Prevention of Prostate Cancer
Common advice given to patients includes:
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Reducing intake of fat and red meat
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Maintaining a healthy body weight
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Taking medications or consuming foods that may help lower PSA levels
Other possible risk factors include a family history of prostate cancer, obesity, and the higher incidence of prostate cancer in African American men.
PSA Testing
A prostate-specific antigen (PSA) test is used in conjunction with a digital rectal examination (DRE) to evaluate your prostate for any abnormalities. Keep in mind that the PSA result is age specific. Consult your urologist for its correct interpretation.
Essentials of PSA Testing
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PSA tests are commonly used to screen for prostate cancer. An elevated PSA level alone does not confirm cancer but signals the need for further evaluation.
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Other medical conditions, such as benign prostatic hyperplasia (BPH), prostatitis, or urinary tract infections, can also raise PSA levels.
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PSA testing should always be combined with a DRE for a comprehensive prostate health assessment.
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In the bloodstream, PSA exists as free-floating or protein-bound forms. Men with prostate cancer often have a lower percentage of free PSA compared to those with benign causes of elevated PSA.
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Free PSA testing is particularly useful for PSA levels between 4 and 10 ng/mL, helping distinguish cancer from non-cancer causes and potentially reducing unnecessary biopsies.
Age-specific PSA Levels
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In younger men, PSA levels between 2 and 4 ng/mL warrant a more aggressive approach, often including an early biopsy.
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For older men, 4 ng/mL is generally considered the cutoff for further evaluation.
PSA Velocity
- PSA velocity—the rate at which PSA levels rise over time—is another important factor indicating the need for further diagnostic testing.
Next Steps After an Elevated PSA Test
If a patient’s PSA level is elevated, the doctor may repeat the test or order additional exams. Multiparametric MRI is frequently used to determine if an MRI-guided prostate biopsy is necessary.
Staging organizes information from prostate biopsies and diagnostic tests to determine the overall extent of cancer. The most common system is the TNM classification:
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T: Extent of the primary tumor in the prostate
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N: Presence or absence of spread to lymph nodes
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M: Presence or absence of distant metastasis
The purpose of staging is to assess tumor size, location, spread outside the prostate, and the characteristics of the cancer cells. Your urologist will decide which tests are necessary to accurately stage your cancer.
Gleason Score
A pathologist examines prostate cancer cells under a microscope and assigns a grade based on how closely the cells resemble normal prostate tissue. The Gleason score is the sum of the two most common patterns observed, ranging from 2 to 10.
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Higher Gleason scores indicate more aggressive cancer, with a greater likelihood of rapid growth and spread.
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For example, a score of 8 reflects a significantly more aggressive tumor than a score of 6.
Imaging Tests
If advanced cancer is suspected (due to a high PSA level, high Gleason score, or large tumor), your urologist may order the following imaging studies:
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Bone scan: Radioactive material is injected, and special X-rays look for bone changes.
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Computed tomography (CT) scan: Detailed images assess pelvic lymph nodes and soft tissues.
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Axumin positron emission tomography (PET) scan: Detects recurrent prostate cancer early after surgery or radiation.
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Prostate-specific membrane antigen (PSMA) PET/CT scan: Detects small lesions (4–8 mm) and is useful in evaluating rising PSA levels after a prostatectomy.
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Lymph node biopsy: Lymph nodes filter infections and foreign cells. They may be removed laparoscopically or surgically to check for cancer spread. Your urologist will discuss the need and method of evaluation.
Imaging and Treatment Recommendations
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Patients with a low Gleason score (6 or less) and PSA less than 10 usually do not require further pre-treatment imaging.
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High-risk patients (high stage, Gleason score, and PSA) typically require bone scans, CT scans, and pelvic lymph node dissection.
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Some patients with a high Gleason score but low PSA may also require staging based on scan results.