COMMONLY ASKED QUESTIONS ABOUT PROSTATE HEALTH

1. WHAT IS A DRE?

DRE stands for digital rectal exam, a simple check of your prostate gland done by inserting a lubricated, gloved finger through the rectum. It is a brief exam commonly used along with the PSA to measure prostate health.

2. WHAT IS A PSA TEST?

PSA stands for prostate specific antigen, a protein produced by prostate cells.Prostate cancer cells produce larger amounts of this protein than normal prostate cells. Since the late 1980’s the PSA test has been used to detect prostate problems, including cancer and benign prostatic hypertrophy, a non-cancerous condition. It is a simple blood test has become the most commonly used method for diagnosing and monitoring prostate health.

3. WHEN SHOULD I GET MY PSA LEVEL CHECKED?

A man should have his PSA level checked if he has any of the warning signs of prostate cancer: 1. A change in urination patterns lasting two weeks; 2. Frequent urination (especially at night); 3. Persistent pain in the back, hip, pelvis or thighs; 4. Burning sensation during urination; 5. Inability to urinate or difficulty starting urination; 6. Weak or interrupted urine flow; 7. Painful urination.
There is significant controversy over when, and even if a man should have his PSA level checked when he has none of these symptoms. Respected experts disagree widely over the test’s use. Our own position is that all men should be tested first at age 40. After the initial screening, the frequency of future testing should be discussed with the man’s physician. If a man’s father, brother, uncle or grandfather has been diagnosed with prostate cancer then the man should start PSA testing at age 35.

4. WHAT IS A ‘FREE’ PSA LEVEL AND WHEN SHOULD I HAVE THIS CHECKED?

The ‘free’ PSA is an additional blood test that should be checked when the man’s PSA is elevated, or when his physician feels something suspicious during a digital rectal exam (DRE). The free PSA should always be done before a biopsy is performed. A biopsy may be indicated if a man’s ‘free’ PSA is low while his total PSA is high.

5. HOW SHOULD I PREPARE FOR THE PSA TEST?

Sexual activity, an infection of the prostate, and pressure on the groin or rectum can elevate the PSA. Our sources and personal experiences vary as to how long a man should abstain from sex, bicycle riding, horseback riding, etc. before having his PSA level checked. Three days (72 hours) seems reasonable. Be sure to have your PSA level checked before your DRE is done.

6. WHAT IS AN ELEVATED PSA?

The general consensus in the medical community is that a PSA level of 4.0 or higher demands further investigation. There are age-related differences that your physician may want to consider. A high PSA does not necessarily indicate cancer, nor does a PSA below 4.0 guarantee an absence of cancer.

7. WHAT DOES AN ELEVATED PSA MEAN?

Besides prostate cancer, an elevated PSA level can indicate prostatitis or benign prostatic hypertrophy (BPH).

8. WHAT IS PROSTATITIS?

Prostatitis is not cancer, nor does it necessarily lead to cancer. It is an inflammation of the prostate gland that can be treated with antibiotics or massage.

9. WHAT IS BPH (BENIGN PROSTATIC HYPERTROPHY)?

BPH is a non-cancerous enlargement of the prostate gland that has not been proven to lead to cancer. In most men the prostate begins to enlarge after the age of 40. This enlargement may lead to difficulty with urination. It may also cause no significant symptoms during a man’s life. It can be detected with a DRE by your physician.

10. WHEN SHOULD I CONSIDER A BIOPSY?

In general, a biopsy is indicated when a man’s PSA is high, but his free PSA is low. It may also be indicated if a DRE is suspicious for cancer.

11. WHAT SHOULD I EXPECT FROM A BIOPSY?

A prostate biopsy is a series of six or more tissue samples taken from the prostate through the rectum. These samples are taken with a needle that is guided with an ultrasound probe. The discomforts of this 10-20 minute procedure include the usual pain that accompanies injections. Some men choose to have a sedative such as Valium before their biopsies. After the procedure infection and bleeding upon urination or defecation are common and may occur. There may also be blood in the semen for a period of days or weeks after the biopsy. Antibiotics are commonly given before the procedure to discourage infection. Fever, excessive bleeding, or inability to urinate after the biopsy should be reported to your physician immediately.

12. WHAT HAPPENS TO THE TISSUE SAMPLES TAKEN DURING MY BIOPSY?

The tissue samples are sent to a pathology (disease) lab and examined by a physician who specializes in determining whether or not cancer is present. A negative biopsy is not a guarantee that you are cancer-free.

13. WHAT SHOULD I DO IF MY BIOPSY IS NEGATIVE (NO CANCER IS FOUND)?

Because a negative biopsy does not completely rule out cancer, many men continue to monitor their PSA every three months, followed by discussion with their physicians. We at PAF encourage you to take proactive responsibility for your prostate health by maintaining a healthy lifestyle.

14. WHAT SHOULD I DO IF MY BIOPSY IS POSITIVE (CANCER IS FOUND)?

DON’T PANIC. Prostate cancer is generally slow growing. You have time to make an informed decision that is right for your individual circumstances. Do not be pressured into a treatment decision.You should expect a call from your physician to arrange a discussion of the results of the biopsy and your treatment options. We recommend that you bring another person with you to the doctor’s office to act as your advocate. The two of you should talk openly with your physician about your concerns. Make sure you discuss and write down the following: 1. Your Gleason score; 2.The stage of your cancer. Make sure you understand what these things mean before you leave the doctor’s office.Then get a second opinion, preferably from a physician with a different specialty. For example, if your diagnosing physician is a urologist, after talking with him/her seek a second opinion from an oncologist. At this time there is no magic bullet for prostate cancer, no single treatment option that will work for all patients. Most men choose one of the following: 1. Watchful waiting; 2. Hormone blockade; 3. Radical prostatectomy; and 4. Radiation. SEE OUR WEB PAGE ON HOW TO TALK WITH YOUR DOCTOR.

15. WHAT IS A GLEASON SCORE AND WHAT DOES IT MEAN?

The Gleason grading system is used to describe the cancerous prostate tissue removed during the biopsy. This tissue is examined by a pathologist under a microscope and compared to normal prostate tissue. Gleason grades are given to the two most commonly occurring cell patterns. The scores are then added together to derive a number between 2-10. Clinicians agree that the higher your Gleason score the more likely that your cancer will spread or has already spread beyond the prostate. Thus, it is essential that a newly diagnosed man get an accurate Gleason grade before making any treatment decisions. There is some subjectivity in deriving Gleason scores. Our experience indicates that pathologists at large medical centers are the most accurate at grading prostate tissue samples. Make sure your urologist saves a sample of your prostate tissue for a possible second (or third) opinion.