Understanding the PSA and Using it Wisely

The beleaguered PSA test is one of the most misunderstood medical tests in today’s headlines. The recent wholesale bashing of the test and the U.S. Preventive Task Force’s recommendation against testing has been a great disservice to men and created greater confusion around just what PSA testing is and isn’t. In my case, I believe there is little doubt that the PSA test helped to save my life.

Since the age of 40, I have had a PSA test and digital rectal exam as part of my annual physical. In 2010, my PSA nearly doubled from the year before and my subsequent biopsy revealed a Gleason score of 7 (4+3) and involvement in 50 percent of my little gland. My urologist classified my prostate cancer as an aggressive variety. Working where I do—at the Prostate Cancer Foundation—I fully agreed.

Unfortunately, after having a radical prostatectomy (full removal of the gland), the post-surgical pathology revealed that my cancer had spread to my lymph nodes. It was on to seven weeks of radiation therapy and two years of androgen deprivation therapy that cuts the production of testosterone that can fuel the growth and progression of this cancer.

While the journey is not an easy one, PSA helped my medical team arrive at an initial diagnosis. Post-treatment, quarterly PSA tests will help us identify the return of cancer if and when it recurs.

What the PSA Is—and Isn’t
Contrary to popular thought, the PSA is NOT a cancer test. It measures prostate specific antigen, which is present in small quantities in men with healthy prostates. However, in the presence of prostate cancer or other prostate disorders such as prostatitis (an infection) or benign prostate hyperplasia (enlargement of the prostate gland), PSA levels can be elevated. Thus, the test is more of a smoke alarm to signal that something might be awry in the prostate.

Since prostate cancer is often asymptomatic, when a man’s PSA levels reach more than 4, it is typically the signal for a physician to consider ordering a biopsy and have a pathologist determine if prostate cancer is present. The initial PSA test is just one step in the diagnostic process. While better, cancer-specific biomarkers are in development, the PSA test remains an important tool when used correctly and with informed patient consent.

If cancer is determined to be present, the pathologist will assign a Gleason score to the cancerous cells. This score, in combination with other factors including PSA velocity (the rate at which PSA levels increase) and percent of involvement, will aid a man’s physician in assessing the potential aggressiveness of the cancer and, in consultation with the patient, in recommending treatment options appropriate for the patient. With 27 known genotypes or varieties of prostate cancer, it is true: some men will die with prostate cancer and not as a result, while others may require moderate to aggressive courses of treatment.

Instead of bashing the PSA test, we would do better to educate the public on the test’s actual capabilities and promote the need to make informed decisions with one’s physician and an understanding that not all prostate cancers are life threatening. This is a better way to move the needle on the urgent need to over-treat less and cure more.


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Dan Zenka

Dan Zenka, senior vice president of the Prostate Cancer Foundation was diagnosed with his own case of prostate cancer in April 2010 at the age of 51. He had a radical prostatectomy in June and was subsequently diagnosed with Stage 4 metastatic cancer. He completed seven weeks of radiation treatment in December 2010 and endured two years of androgen deprivation therapy, which he is soon concluding. He started this blog within days of his original diagnosis to share information and patient perspectives and, most importantly, to encourage men to talk about prostate cancer.

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