How We Use PSA to Stratify Prostate Cancer Risk

Doctor in gloves holding a PSA test tube

PSA has a fascinating past. First discovered in the late 1970s, PSA ushered a catalyst in prostate cancer treatment and survivability. Knowing that there was a measurable compound specific to the prostate that was sensitive to cancerous development was a huge step forward. Indeed, this led to widespread and, most would argue, overuse of PSA to detect possible prostate cancer, direct biopsies, and ultimately treat it. There’s still the misconception today that a PSA of about four or greater is a definite marker of prostate cancer, requiring a biopsy. This interpretation of PSA, which was prevalent throughout the 80s and 90s, resulted in many men getting unneeded prostatectomies, which, as we know, can lead to urinary incontinence and erectile dysfunction. After this realization, PSA found itself in the dog house and was labeled one of the least helpful cancer diagnostic tests.

The Comeback

Over the past decade or two, we have modified our way of looking at the PSA, eliminating the previous thinking that there is a setpoint at which PSA means cancer and instead using a trend test. This test is just as it sounds; we look at the trend in PSA rather than a fixed number, and in doing so, we can deduce when patients have concerning, aggressive, or fast-growing prostate cancer. After all, you may know that prostate cancer is a dichotomy. On one end, slow-growing prostate cancer may never need to be treated. On the other, an aggressive form of prostate cancer is deadly.

Our new way of measuring PSA considers baseline levels that may be elevated as a result of benign prostate hyperplasia/enlarged prostate/BPH. Inflammation or infection of the prostate can also cause an increase in PSA. None of these are malignant and do not require a biopsy. However, if over a relatively short period, call it months, the PSA is rising significantly, we know there is something at play, and it could be the early stages of prostate cancer. As such, visiting an experienced, qualified men’s health urologist like Dr. Natale is your best bet for getting a diagnosis and, ultimately, a treatment plan.

What’s Next

First, if you are not on a regular prostate cancer screening regimen and you’ve reached middle age, speak to Dr. Natale about what that should look like. Regular screenings, including PSA tests, are very useful in catching early-stage prostate cancer, making a swift diagnosis, and ultimately choosing the most effective treatment plan. If you are diagnosed with prostate cancer, make sure you speak to Dr. Natale about what that exactly means. While cancer will strike fear into even the bravest of us, prostate cancer does not necessarily equal aggressive. Some cases of prostate cancer are so slow-growing that many clinicians want to classify low-grade prostate types to exclude the word cancer.

No matter your diagnosis, it’s essential to be under the care of a qualified health urologist to understand your prostate function and get advice for any urinary issues you may have.

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