- TWO TESTS
- THE PSA TEST
- THE PROSTATE GLAND
- PROBLEMS OF PROSTATE CANCER
- WHAT ARE THE ODDS?
- SIDE EFFECTS OF TREATMENTS
- UNNECESSARY TREATMENTS
- TREATMENT DECISIONS
- SLOW GROWING AND FAST GROWING CANCERS
- HOW AND WHEN WILL I KNOW IF I HAVE PROSTATE CANCER?
- BIOPSY, THE ONLY PROOF OF CANCER
- WHAT’S IT LIKE TO GET PROSTATE CANCER?
- WHAT THE NATION’S HEALTH ORGANIZATIONS SAY ABOUT THE PSA TEST
What is the purpose of screening?
To look for cancer early, before any symptoms are present.
How many screening tests are there?
Two. The PSA blood test and the digital rectal exam.
Can the PSA test tell me if I have prostate cancer?
No. The PSA test can indicate you might have cancer but only a biopsy can prove that a man has cancer.
Can the PSA test indicate cancers long before symptoms develop?
What could an elevated PSA and a bump on my prostate mean?
It could mean nothing; it could mean early signs of a treatable condition that could prevent a lot of pain and suffering later on; or it could mean a more serious medical problem.
What can the PSA blood test tell me?
That you might be at risk for prostate cancer; but it can not tell you with certainty that you need a biopsy; it can not tell you that you have “clinically significant” prostate cancer; if you do have a biopsy later, the PSA test can not tell you with certainty whether you need a treatment.
If I am not expected to live more than 10 years because of other health issues, should I bother with the test?
At what age should I consider having my first test?
40 for a “baseline” test, recommends the American Urological Association. Earlier if you are African-American. Or if you have a history of PC in your family.
Is there one specific test that will tell me for sure, if I have prostate cancer?
Should I have a PSA test if I’m over 75?
You can consider skipping the test if it is a screening test. Or you can get a test to establish a baseline. Or get a test to see if you have advanced cancer.
Before I get tested, do I have to take any pills or laxative? Any preparations of any kind?
Does the PSA test hurt?
No. It’s only a drawing of a small amount of blood. Usually from your arm.
How long does it take?
About five minutes.
Will I have any after-effects from the PSA test like pain or nausea?
No. It’s only a blood test.
How much will it cost me?
It’s covered by Medicare, Medicaid and probably by your insurance company.
When will I get the results?
In about a week.
What is a “base line” PSA test?
It is a man’s first PSA test. Its purpose is to able to compare future PSA test results against this baseline. A fast-rising PSA is a strong indicator of cancer.
How big is my prostate and where is it?
It’s a gland about the size of a walnut located below and around the exit of your bladder. It’s next to your rectum and about one inch from your anus.
What’s the function of the prostate?
It provides part of the fluid that makes up your semen.
Do I need my prostate to make babies?
Do I need my prostate to be potent (to get an erection)?
What is PSA?
It’s a protein made by the prostate gland that is mainly in the semen. Normally a small amount leaks into the blood stream where it is easily measured. A high level of PSA can indicate the presence of cancer.
How many men in the U.S. will die of prostate cancer in 2011?
34,000 forecasts the American Cancer Society.
How serious a problem is prostate cancer in the US?
It is the greatest cancer killer of men over 50.
It is the second greatest cancer killer of all men, regardless of age.
More men are diagnosed with prostate cancer than women with breast cancer.
How many men are diagnosed with prostate cancer each year?
How many men have been diagnosed with prostate cancer because of screening?
About one million.
What is the chance of my dying of prostate cancer?
Three percent. (3%) Of every 100 men who die, three will die of prostate cancer.
How many men will have prostate cancer sometime during their life?
One of every six.
Who is at risk for prostate cancer?
Men with a family history of prostate cancer
Men over 50
What’s my chance of getting prostate cancer according to my age?
Birth to 39 1% 1 in 12,000
40-59 2% 1 in 44
60-79 14% 1 in 7
Lifetime 17% 1 in 6
What percent of men over 50 who are tested will have an elevated PSA?
Of those 10-15%, how many will be diagnosed with prostate cancer?
Does the PSA test save relatively few lives?
Might finding cancer early save my life?
Yes. The earlier that cancer is diagnosed and treated (if necessary), the fewer complications from the cancer and its treatment, and the greater the chance of a complete recovery.
What percent of prostate cancer deaths are caused by finding the cancer too late?
What are the odds that the PSA test might save my life?
Let’s say that your PSA test led to a biopsy that revealed you have prostate cancer. And you chose to be treated for that cancer. Having this treatment provides a one in 50 chance that 10 years later, you will have been spared death from a cancer that would otherwise have killed you.
What’s the chance that my treatment was not necessary?
