By Dr Raju Abraham
Making the decision to have a PSA (prostate-specific antigen) test depends on a variety of factors. Here are some tips that can help you make a good decision.
Cancer screening tests, including the PSA test, to look for signs of prostate cancer, can be a good idea. Prostate cancer screening can help identify cancer early on, when treatment is most effective. And a normal PSA test, combined with a digital rectal exam, can help reassure you that it’s unlikely you have prostate cancer.
Professional organisations vary in their recommendations about who should and who shouldn’t get a PSA screening test. While some have definitive guidelines, others leave the decision up to men and their doctors. Organisations that do recommend PSA screening generally encourage the test in men below 40 years and in men with an increased risk of prostate cancer.
Ultimately, whether you have a PSA test is something you should decide after discussing it with your doctor, considering your risk factors and weighing your personal preferences.
What is PSA?
Prostate specific antigen is a protein produced by both cancerous (malignant) and noncancerous (benign) prostate tissue. PSA helps liquefy the semen. A small amount of PSA normally enters the bloodstream. Prostate cancer cells usually make more PSA than do benign cells, causing PSA levels in your blood to rise. But PSA levels can also be elevated in men with enlarged or inflamed prostate glands. Therefore, determining what a high PSA score means can be complicated.
Besides the PSA number itself, your doctor will consider a number of other factors to evaluate your PSA scores:
* Age
* The size of your prostate gland
* How quickly your PSA levels are changing
* Whether you’re taking medications that affect PSA measurements, such as finasteride (Propecia, Proscar), dutasteride (Avodart) and even some herbal supplements.
When elevated PSA isn’t cancer
While high PSA levels can be a sign of prostate cancer, a number of conditions other than prostate cancer can cause PSA levels to rise. These other conditions could cause what’s known as a ‘false positive’, meaning a result that falsely indicates you might have prostate cancer when you don’t. Conditions that could lead to an elevated PSA level in men who don’t have prostate cancer include:
* Benign prostate enlargement (benign prostatic hyperplasia)
* A prostate infection (prostatitis)
* Other less common conditions
* False positives are common. Only about 1 in 4 men with a positive PSA test turns out to have prostate cancer.
When prostate cancer doesn’t increase PSA
Some prostate cancers, particularly those that grow quickly, may not produce much PSA. In this case, you might have what’s known as a ‘false negative’, a test result that incorrectly indicates you don’t have prostate cancer when you do. Because of the complexity of these relating factors, it’s important to have a doctor who is experienced in interpreting PSA levels evaluate your situation.
What’s the advantage of a PSA test?
Detecting certain types of prostate cancer early can be critical. Elevated PSA results may reveal prostate cancer that’s likely to spread to other parts of your body (metastasize), or they may reveal a quick growing cancer that’s likely to cause other problems.
Early treatment can help catch the cancer before it becomes life threatening or causes serious symptoms. In some cases, identifying cancer early means you will need less aggressive treatment, thus reducing your risk of certain side effects, such as erectile dysfunction and incontinence.
What’s risky about a PSA test?
You may wonder how getting a test for prostate cancer could have a downside. After all, there’s little risk involved in the test itself, it requires simply drawing blood for evaluation in a lab. However, there are some potential dangers once the results are in. These include:
* Worry about false positive results caused by elevated PSA levels from something other than prostate cancer.
* Invasive, stressful, expensive or time consuming follow-up tests.
* False reassurance from a PSA test that doesn’t reveal cancer (false-negative), leading to a missed diagnosis of aggressive prostate cancer that needs treatment.
* Stress or anxiety caused by knowing you have a slow growing prostate cancer that doesn’t need treatment.
* Deciding to have surgery, radiation or other treatments that cause side effects that are more harmful than untreated cancer
Digital rectal examination
The PSA test isn’t the only screening tool for prostate cancer. Digital rectal examination (DRE) is another important way to evaluate the prostate and look for signs of cancer. Your doctor performs the test by inserting a gloved, lubricated finger into your rectum to feel the prostate for bumps or other abnormalities. It’s a quick, safe and easy test.
In addition to checking for signs of prostate cancer, your doctor can use a DRE to check for signs of rectal cancer. A DRE should always be done with a PSA test when screening for prostate cancer. This will help minimise the risk of missing prostate cancer or wrongly identifying a benign prostate abnormality as cancer.
Trans rectal ultrasound study plays an important role in the detection of prostate cancer along with PSA and DRE.
Risk factors
Knowing the risk factors for prostate cancer can help you determine if and when you want to begin prostate cancer screening. The main risk factors include:
Age: As you get older, your risk of prostate cancer increases. After age 50, your chance of having prostate cancer increases substantially. The majority of prostate cancers are found in men age 65 or older. The option to have PSA testing begins at age 40 and continues until you’re at the age when your life expectancy is 10 years or fewer. Once you reach that age, the likelihood that a prostate cancer would progress and cause problems during the remainder of your lifetime is small.
Race: For reasons that aren’t well understood, black men have a higher risk of developing and dying of prostate cancer.
Family history: If a close family member, your father or brother was diagnosed with prostate cancer before age 65, your risk of the disease is greater than that of the average man. If several of your first degree relatives, father, brothers and sons have had prostate cancer at an early age, your risk is considered very high.
