Considering a PSA Test? Don’t “Shave” It For Later.

HYANNIS – When it comes to the PSA test, the most important numbers to know are 55 to 69.

Those aren’t result numbers. They’re the ages at which it’s important for men to have the PSA (prostate-specific antigen) test as part of an annual exam, according to Brian Kowal, MD, of Urology Associates of Cape Cod, which has offices in Hyannis, Sandwich and North Falmouth.

For most men, there’s less benefit to the test before and after those years, but there are important exceptions, he said.

For the PSA test, a blood sample is analyzed. Men with prostate cancer usually have an elevated level of PSA.

“Prostate specific antigen really has one job – to liquify semen, which starts out as a coagulum,” Dr. Kowal said. “Thirty or forty years ago, researchers realized that men with prostate cancer showed higher levels of serum PSA. That’s when PSA was recognized as a screening tool.”

Who and When?
Under American Urological Association guidelines, the screening is not recommended for most men under 55.

“Screening between the ages of 40 to 54 years is based upon those groups that have increased risks,” said Dr. Kowal. That includes men whose father or brother had prostate cancer, especially at a young age, or if it was a high-grade cancer. Another risk factor is a family history of breast cancer, ovarian cancer or pancreatic cancer spanning multiple generations. African American men are another high-risk group who should consider earlier PSA screening.

Because prostate cancer tends to develop very slowly, most men over 70 do not need routine PSA screening, but Dr. Kowal said there also are exceptions in that group.

“If you have a greater than 10- to 15-year lifespan, you can continue the screening,” he said. “Somebody who’s completely healthy at 70 years old, runs marathons, is on one or two meds, had parents who lived into their nineties and looks like they’re heading in the same direction, they can certainly consider continuing prostate cancer screening past the age of 70.

“It’s something that I tailor to people, based upon their health and their family history and also upon what their own fears and predispositions may be driving them to do.”

A Silent Illness
“One thing to know about prostate cancer is that generally it tends to be an illness that’s very silent,” Dr. Kowal said. “Many of my patients, when I tell them they have prostate cancer, are very surprised because they essentially have no symptoms.

“People usually have many more symptoms from benign prostate disease rather than from prostate cancer. Most of the time you really won’t detect anything for prostate cancer until you have advanced disease.”

Prostate cancer may be suspected either due to PSA results or when a doctor discovers a nodule during a digital rectal exam.

“There’s no imaging or lab test that can prove that you have prostate cancer,” said Dr. Kowal. “The biopsy is the gold standard test to diagnose prostate cancer.”

The clear majority of prostate cancers that are detected early by PSA screening or by rectal exam screening are curable, he said.

“When I go over a patient’s initial biopsy results, I usually give them a risk calculation and, even for people who have very advanced cancers, it’s usually less than a 1 percent chance of dying of prostate cancer over the next 10 or 15 years with treatment.”

An elevated PSA level is not always linked to cancer.

“Sexual activity, if it happens within a few days of the PSA, can make the PSA go up,” he said. “Bike riding or motorcycle riding, or sometimes if somebody doesn’t empty their bladder well, that can make the PSA go up. I had a couple of motorcycle riders who had very elevated PSAs, especially at the end of a long summer of riding. I told them to stay off the bike for a couple of weeks and their PSAs came down.”

“The most important thing about the PSA is that you don’t necessarily have to make all your judgments based upon one elevated result. I will usually validate it with a second result.

Urologists have been trained in how to interpret the PSA results and how to calculate your risk of having prostate cancer as accurately as possible, Dr. Kowal said.

“We then come to a shared decision about whether to go forward with a biopsy or not. The main thing is making sure that you get evaluated, get all the information, confirm the result, and then make a decision going forward based upon all the best information.”

By BILL O’NEILL, Cape Cod Health News