Can Prostate Cancer Be Detected Early?

Prostate cancer screening in the community can help some types of cancer to be found at an early stage where it is easier to treat. Prostate cancer can usually be detected early by testing the levels of prostate specific antigen (PSA) in the blood. Another way to find prostate cancer is with a palpable digital rectal examination (PRM) of the prostate. If the results of any of these tests are abnormal, further tests and prostate biopsy can usually be performed to see if cancer is present. In fact, most of the studies have focused on making this distinction. Thus, it is tried to reduce the diagnosis of clinically insignificant cancer and to avoid unnecessary biopsies. As a result, excessive treatments such as urinary incontinence, impotence and hormone use that reduce the quality of life are avoided. Sometimes, patients diagnosed as clinically insignificant may decide to have active monitoring without any treatment, even the examinations performed during the follow-up and the biopsies that need to be performed repeatedly create stress on the patient, and they are forced to be exposed to the side effects of biopsies such as infection and bleeding.

Screening Tests for Prostate Cancer

Screening is tests to detect prostate cancer in people before they have symptoms. However, it is unclear whether the benefits of community screening for prostate cancer outweigh the risks. However, after discussing the pros and cons of screening, some people may be screened.

PSA

Prostate specific antigen (PSA) blood test: Prostate specific antigen (PSA) is a protein made by cells in the prostate (both normal cells and cancer cells). PSA is found in large amounts (one million times) in semen, it is an enzyme that provides watering of the semen in the external environment, and a small amount passes in the blood. The level of PSA in the blood is measured in units of nanograms per milliliter (ng/mL). The higher the PSA level, the higher the chance of getting prostate cancer. increases, but there is no definite cut-off point that can tell with certainty whether prostate cancer is present. He often uses a PSA cut-off point of 4 ng/mL or higher, but may generally recommend starting at a lower level such as 2.5 or 3 ng/mL.

Prostate cancer Most men who do not have PSA levels below 4 ng/mL. When prostate cancer develops, the PSA level usually rises above 4. Still, a level below 4 is not a guarantee that a man does not have cancer. Prostate cancer can be detected if a biopsy is performed in approximately 15% of men with PSA levels below 4ng/mL. PSA, 4-10 ng/nl range is called gray-zone or border range, and the approximate prostate cancer risk is 25% in this range. If the PSA is higher than 10, the chance of getting prostate cancer is over 50%.

Factors that can affect PSA levels: One reason why it is difficult to use a specific cutoff point with a PSA test when looking for prostate cancer is because Many factors other than cancer can also affect PSA levels.

The following are factors that can increase PSA levels

• 1- Prostate enlargement: Benign prostatic enlargement (BPH) can increase PSA levels in non-cancerous prostate enlargement that affects many men as they age.

• 2 - Advanced age: PSA levels normally rise slowly as you get older, even if you don't have a prostate problem.

• 3- Prostatitis: Prostatitis: Prostatitis is an important clinical condition that can increase PSA levels, so much so in acute infections. .

• 4- Semen Ejaculation: May cause PSA to rise for a short time. For this reason, it is recommended to avoid ejaculation for a day or two before testing.

• 5- Cycling: Although some studies claim that cycling can raise PSA levels for a short time, this has not been proven.

• 6- Some urological procedures: Some procedures that affect the prostate, such as prostate biopsy or cystoscopy, may raise PSA levels for a short time. Some studies, It has been suggested, but not proven, that ital rectal examination (DRE) may slightly raise PSA levels. As a rule, it is recommended that the PSA test be performed before digital rectal examination.

• 7- Some drugs: Taking male hormones such as testosterone and taking these hormones can cause an increase in PSA.

The reasons that lower PSA levels are (even if prostate cancer):

• 1- Finasteride and Dudaster (5-alpha reductase inhibitors): Some drugs such as finasteride (Proscar) or dutasteride (Avodart), which are used to treat normal prostate enlargement or some urinary complaints, reduce PSA levels by half within 3 months. In areas, the PSA level is obtained by multiplying by two. These drugs may also affect the risk of prostate cancer and may mask prostate cancer by lowering PSA.

