Prostate diseases are among the most common health
problems in the elderly male population. PCI is a tool
available to educate patients and to promote their involvement
in decision making regarding their healthcare, making
them more knowledgeable about their medical condition
and more satisfied with the decision- making process
and the therapy.
PCI is concerned about patients receiving treatment for
different prostate problems such as benign prostatic hyperplasia,
prostatitis and prostate cancer as well as screening tests
for prostate specific antigen.
Only your doctor can tell for sure whether or not you
have an enlarged prostate. However, you can help your doctor
diagnose your condition by knowing the symptoms and warning
signs of an enlarging prostate. The more you know, the
better. The doctor can tell if your symptoms are from a
benignly enlarged prostate and not a more serious condition,
such as prostate cancer. See your doctor for regular exams.
Screening for prostate cancer
The purpose of screening for cancer is to detect the cancer at its earliest
stages, before any symptoms have developed.
Typically, men whose prostate cancer is detected through
screening are found to have very early-stage disease that
can be treated most effectively.
Screening for prostate cancer can be performed quickly
and easily using three tests: the digital rectal exam (DRE),
transrectal ultrasound scan TRUS and the PSA (prostate-specific
antigen) blood test.
To help with the diagnosis, your doctor will do a digital
rectal exam DRE. During the examination, the doctor inserts
a gloved, lubricated finger into your rectum to feel the
prostate and see how big it is. its characteristics help
the doctor predict whether your PSA reading is likely to
indicate a cancer or not. While it is uncomfortable, the
brief exam is not painful. However, because the finger
can only reached to that part of the prostate that can
be felt per rectum, there is need for aid by way of TRUS
to assess the anterior aspect of the gland.
Transrectal ultrasound
In this procedure, an ultrasound probe into the rectum to view the prostate
gland through a image projected on the monitor. it shows the prostate gland
structure entirely and suspicious areas may be identified. During this procedure,
a biopsy may be done. the visual display helps so that the doctor can guide
the precise insertion of the biopsy needles through the wall of the rectum
to take about 6 to 8 core tissue samples from the prostate. The needles are
inserted only for a fraction of a second, and the procedure is essentially
painless. It takes about 20 minutes. Tissues sample may be taken which are
sent for histopathology, where they will be examined for presence of cancer.
Screening men for prostate cancer involves measuring the
PSA level of all men in the ‘at risk’ age group
(over 50 years), even if they do not have any symptoms.
The PCI help men decide whether to have a PSA test. It
recommends that men who are concerned about prostate cancer
are given information about the advantages and disadvantages
of the PSA test and prostate cancer treatment.
Screening for cancer is an important part of cancer care.
The aim of screening is to diagnose disease
At an early stage
Before symptoms start
When it is easier to treat
When it is more likely to be curable
At the moment, there is no single, effective screening test for early prostate
cancer in healthy men and the triage adopt above is best.
PSA
PSA is a protein that is only produced by the prostate
gland. Its job is to keep the fluid that carries sperm
(semen) in a liquid form. All men have some PSA in their
blood, and the level can be affected by several factors,
including age, infection and some medications.
Age PSA rises with age. The accepted normal PSA test result is up to 2.8 ng/ml
for men in their 50s, and up to 4 ng/ml for men in their 60s. For men in their
70s, a PSA of up to 5.3 ng/ml can still be normal. However, PSA ranges may
vary slightly between laboratories, as they may use different testing kits.
Infection A urine infection can cause the PSA to rise. You will have a simple
urine test to rule out infection before having a PSA test. If the test result
is not clear, a urine sample will be sent to the laboratory and you will be
given a course of antibiotics. Any infection should be treated before you have
a PSA test.
Ejaculation
Ejaculation in the 48 hours before a PSA test may affect the results,
especially in younger men.
Prostate biopsy If you have had a biopsy in the six weeks before a PSA test,
this can affect the PSA result.however practically, this should occur as an
elevated PSA is the prerequisite for prostate biopsy.
Digital rectal examination (DRE)
This remains controversial however if possible,
the PSA test should be done before a DRE
BPH (Benign Prostatic Hyperplasia) BPH is a common condition that mainly affects
men over the age of 50. It is a non-cancerous enlargement of the prostate.
The increase in size may cause the prostate gland to produce more PSA.
Prostatitis
This is inflammation of the prostate gland, which can affect men
of all ages. It can be caused by a bacterial infection or BPH. The inflammation
allows more PSA to move from the prostate into the blood causing the PSA level
to rise.
Prostate cancer Prostate cancer may cause the PSA level in the blood to rise.
However, some men with early cancer may not have a raised PSA.
.
The PSA Test
The standard PSA test is a simple blood test that measures the total amount
of PSA in your bloodstream. It can show that there is a problem with the
prostate, which may sometimes turn out to be prostate cancer. PSA is released
in very small amounts into the bloodstream. When there’s a problem
with the prostate, such as when prostate cancer develops and grows, more
PSA is released, until it reaches a level where it can be easily detected
in the blood.