Diet: A high fat diet and obesity may increase your risk of prostate cancer.
How does it add up?
A positive PSA test can be a lifesaver for some men, identifying prostate cancer that needs treatment early. It’s generally a good idea to have PSA testing done if you’re at increased risk of prostate cancer. However, not all men need to have the screening. You may want to think twice if you’re in a group of men unlikely to benefit from it. After considering the pros and cons of screening, your age, general health and risk factors, your preferences and what the experts say, talk to your doctor. Together you can make the right decision for you.
Many heart-attack
survivors make no
changes after event
By Tara Kulash
There’s no stronger scare tactic into leading a healthy lifestyle than suffering a heart attack or stroke, which is why it may be surprising that many survivors don’t make changes needed to improve their health.
A study published in April in the Journal of the American Medical Association shows one in four men doesn’t make any lifestyle changes after a heart attack, stroke or other major cardiac event. Women were more likely to change unhealthy behaviours, and urban residents were more likely to make at least two lifestyle changes than those who lived in rural areas.
Three behaviours were included for the study: smoking cessation, healthy eating and physical exercise. Out of 7,519 patients surveyed in 17 countries, just 4.3% of participants improved their habits in all three areas, more than 30% made two lifestyle changes and more than 47% changed at least one lifestyle behaviour to better their health.
Dr Mark Friedman, a cardiologist at the SSM Heart Institute, said changing one’s lifestyle can be very difficult. “Patients don’t want to be talked down to,” he said. “They don’t want to be told they’re bad.”
But much of the problem is lack of education. While patients used to stay in the hospital for up to two weeks after a cardiac event, they now are discharged within a day or two. This leaves little time for the medical staff to educate patients on what happened to them and what it could mean for their future.
Friedman attempts to motivate patients by starting small. While the American Heart Association recommends walking for 30 minutes a day five times a week, the SSM cardiologist encourages his patients to begin with walking three days a week. He also recommends frozen fish and fruit for those on a low budget.
What really surprised Friedman about the study is that patients had the most success with smoking cessation — more than 52%. People in wealthier countries had more success than those in poorer countries, the study showed. Friedman said higher income individuals are likely to have more education and resources to quit smoking.
The numbers pleased him, though, as Friedman said smoking cessation is one of the best ways to avoid heart disease. Still, he said he believes it is one of the hardest habits for his patients to cut, and they have to really want to stop for it to work.
Other changes include diet, with 39% reporting eating more healthful food, and physical activity, with 35% saying they were more active.
Urban area residents were 22% more likely in the study than those in rural areas to make at least two lifestyle changes. Friedman said this could again be because of more education and resources in cities. More physical activity was reported by people at all income levels.
Women were more likely than men to make lifestyle changes after a major cardiac event.
More than 7% of women made all three recommended lifestyle changes, compared to less than 2.5% of men. They were also 66% more likely than men to make at least two lifestyle changes, and more than 26% of men changed nothing compared to about 7% of women.
Friedman and his team do their best to educate victims of major cardiac events by bringing in dieticians and models that show what’s happening in the patient’s body. Then they have a mandatory follow-up visit.
Deb Garbo, a nurse practitioner, sees patients shortly after their release from the hospital to prescribe medications and treatment. She said many people don’t absorb what they’re taught in the hospital because they’re more focused on being released, so it’s her duty to reteach the patients everything.
Garbo assesses patients’ readiness to make changes. Sometimes they will tell her that they aren’t confident they can handle breaking a habit, so she doesn’t force it on them.
A scared straight method that Garbo uses sometimes is she will ask the patients to hang a photo of their heart stent in their homes so they can look at it when they’re tempted to smoke a cigarette or eat unhealthily.
One way to succeed is to participate in a cardiopulmonary rehabilitation programme, she said.
At the heart institute, patients are overseen by a medical director for an hour three times a week for exercise and education. Amy Puricelli, a nurse at the St Mary’s Health Center cardio rehab, said the patients she sees usually are genuinely trying to make changes.
However, only 10% to 20% of patients eligible for cardiac rehab actually sign up for the programme. Many people may not be able to fit it into their work schedule. Rose Burns, 70, a St Louis resident, had a heart stent procedure four years ago because of a clogged artery and had to receive another stent in April.
Burns believed she was not at risk because of her slender build, so she continued to eat unhealthily after her first event. Now that she’s in the cardiac rehab programme, she said she feels more motivated because nurses hold her accountable by asking about her daily habits.
“I’m running out of years,” she said. “That makes a big difference in your life. It’s very important to me to have a lifestyle of better eating habits.”
Fred Piercefield, 73, had a heart attack in June 2012 and again in June of this year. He said he changed his diet after his first attack and did the cardiac rehab, but after his second attack he’s more aggressively making lifestyle changes. “A heart attack makes a believer out of you, and it shows you that you’re not invincible and not immortal,” he said.
Though the percentage of people making lifestyle changes after a major cardiac event is not as high as it could be, Friedman said he thinks there has been improvement, considering more than 50% quit smoking and 39% reported keeping a healthier diet.
“We’re on the right track,” he said. “But a lot more has to be done for sure.” — St Louis Post-Dispatch/MCT
Dr Raju Abraham is a specialist-urologist at Aster Medical Centre in Al Hilal.