• 2- Herbal blends: Some blends sold as dietary supplements may mask high PSA levels. Saw palmetto, used in normal prostate enlargement, does not seem to affect PSA much.

• 3- Some other drugs: Some studies show that aspirin, statins (cholesterol-lowering drugs), and thiazide diuretics (hydrochlorothiazide) suggested that long-term use of certain drugs, such as

Special PSA types: Because PSA includes different forms of PSA, sometimes the total It is called PSA. If the PSA screening test result is not normal, he or she may sometimes consider different PSA tests to help you decide whether you need a prostate biopsy.

These special PSA derivatives are:

Percentage of free PSA:

strong>PSA occurs in the blood in 2 main forms. One form binds to blood proteins, while the other circulates free (unbound). The percentage of free PSA (% fPSA) indicates what percentage of the total PSA free PSA constitutes. The percentage of free PSA is lower in men with prostate cancer than in men without. Normally, it is expected to be above 25%. In particular, it guides us in making a biopsy decision in patients with blood total PSA levels in the range of 4-10 ng/mL (grey zone). Low free PSA and high total PSA levels are a finding that increases the probability of prostate cancer and is an effective factor in our decision to biopsy.

Complex-Complex PSA: This test directly measures the amount of PSA (the "non-free" part of PSA) that binds to other proteins. This test can be used in place of total and free PSA and may give us the same value of information, but is not widely used.

Tests that combine different types of PSA: Some new tests combine the results of different types of PSA to produce an overall score that reflects the chance of getting prostate cancer. Prostate Health Index (PHI)

-4Kscore test combining total PSA, free PSA, intact PSA and human kallikrein 2 (hK2) results with several other factors

These tests may be useful in patients with a slightly elevated PSA to help determine if they should have a prostate biopsy. These tests can also be used to determine whether a patient who has had a prostate biopsy but no cancer is found should have another biopsy.

PSA rate: PSA rate is different. It's not a test. It is a measure of how quickly the PSA rises over time. Normally, PSA levels gradually rise with age. It has been found that it increases more rapidly in prostate cancer patients. Although it is not used much, an increase of more than 0.74ng/mL/year per year can be considered significant.

PSA density (PSAD) : The volume (size) of the prostate gland is measured by transrectal ultrasound and the PSA level is divided by the prostate volume, that is, the amount of PSA per gram of tissue gives the PSA density. Normal value is expected to be below 0.15, biopsy can be considered with a value above 0.15.

Age-specific PSA ranges: Blood PSA levels are normally higher in older men than in younger men higher than. A PSA value in the upper range of normal may be worrisome for a 50-year-old man, but is less of a concern for an 80-year-old. Some age-specific PSA levels have been defined, but it is not a widely used test.

Digital Rectal Examination (PRM)

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In Finger Rectal Examination, while the prostate is felt very hard with a focus that may be cancer, the normal prostate tissue has the consistency of a rubber ball. It is unlikely to make a diagnosis on its own.

Prostate Cancer Screening Criteria

• 1- Age 50 for men at average risk of prostate cancer and expected to live at least 10 more years. Age 45 for people at high risk of developing prostate cancer. Among the risky people; Those who have a first-degree relative (father or brother) diagnosed with prostate cancer younger than 65 years of age and having black race can be counted. For men at higher risk, 40 is the age limit, and those who have more than one first-degree relative with prostate cancer at an early age are included in this group. People with these criteria can be screened by performing PSA and digital rectal examination.

• 2- Those who have BRCA gene mutation and/or those of African origin are included in the group with a high risk of developing prostate cancer

• 3- If the PSA value is less than 2.5 ng/mL in the patients who are included in the screening criteria, an annual PSA is determined every 2 years for men with a PSA level of 2.5 ng/mL or higher. test should be repeated.

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