Updated: Apr 15, 2021
A Few Realistic Words about PSA and Prostate Cancer Chin-Ti Lin, M.D.
What is PSA?
PSA stands for prostate-specific antigen - a protein specifically coming from the prostate, so it's organ-specific (not cancer-specific).
Over the past 50+ years since its discovery in 1970, testing PSA in blood has been used as a reasonably useful tool to alarm men if
they have a high suspicion of prostate cancer.
However, its accuracy in telling us about the existence of prostate cancer has been confusing and conflicting.
Social Impact of PSA Testing
As a result, many men have been living under the siege of anxiety and fear for prostate cancer and falling victims to the "advance" in modern medicine.
Some Known Truth and Facts on PSA
Therefore it's important to know more about the currently available truth and facts of PSA as follows:
1. A rise of PSA occurs not just in the presence of prostate cancer but also at that of increasing age, prostate enlargement, urinary tract infection, or any sort of inflammation of the prostate.
2. Besides, it would be useful to know how common prostate cancer can be found in men. For example, if men died of reasons other than prostate cancer at age of >60, >70, and >80 years and we examined these men's prostates from autopsy under a microscope carefully, we would still expect to find the presence of prostate cancer at a rate up to as high as >65%, >75%, and >85% respectively.
3. In other words, most elder men walk around with tiny prostate cancer although their prostate cancer never grows to size or degree to bother and affect their life.
4. Despite testing PSA having diagnosed more men with prostate cancer (P-Ca) than ever, most patients with P-Ca will still die of other causes, not prostate cancer, and their possibility to die directly of it has remained about the same before and after PSA discovery in 1970.
5. "Normal" PSA value does not guarantee men not to have prostate cancer. At times, doctors still cannot find prostate cancer in men with elevated PSA outside its normal range even after 3-5 prostate biopsies.
6. The accumulation of experience over the past four decades indicated, in order to save a a man dying of prostate cancer (P-Ca), we would need to perform more than 25 to 45 radical prostate surgeries.
7. The "best" use of PSA thus far has been as an effective tool for following the patients after definitive treatments such as radical prostatectomy, radiation therapy, cryotherapy, etc. for prostate cancer.
Conclusion and Recommendation
Despite significant inevitable disturbance from the above truth and facts of PSA and prostate cancer, the bottom-line on the issues of PSA uncertainty still lies on:
Who are the men requiring timely active attention with a further evaluation with prostate ultrasound examination and biopsy as well as the treatment for prostate cancer if any?
To solve these concerns, a qualified medical provider will be able to help you walk through a reasonable process of evaluation and care although perfection in life and care would and will never happen.
In practice, PSA is the most useful tool to follow patients with prostate cancer under and after treatment. Of note, PSA will decrease by about 50% within 3 months after using 5 alpha-reductase inhibitors such as Proscar or Avodart to shrink the size of BPH (benign prostate
enlargement), usually be 20-25% in volume.
For more information from the Internet, please click More Prostate below.
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