A little bit about the prostrate

Benign Prostatic Hyperplasia (BPH) — typically presents with a gradual reduction in urinary flow, hesitancy, frequency and nocturia. It may also present with acute retention of urine (CKS 2022).

Many men worry that having an enlarged prostate means they have an increased risk of developing prostate cancer. This is not the case. The links below hold some excellent information and videos.

https://www.nhs.uk/conditions/prostate-enlargement/

https://cks.nice.org.uk/topics/prostate-cancer/diagnosis/assessment/

If Sidney had attended his appointment would your management have included a PSA blood test?

If an 85 year old man (Barry) who had advanced COPD who had no urinary symptoms requested a PSA what would you do?

If a 51 year old man (Terry) who was asymptomatic man requested a PSA what would you do?

If your response is – “its only a blood test so why not or I am not sure?” The information below may help you to make an informed decision.

PSA

  • Prostate-specific antigen (PSA) is a protein produced by the prostate gland. It is secreted by prostate epithelial cells into prostatic fluid, where its function is to liquefy semen and thus allow spermatozoa to move more freely. Although PSA is secreted into prostatic fluid and semen, small amounts are present in blood.

Because of the altered shape of the prostate in prostate cancer, more PSA leaks out increasing the levels in the blood. 

If cancer is present but does not alter the prostate shape the level of PSA in the blood can be normal.

Also there can be a raised PSA in the blood in other conditions such as benign prostatic enlargement, prostatitis and urinary tract infection.

  • The aim of PSA testing is to detect localised prostate cancer when treatment can be offered that may cure cancer or extend life. It is not usually recommended for asymptomatic men with less than 10 years’ life expectancy – So it is unlikely that Barry would be offered a test – why? carry on reading.

About 3 in 4 men with a raised PSA level (3 nanograms/mL or higher) will not have cancer. Around 15% of men with a normal PSA do have cancer.

  • PSA testing should be:

Considered in men with suspected prostate cancer. – (This may be Sidney)

Offered to men older than 50 years of age who request a PSA test. (this may be Terry)

  • Before offering prostate-specific antigen (PSA) testing, appropriate information should be provided to Sidney and Terry to enable them to make an informed choice about testing.
  • Benefits of PSA testing include

Early detection — PSA testing may lead to prostate cancer being detected before symptoms develop.

Early treatment — detecting prostate cancer early before symptoms develop may extend life or facilitate a complete cure.

  • Possible disadvantages

anxiety about a raised PSA level, without cancer.

The PSA test can miss prostate cancer. A small proportion of men who have a low PSA level will have prostate cancer.

Always use the results in the context of the rest of your consultation.

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