The ABC'S of Good Health
By Dr. Jo Gjelsten
Ok I'm gonna get it right out there. Rectal exams. No don't go away, ya big baby, just read on and learn a thing or 2 from Dr. Aunt Jo, so you can be well informed and look cool at the same time. Nobody wants rectal exams, unless they do, go figure. This is a Two Part Article. Part One follows, and Part 2 in April will deal with Nutritional Support for those dealing with Prostate Cancer Risk, which is about 1 in 7 men. Most, especially if it hasn't spread out of the prostate (100% survival after 5 years), won't die from it, but if the cancer has spread found outside the prostate the survival rate is about 29%, so while the risk is small, early detection is crucial.
Most guys like numbers, as in sports, so here are a bunch of tests you should know about, and their explanations in part. They involve the initial exam, when to test, relative age to risk, other tests, how much PSA, how fast PSA is rising, and how dense the prostate is.
DRE'S (digital rectal exams) are important because Doc's don't have MRI or CT or X-ray vision they have to feel around and look for anything that feels lumpy, Lumpy! This exam is always done AFTER blood has been taken to measure your PSA (prostate specific antigen) because any jiggling around down there can falsely raise that level of PSA.
PSA. Now, a PSA may be over 10, and in that case your Doc may do, perhaps should do, and if you were a patient of mine I would like your Doc to do Lou, a PsCA test. and maybe some others to go further. You can still have cancer under 10 though so pay attention to your Doc's advice.
Family History Men who have a family history of prostate cancer and African Americans may want to start getting tested at age 40 because it's 74% higher in this population, but speak to your Doc about this. If it's low, a 1 for instance, then test again in 5 years but if it's an aggressive cancer you pick up early, good for you! If between 40 and 50 years old and PSA at 2.5, see below, one recommendation is to get tested every 6 months to a year. Over 60 years, 2.5 is about normal on some tests. Here's a chart for you chart fanatics:
PSA levels chart
Age Range (Years)
Asian Americans African Americans
40 to 49 0 to 2.0 ng/mL 0 to 2.0 ng/mL
50 to 59 0 to 3.0 ng/mL 0 to 4.0 ng/mL
60 to 69 0 to 4.0 ng/mL 0 to 4.5 ng/mL
70 to 79 0 to 5.0 ng/mL 0 to 5.5 ng/mL
FREE PSA Another test measures the percent of free PSA floating around in your bloodstream compared to total PSA. In this case, if it isn't bound to something, in other words more free PSA or over 25% of total PSA is FREE, that means a 10% LESS likely to be cancer, and the LESS unbound, or lower the number, it's 25% more likely it is cancer. So, you'll like this number to be higher.
PSAV And, to see how long it takes the PSA to double, a PSA velocity test PSAV for short, is a measure of how fast that PSA is rising, so that's important to know. Faster is not better, contrary to the mindset of some race car enthusiasts out there. In fact at .75 over a period of one year it's actually fast enough to probably be cancer.
PSAD Is a density score is measured by Ultrasound or MRI. Over .15 indicate aberrant (cancerous) cells in the prostate.
4KScore Test This test includes much of the above, PSA, free PSA, intact PSA and an enzyme and is used to see if it's an aggressive cancer. This is a good screening tool according to a Doc at Memorial Sloan Kettering, and some Docs use it before biopsy or after a negative biopsy.
Older men, after 70 seem to get a slower growing type, and PSA is not a determining factor, in fact men greater than 70 are told that they'll likely die of something else, thanks a lot Doc.
There are many helpful brochures out there, many of which start with Understanding Statistics, Understanding Prostate Cancer, followed by another caption like A Guide to Treatment and Support, What to Make of This, What To Do, Hell why Do I Have to Deal With This NOW!!, ok not the aforementioned few, but one actually has a smiling middle aged guy on the front with a caption that sort of says A Model, Not Actual Prostate Cancer Patient, (so I guess if you're a model you don't get this?) hence the smile, where they are very understanding about it, which is understandable since they obviously don't have it. Ok back to my column.
Urine Test PCA 3 aka (Prostate Cancer Antigen 3) if found in urine indicates prostate cancer and is done if PSA results are iffy or continue to be high even with a negative biopsy. It's done after three strokes of each prostate lobe stroked during another rectal exam. Oh isn't this fun guys? But it's necessary, because you don't want this to spread if you can help it.
Biopsy Speak to your Doc. Ask about, and look up, in addition to your Doc's recommendation, a test called an Targeted Biopsy, or Ultrasound Fusion Biopsy, especially good, it is said, for targeting aggressive higher risk kinds of cancer, and believed by some to be more accurate. You may pay out of pocket for it, but it may be worth a look.
After a biopsy this is a staging score, a score of 2 parts of the cancer, a combination of numbers that indicate some of the tissue may be, for example, a 3 and some may be a 4.
Groups Gleason scores are now further put into groups 1 to five as per below :
From the American Cancer Society “Doctors have developed Grade Groups, ranging from 1 (most likely to grow and spread slowly) to 5 (most likely to grow and spread quickly):”
Grade Group 1 = Gleason 6 (or less)
Grade Group 2 = Gleason 3+4=7
Grade Group 3 = Gleason 4+3=7
Grade Group 4 = Gleason 8
Grade Group 5 = Gleason 9-10
Next Month, Nutritional Considerations for Prostate Health