Excel Urology
Prostate Cancer

Prostate cancer is the most common non-skin cancer in men in the United States. It is also the second-leading cause of cancer death in men. One in six men will be diagnosed with prostate cancer. African-American men face a one-in-three chance of being diagnosed. Over 28,000 men die each year from prostate cancer, but early detection may save lives.

The Urology Department is concerned that recent reports about PSA (Prostate Specific Antigen) testing may confuse patients about the value of this prostate-cancer screening tool. The PSA test is not perfect. However, when used correctly, this blood test gives important information. The PSA test can help diagnose, assess the risk of, and monitor prostate disease such as cancer.

The Urology Department believes men should talk to their health care provider about whether to get screened or not. Talk with your provider about the benefits and risks of testing. You should also talk about factors that can increase your risk for prostate cancer, including:

  • Your family history of prostate cancer (Did your father, brother or other relative have prostate cancer?)
  • lf you are African-American
  • A high BMI (a measure of your body fat)
  • Your age
  • Your previous health history
What is PSA?

PSA is a substance made by the prostate gland. The level of PSA in a man's blood can be a marker of many different prostate diseases, not just prostate cancer. The PSA test became available in the early 1990's and has been used widely since.

A number of things can change PSA levels and should be kept in mind when reading the results. High PSA levels can be caused by more than just prostate cancer. Other causes of higher PSA levels include:

  • Prostatitis (inflammation of the prostate) and other types of Urinary Tract Infections (UTIs)
  • Benign Prostatic Hyperplasia (BPH - enlargement of the prostate)
  • Injury
  • Treatments such as prostate biopsies (tissue samples) or cystoscopy (a test to look inside the urethra and bladder)

Men choosing the PSA test should know their results could be influenced by some important factors, such as:

  • Blood PSA levels tend to rise with age
  • Larger prostates make more PSA
  • Change in PSA levels over time (known as PSA velocity) can be markers of both cancer risk and how quickly a cancer may be growing

A prostate biopsy (tissue sample) is the only way to know for sure if you have prostate cancer. The decision to go ahead with a prostate biopsy should be based mostly on PSA and findings on a digital rectal exam (physical exam of your prostate). Other factors to take into account include your family history of prostate cancer, your race, results of any prior biopsies and other major health issues you may have.

The choice to use PSA for early detection of prostate cancer is a personal choice. While PSA screening has been shown to have benefits, it also carries risks.

Possible Benefits of having a PSA Test
  • A normal PSA test may put your mind at ease
  • A PSA test may find prostate cancer early before it has spread
  • Early treatment of prostate cancer may help some men slow the spread of the disease
  • Early treatment of prostate cancer may help some men live longer
Possible Risks of having a PSA Test
  • The PSA test is not perfect. A normal PSA result may miss some prostate cancers (a false negative)
  • Sometimes the test results suggest something is wrong when it isn't (a false positive). This can cause unneeded stress and worry.
  • A false positive PSA result may lead to an unneeded prostate biopsy (tissue sample)
  • A positive PSA test may find a prostate cancer that is slow-growing and never would have caused you problems
  • Treatment of prostate cancer can cause side effects. Short or long term problems that can occur are issues with getting erections (ED), leaking urine or bowel function

Before you decide to have a PSA test, talk with your doctor about the benefits and risks of testing. Also talk about your individual risk of prostate cancer, including your personal and family health history.