725-732.
4. Kilpeläinen, T. P., et al. “False-positive screening results in the Finnish prostate cancer screening trial.” British journal of cancer 102.3 (2010): 469-474.
5. American Cancer Society. Testing for Prostate Cancer. Link at: http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-024618.pdf Acesed on: 16/11/15
6. Patient.co.uk The Prostate Specific Antigen Test. Link at: http://patient.info/health/prostate-specific-antigen-psa-test Acessed on 16/11/15.
7. National Cancer Institute. Prostate Specific Antigen Test. Link at: http://www.cancer.gov/types/prostate/psa-fact-sheet/print Acesed on 16/11/15.
8. Carroll PR, Parsons JK, Andriole G, et al. Prostate Cancer Early Detection. Version 2.2015. In: National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines). NCCN 2015
9. Explanatory note on the 2014 Human Development Report composite indices: Trinidad and Tobago. Link at: http://hdr.undp.org/sites/all/themes/hdr_theme/country-notes/TTO.pdf Acessed on 18/11/15.