Health and Prostate

Controversy surrounds screening for prostate cancer with the main arguments being questionable cost-effectiveness and overdiagnosis when the disease can be indolent and may be at a point where it is medically irrelevant to intervene. Screening for prostate cancer is done by digital rectal exam (DRE) and prostate-specific antigen (PSA). DRE and PSA should be done annually in men starting at age 50, and at age 45 for those who are at high risk (eg, African-American men, and men with a family history of prostate cancer). There are limitations to PSA and DRE. Prostate-specific antigen (PSA) is not specific to men with prostate cancer, as it is also elevated in benign prostatic hyperplasia (BPH). Another disadvantage of PSA is that it cannot predict the stage, aggressiveness, or metastasis of cancer. Although DRE is more specific than PSA for prostate cancer, it is subject to human observation, and the disease is often not localized when diagnosed.

Normal PSA range is based on age and race (Table 2). PSA velocity is a measurement of how much the PSA level is rising over time. When PSA levels increase by more than 0.75 ng/mL per year it may be indicative of prostate cancer. If either PSA or DRE is positive, then further evaluation needs to be done by imaging procedures, such as transrectal ultrasonography (TRUS), and biopsy.

• TRUS uses sound-wave echoes to create an image of the prostate gland to visually inspect for abnormal conditions such as gland enlargement, nodules, penetration of tumor through capsule of the gland, and/or invasion of seminal vesicles; it may also be used for guidance of needle biopsies of the prostate gland and/or guiding the nitrogen probes in cryosurgery.
• Computed tomography scan (also called CT or CAT scan) is a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than x-rays.
• Magnetic resonance imaging (MRI) is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
• Radionuclide bone scan is a nuclear imaging method that helps to show whether the cancer has spread from the prostate gland to the bones. The procedure involves an injection of radioactive material that helps to locate diseased bone cells throughout the entire body, suggesting possible metastatic cancer.
• A (lymph node and/or prostate) biopsy is a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope to determine if cancer or other abnormal cells are present. The diagnosis of cancer is confirmed only by a biopsy.