Over the past few days the media has reported that for the first time in the UK, the number of deaths from prostate cancer has overtaken the number of deaths from breast cancer.
Despite the fact that screening for prostate cancer has been available widely in the private sector for the past few years, the number of patients enquiring about health screening and cancer screening consists mostly of women. Many men associate the prostate disease with old age, missing the fact that most of the aggressive prostate cancers occur under the age of 50.
We recommend men commence prostate cancer screening at the age of 40. This is done by a combination of history, examination and blood tests (the PSA test). PSA stands for prostate-specific antigen. It is a protein made by both normal and cancerous cells in the prostate gland.
The PSA Test – there is more to it than meets the eye if done with all its fractions!
What men commonly tend to remember is that 2 out of 3 men can have an elevated PSA without cancer and that the PSA can be normal in someone with prostate cancer.
Indeed, the PSA can be elevated in the following circumstances:
- An infection of the prostate gland (prostatitis)
- A benign (non-cancerous) enlarged prostate
- Prostate cancer
So, the PSA alone is not enough to help a doctor decide whether you may have Prostate Cancer.
Over the past 10 years and more, evidence has come out to suggest that different fractions of the PSA are important when interpreting the result. Unfortunately, this breakdown of the PSA is not available freely on the NHS or at many private clinics. Here at ROC, we have undertaken this analysis for the past 10 years. Certain fractions of the PSA suggest that is more likely you may have cancer and further tests may be recommended. These fractions can be abnormal even with a normal total PSA.
What Next? Ultrasound or MRI?
In terms of further investigations, the ultrasound of imaging the prostate gives limited information, although it is cheaper. An MRI scan of the prostate, although more expensive, is the best investigation, as it gives excellent views of the prostate and the pelvis.
If thought necessary, a prostate biopsy may be recommended.
There are two types of biopsies – transrectal (with the help of an ultrasound) and a template biopsy. A transrectal biopsy is what commonly is offered on the NHS. However, it may miss areas of cancer and involves significant discomfort.
The advantage of the template biopsy is that apart from the fact that is undertaken under an anaesthetic, takes a significantly larger number of biopsies and allows for accurate mapping of all prostate tissue, into areas affected or not affected by the disease.
Choose the Template Biopsy!
For those patients who may not go down the path of an MRI scan or biopsy, undertaking a genetic screen of a urine sample, a test called PCA3 test. This test is available at ROC Clinics and it works by identifying the activity of a gene called PCA3, which is unusually active in prostate cancer cells.
Can it be anything else?
Occasionally we see men coming to see us regarding symptoms pointing towards the prostate but it turns out to be the bladder for example.
It is therefore important not to delay seeing a doctor when you have symptoms but even if you don’t, make sure you have your Annual MOT!
If you wish to make an appointment or you have a question about any of the issues raised here, do get in touch!