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Prostate Cancer and PSA Trends

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The prostate-specific antigen (PSA) blood test started being used two decades ago as a detection method for prostate cancer. PSA is a protein manufactured in the prostate, and there is a relationship between the PSA level and the likelihood of the man having prostate cancer.

As a man ages, his prostate grows which is known as benign prostatic hyperplasia (BHP). This increase in size also elevates the PSA, which leads to controversy as to whether or not to send the man for a prostate biopsy. A biopsy is the method by which prostate cancer is diagnosed, but it is an invasive procedure.

The level of a man’s PSA changes over his lifetime. As he ages and his prostate enlarges, his PSA level rises naturally and this higher PSA level can be considered normal. If a normal PSA level is 2.5, a man in his 70s might accept a level of over 2.5 because the likelihood of that person’s elevation of PSA being a consequence of benign prostatic hyperplasia is much greater than his likelihood of having prostate cancer. For younger men, it might be a cause of concern if the PSA rises above 2.5.

Doctors also like to monitor the trend of the PSA level, and the rate at which it changes over time. For instance, a PSA that rises gradually over many years is much less concerning than a number that jumps from 2 to 4 in less than one year. The change of PSA level over time is known as the PSA velocity. And PSA doubling time is the time it takes for the PSA to go from a tested level to twice that level. The shorter the PSA doubling time is, the greater the rate of growth of a man’s prostate cancer.

The treatment for early stage prostate cancer is usually surgery or radiation therapy. If the prostate is surgically removed, the PSA level will drop to about zero. If a man undergoes radiation therapy, there may still be some detectable PSA, but at very low levels. After both surgery and radiation therapy, doctors generally check the PSA every three months from then on. If the PSA level remains stable over time, the likelihood is strong that the person has been cured. Ongoing tests of the PSA level are an important way to monitor a person who has had prostate cancer.

When the PSA level climbs over several sequential measurements in a short space of time, it is considered to indicate PSA-detectable disease, PSA recurrence, or what is called a biochemical failure. But again, as a man ages and his prostate enlarges, the level of PSA rises normally. There are men who have a rising PSA level after treatment, but who will never have any problem with recurrent cancer. The way doctors monitor and manage a PSA recurrence and decide the proper reaction varies from one patient to the next.

If a man who has had prostate cancer experiences a rapidly rising PSA occurrence, it is possible that the cancer has come back. A large increase in PSA level can be a warning of cancer before the cancer is even detectable on a scan.

Aggressive prostate cancer treatment can make a difference in the longevity of a man. One of the available treatments is the use of hormonal or androgen-deprivation therapy, to prevent the production or action of the male hormone testosterone, which can encourage prostate cancer cell growth. Hormone therapy is achieved by the use of drugs or by the surgical removal of the testicles. However, hormonal treatments often become ineffective over time, and rising PSA levels may be the first indication.

PSA testing is one of the best means to detect cancer in its early stages, or a recurrence of cancer after remission, and is strongly recommended by doctors.

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