Prostate cancer is the most commonly diagnosed cancer in Australia, according to the Australian Institute of Health and Welfare.
“More men die of prostate cancer in Australia than women die of breast cancer,” urologist Associate Professor Troy Gianduzzo, one of Australia’s most experienced prostate cancer surgeons, said.
A PSA (prostate specific antigen) test is a simple blood test that determines whether a man’s PSA levels are above normal for his age.
“PSA is a normal enzyme the prostate makes to help semen go runny, to liberate sperm. PSA leaches into the bloodstream in normal amounts, but in certain conditions it [leaches] out in higher than normal amounts,” Gianduzzo said.
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In some cases, above normal PSA levels might indicate prostate cancer, so why is it that PSA testing is not recommended for every male? “The pros [of a PSA test] are that you identify prostate cancer earlier and decrease the number of men presenting with advanced disease, disease that’s spread,” Gianduzzo said.
“[But] there can be false positives. You can have a PSA elevation for any number of reasons: inflammation, infection, a big prostate, cycling, sexual activity, or heavy exercise just before a test."
“If PSA is elevated, the first thing to do is repeat the test one to three months later [to] see if it is a real rise or if it [returns to normal]. If there is a real rise, the patient should see a urologist, who will probably order a prostate MRI,” he said.
This is now rebated by Medicare under certain criteria.
“A prostate MRI can determine whether a biopsy is needed, and [increase its accuracy]. If the MRI is negative, the urologist might cautiously not do a biopsy and just watch that patient, depending on their risk. But sometimes MRI can miss some cancers and in some cases the urologist may still elect to do a biopsy even if the MRI is negative.
“The downside [to PSA testing] is that some prostate cancers may never cause a problem, either because the disease is not particularly aggressive, [sitting] idle in the body for years, or because the patient is [elderly]. But we are getting much better at working out who [does and doesn’t need treatment,] and which men can be safely watched.”
Which men should be getting a PSA test?
Men with strong prostate cancer risk factors should be getting PSA tests from age 40, Gianduzzo said.
“In Australia, the main risk factor is a family history of prostate cancer in a male first-degree relative,” he said.
“A strong family history of breast, ovarian or pancreatic cancer may indicate a BRCA1 or BRCA2 mutation [that can cause prostate cancer]. People with Lynch Syndrome, which is rare, should also be checked. Men who are otherwise fit and well with no risk factors should get the test from 50.”
The test is annual but can be less often if PSA levels are consistently low and the man is not at high risk.
“Data for PSA testing beyond age 70 to 75 is less clear, [but if the patient is in good general health for their age], particularly if they have longevity in the family, [the test may still be recommended].
“The key to detecting prostate cancer is PSA testing. There are no symptoms at all in the early stages,” the Associate Professor said.
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