During a PSA test, a small amount of blood is drawn from
the arm, and the level of PSA is measured. PSA levels under
4 ng/mL are usually considered "normal", results
between 4 and 10 ng/mL are usually considered "high
normal", while results over 10 ng/mL are usually considered
to be "pathological".
PCI is not about the use of the PSA test only when a man
has symptoms which could be prostate related, but about
the possible widespread and systematic use of the PSA test
involving apparently 'well' men. The aim is to have a system
in place where men, otherwise apparently well and symptom
free, receive regular invitations for the PSA blood test
which might indicate the need for further tests for prostate
cancer.
Many men with prostate cancer believe that their lives were saved because they
had a PSA test, and are keen that all men have PSA tests regularly through
a screening programme. Other men diagnosed with prostate cancer at an advanced
stage are angered that they had no early warning and support screening.
It can take between one and two weeks to get the test
results. If the result is high there may be need for you
to have further tests. The PSA result cannot tell you whether
or not you have prostate cancer. A raised PSA can be caused
by other conditions such as BPH (Benign Prostatic Hyperplasia)
or prostatitis. The higher the level of PSA, the greater
the risk that prostate cancer is the cause.
If you have a normal PSA test result, it is unlikely to
get any new information from a repeat test within 2 years.
If borderline, you should have a repeat test in 1 - 3 months
to check if the level is on its way up or stable.
The PSA test is not a test for cancer but can assess your
risk
Advantages
It may pick up prostate cancer before you get any symptoms
It may pick up cancer at an early stage when treatment can prevent the cancer
from becoming more advanced
A normal test result may reassure you
Disadvantages
It may not pick up some early cancers as up to a fifth of men who have prostate
cancer will have a normal PSA level
If your PSA is raised, you may need further tests and treatment that carry
their own risks and side effects
It cannot tell you whether a prostate cancer is likely
to be fast or slow growing
It may pick up a slow-growing cancer that would not have caused any symptoms
or shortened your life span
In view of the drawbacks, PCI thus applies the triad approach.
The PSA test will not help to identity all prostate cancers.
Equally, not all cancers which it will help to identify,
will need treatment.
Most prostate cancers are slow growing and will never
become life threatening. Some, of course, are aggressive
and potentially life threatening. These aggressive prostate
cancers which cause most concern will not necessarily be
picked up by screening with the PSA test, as they can develop
in the intervals between ‘screening.’ Some,
of course, would be. Equally, not all aggressive cancers
change the PSA level and would therefore avoid detection.
If you decide to have a PSA test, your doctor will make
sure you have been given information about the test before
going any further. If you are at a higher risk of getting
prostate cancer, for example if your father or brother
had it or if you are of African or Caribbean background,
you should speak to your doctor for advice on your individual
situation. You can also call our helpline on 234-1-8922649.
RESULTS ANALYSIS
If your PSA level and rectal examination
are both normal, it is unlikely that you have prostate
cancer and you will not need to have any further tests.
If the PSA is slightly raised, you may need some more tests
or another PSA test in the near future. A raised PSA can
be caused by many factors. If your PSA level is higher
than normal, and the DRE is 'abnormal' then a biopsy is
indicated during TRUS.
If the biopsy indicates the presence of cancer, further test are needed to
determine its extent eg IVU, CT scan, bone scan etc. The result are used to
determine the stage and grade of the cancer which will be instrumental in choosing
the best treatment option(s).
PSA monitoring PSA tests are used to check if and how
well you are responding to treatment. Regular tests can
also be used to check that the cancer is not growing again
after treatment. Even if you have had your prostate removed,
the PSA test can be used to check that no prostate cancer
cells have spread to other parts of your body. If your
PSA starts to rise, you may need further treatment.
Follow-up After Treatment
Prostate Care Initiative encourages follow -up of its patient. it aims to follow
patients for at least 10 years. If you have received treatment for localized
prostate cancer, you will come for checkups every three to six months for the
first two years after your treatment for prostate cancer is completed.
Those who reach the two-year mark without having a recurrence
of their disease will be seen less often henceforth. Appointments
are then scheduled for every 6 to 12 months for a checkup
for the next 5 years.
Thereafter, once yearly.
Men who are managed for advanced prostate cancer will
be followed more closely, with much more frequent appointments.
SUMMARY
Prostate cancer is not always an aggressive disease. It can be very slow growing.
Many men with prostate cancer don't have symptoms. Prostate cancer grows
slowly in many older men and they are unlikely to die from it. These men
don't really need treatment.
Other men do need treatment.
Men who are diagnosed with prostate cancer aren't always given all of their
treatment options. Prostate Care Initiative offers a dedicated care coordinator
who serves as an advocate for patients' right to know. You'll meet with our
care coordinator, who will explain all treatment options and provide support
so you can pick the option that's best for you.
|
