A new study finds that most men with low-risk prostate cancer undergo aggressive therapy — even if they have a low prostate-specific antigen (PSA) level and low-risk disease.
It’s normal for men to have low levels of PSA in the blood. Certain conditions in the prostate, including prostatitis or an enlarged prostate, can cause these levels to rise. A rise in PSA can also indicate the presence of cancerous cells.
That’s why, depending on a man’s age, the PSA levels and the rate of change of these levels, a doctor may order a biopsy of some of the prostate tissue.
The study, conducted by researchers at the Cancer Institute of New Jersey and published in the July 26 issue of Archives of Internal Medicine, found that men with PSA values of 4.0 nanograms (the threshold PSA value for biopsy) or lower underwent radical prostatectomy or radiation therapy at rates comparable to men with PSA values between 4.0 and 20 nanograms per milliliter.
The study authors suggest that the PSA level “is not a sufficient basis for treatment decisions” and “lowering the biopsy threshold might increase the risk of overdiagnosis and overtreatment.”
Dennis Pessis, MD, a urologist at Rush University Medical Center, agrees that PSA alone has its shortcomings, but he adds that PSA used appropriately with physical exam, patient history, family history and symptoms is extremely effective for diagnosing prostate cancer. He notes that the problem with PSA is that it is not good at predicting if and how fast the prostate cancer will spread.
“At this time, we don’t have a sophisticated and prognostic tool to determine which prostate cancers will be more aggressive,” says Pessis. “It is better to err on the side of caution with prostate cancer — especially in patients younger than 65.”
Pessis believes the urologist should look at the patient’s age, general physical health, grade and stage of the tumor, physical exam and how fast the PSA is rising to determine treatment options.
According to the study, if the threshold PSA value for biopsy was decreased from 4.0 to 2.5 nanograms per milliliter, the number of the men with abnormal PSA levels would double to approximately six million.
Pessis has mixed feelings about the debate to lower the threshold for biopsy, but he says it may be appropriate for men younger than 65 because prostate cancer in younger men tends to be more aggressive. Younger patients, therefore, have a higher risk within 10 years of developing advanced cancer that can’t be controlled.
Recognize the Signs
While many men with prostate cancer don’t have symptoms at all, symptoms can include one or more of the following:
- Urinary problems
- Not being able to pass urine
- Having a hard time starting or stopping the urine flow
- Needing to urinate often, especially at night
- Weak flow of urine
- Urine flow that starts and stops
- Pain or burning during urination
- Difficulty having an erection
- Blood in the urine or semen
- Frequent pain in the lower back, hips or upper thighs
Keep in mind that most of the time, these symptoms are not caused by cancer. But don’t ignore them: See your doctor so he or she can determine the cause and, if necessary, the appropriate treatment.
More Information at Your Fingertips:
- For more information about diagnosis and treatment of prostate cancer, visit the Coleman Foundation Comprehensive Prostate Cancer Clinic at Rush page on the Rush Web site.
- Join specialists from the Coleman Foundation Comprehensive Prostate Cancer Clinic at Rush on Tuesday, Sept. 21, from 6 to 8 p.m. for the free event “Advances in Prostate Cancer Treatment.” These experts will discuss prostate cancer prevention, screening, diagnosis and treatments, including the latest surgical options, radiation therapies and clinical trials. Registration is required. To register or for more information, call (888) 352-RUSH (7874) or visit the “Events and Classes” page on the Rush Web site to register online.
- Looking for a doctor? Call toll free: 888 352-RUSH (888 352-7874)
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Please note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.
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