Dr. MD, DNB, DM, ECMO, MRCP (UK) EMPH, Senior Director of Medical Oncology & Hemato-Oncology at Fortis Group of Hospitals at Richmond Road, Bangalore. Niti Raizada’s
Prostate cancer cases are becoming serious in India. About 50 percent of all prostate cancer patients die from this disease. About 34,500 cases of prostate cancer are reported every year. Prostate cancer accounts for 2.6 percent of all cancer cases in the country. Prostate cancer is the sixth most common cause of cancer in men globally.
It’s important to note that prostate cancer is a spectrum of disease and not all men with prostate cancer require treatment. Early detection of prostate cancer includes diagnosis of slow-growing and aggressive or fast-growing prostate cancer. The challenge is to reduce overtreatment of indolent cancer by considering individual factors. Adverse effects on quality of life can be controlled as a result of detection and appropriate treatment of serious cancers. Disability and mortality can be significantly reduced as a result.
Screening for prostate cancer
Current guidelines focus on appropriate benefit-risk counseling before placing the patient in an early diagnostic program. When to start or stop screening at this stage and at what interval should screening or biopsy be done? There is no clear consensus on that. However, regular screening is recommended for patients at highest risk.
Method of diagnosis of prostate cancer
First the patient’s family history is considered. A physical test is done. Family history focuses primarily on the family history of first-degree relatives or second-degree relatives. A history of other cancers or risk germline mutations, including BRCA or HOXB 13 mutations, are also reported in the individual.
In men with African ancestry who have a higher risk of prostate cancer, drugs such as 5-alpha1 reductase-finasteride or dutasteride reduce PSA by about 50 percent. Hence PSA value needs correction. These drugs are often taken by men to reduce urinary problems due to prostate enlargement.
The test is not generally recommended for patients over 75 years of age. For high-risk individuals, PSA screening and DRE (digital rectal exam) begin at age 40. These screenings and tests are done annually. Screening is done between the ages of 45 and 75 for an average-risk patient.
When to do a biopsy?
Multi-parametric MRI or biopsy is advised when serum PSA is greater than 3 ng/ML and DRE is more suspicious. A trans-rectal ultrasound guided biopsy is usually performed.
As biopsy results may reveal cancer or mild intraductal carcinoma, atypia may be suspicious for cancer. Or it can be high-grade prostatic intraepithelial neoplasia (PIN) or it can be mild. Based on these results, treatment is decided.
Learn more about serum PSA
PSA is called a glycoprotein. which is secreted by prostate epithelial cells. It is not a cancer-specific marker. If the total PSA in the biopsy is greater than 10 ng/ML, the chance of cancer is 67 percent. A PSA between 4 and 10 has a 20 percent chance of a positive prostate biopsy. Infections, cystoscopy, or instrumentation such as TURP can also cause an increase in PSA. Certain medications, such as finasteride or dutasteride, can lower PSA values. Ketoconazole or some herbal medicines may also prove useful.
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The US Preventive Task Force recommends discussing the benefits and harms of serum PSA with the patient before recommending it. PSA can cause stage changes. Early PSA assessment may increase life expectancy due to early diagnosis. PSAV is the velocity of PAS. Which is measured at 3 different values over 18 months. Unbound or free PSA (f-PSA) as a ratio of total PSA is also an FDA-approved measure.
Early diagnosis methods such as physical examination and patient history are used to rule out prostate cancer. Things like general health, comorbidities, age have to be kept in mind while using a detection program.
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