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Prostate Cancer Early Detection – Why Is It Important?

By Robert L. Waterhouse, Jr., MD

What is the prostate gland?

The prostate gland is a small organ (the size of a walnut in the non-diseased state) that lies at the base of the bladder in men.  When it grows, it can interfere with bladder emptying because of its location.  It produces ejaculatory fluid that combines with sperm to make semen.  Unfortunately, like many organs in the body, it can develop cancer and attack normal tissues in an uncontrolled fashion.

What is PSA?

PSA stands for prostate specific antigen.  It is a protein naturally produced by the prostate gland as a secretion that facilitates the thinning of semen.  A small amount of the protein circulates in the blood stream.  When the prostate is diseased or has cancer, a larger quantity of the protein is released into the blood stream.

How should screening for prostate cancer be performed?

Screening should be offered at age 40.  Men of African American ethnicity have 2 fold increased incidence of prostate cancer and higher death rate from it and should definitely start at this age.  Also, men who have a family history are at greater risk.  Screening includes drawing blood from a small vein in the arm the way other blood tests are performed which will measure PSA and performing a palpation of the prostate gland by a rectal examination.  It is important to note that screening refers to testing of men who have no symptoms.  Prostate cancer does not produce any symptoms at its earliest stages.  Men should not believe they should avoid screening because they don’t have symptoms.  It is, also, important to note that there is no single PSA cutoff value that is uniformly normal for every man.  The PSA value needs to be interpreted based on multiple factors including the patient’s age, size of the prostate gland, change of PSA from year to year, and overall health of the patient.

What are the benefits of prostate cancer screening?

Screening facilitates detection of prostate cancer at its earliest stages to allow treatment before it progresses.  Early treatment can hopefully prevent progression of the cancer to a stage of spreading to other areas of the body or even causing death.  Potential for cure from treatment is much greater before the disease spreads.  In the last 2 decades, since PSA screening has been used, the vast majority of prostate cancer diagnosed is localized to the prostate at the time it is discovered.  Before PSA, over 30% of prostate had spread to other areas of the body at the time of initial diagnosis.  However, there has been some controversy over whether PSA is a good screening tool.  One thing that is undeniable is that there is no better laboratory blood test works as well as PSA for any cancer.  The results just need to be interpreted appropriately.  In addition, some research studies have been done to look at how screening affects risk of dying from prostate cancer.  In two very large studies – one reported with 182,000 men published in the New England Journal of Medicine in 2009 and one with 20,000 men published in Lancet Oncology in 2010 – risks of prostate cancer death was reduced forty percent.

Closing comments

Men need to be proactive in taking control over their health.  There is no specific supplement to take to prevent prostate cancer but it is commonly thought that a diet low in fat and rich in fruits, vegetables, and nuts is best.  More than 30,000 men die of this disease in the United States each year (which many believe is a low estimate) – so there remains a lot of community education, research, and work to be done.