The figures above mean there is a 49 in 50 chance that you will have been treated unnecessarily. And that it was not necessary that you suffered the after-effects of the treatment.
More than 70% of prostate cancers are diagnosed in men over 65. True or false?
What are the possible side effects of treatments?
Incontinence (inability to control flow of urine)
Need to urinate frequently and urgently.
Erectile dysfunction (erections inadequate for intercourse)
If I’m diagnosed with PC, and choose to be treated, how likely am I to have some or all of these side effects?
It depends on the treatment you choose, but generally all treatments have at least one side effect.
What is an “unnecessary treatment?”
Some men who receive a treatment may have had a less aggressive form of prostate cancer. Their cancer posed no threat to their health. But as a result of their treatment, they suffered significant side affects. Their treatment was unnecessary.
Why do so many men who have recently been diagnosed with prostate cancer agree to be treated, when the treatment is probably not needed?
Many men demand, “Get this cancer out of my body! Cancer scares me.”
Does the PSA test lead to risky and unnecessary treatments for many men?
When told they have been diagnosed with a low grade cancer that is unlikely to kill them and does not require immediate treatment, what percent of men delay treatment?
Fewer than 10%. More than 90% choose to be treated.
What does “over diagnosis” mean?
The PSA test may detect small cancers that would never become life-threatening.
Is this true? Many cancers grow slowly and are not life-threatening.
Is this true?
Some men who receive treatment may have had a less aggressive form of prostate cancer that posed no serious threat to their health. But, as a result of treatment, they suffered significant side effects.
Is it true that many cancers will not cause health problems and therefore do not need treatment?
Who makes the decision as to whether I will be treated?
You do. But you will want the input of your doctor, urologist, spouse and others.
Who makes the decision as to the type of treatment?
You do. But you will want the input of your doctor, urologist, etc.
How will I know which treatment would be best for me?
You will want to listen to the recommendations of medical people and survivors. There is much valuable information on the internet, in books and pamphlets, and from the many national cancer organizations. Each man has his own fears and expectations. But in the end, you need to make your own decision.
What can happen if the biopsy finds cancer and I choose to have no treatment?
Much depends on the aggressiveness of your own particular cancer.
What percent of cancers are fast growing and could kill a man within a year?
Less than 10%.
Is it true that many cancers are so slow-growing they may not require treatment at all, ever?
What percent of deaths are caused by fast-growing cancers?
Can doctors distinguish between cancers that would be deadly without treatment, from cancers that would not?
Not for certain. But they have a good idea that a cancer that looks “angry” under the microscope, and is larger, is more likely to be deadly.
If the PSA test is only an indicator, how will I know if I have prostate cancer?
The only proof that you have cancer is if pathologists discover cancer in your biopsy.
What are my options if I’m diagnosed with PC?
1. “Watch and wait” (Your doctor closely monitors your condition. No treatments at this point.)
2. Active surveillance.Which means regular PSA tests (3-6 months) and repeat biopsies at regular intervals.
3. Definitive treatment.
What is a biopsy?
Samples of tissue are taken (often 12) from within your prostate gland. In the lab, a pathologist searches for cancer in those samples.
What is the purpose of a biopsy?
To look for cancer.
Who would recommend or advise me to have a biopsy?
Does a biopsy hurt?
Sometimes. As there is usually some discomfort, a local anesthetic is used.
How long does a biopsy take?
About 15 minutes. It’s done in the urologist’s office.
How much will a biopsy cost me?
It’s probably covered by your insurance. But make sure it is.
How would I know positively that I have prostate cancer?
Only if pathologists discover cancer in your biopsy.
If a biopsy finds cancer in my prostate, what should I do?
Consult with your physician and those he/she suggests.
How does prostate cancer affect the body?
It can spread locally to block the bladder or the kidneys. It can invade the rectum or compress the lymph chambers or veins. It can spread to bones and other organs outside the pelvis.
Other than physical effects, what other affects might there be?
It might affect your ability to perform your job.
What is it like to die of prostate cancer?
Cancer spreads to the bones where it causes pain and interrupts the blood-producing bone marrow, causing anemia. It may also spread to organs such as the liver, lungs and brain, or obstruct the drainage of kidneys. There may be bleeding from the prostate if it is still there.
American Urological Association.
In April of 2009, this group recommended that men should be offered a baseline PSA test at age 40, and follow-ups at intervals based on each man’s situation.
The American Cancer Society.
It recommends that when a man reaches age 50, he consult with his doctor whether he should be tested. If he is African-American, or has a history of PC in his family, he should be tested at age 45.
American Cancer Society and US Food and Drug Administration.
Both are in favor of doctors offering the test to men at age 50, who are at average risk.
The National Comprehensive Cancer Care Network.
It recommends an initial PSA for men of all races.
The American Academy of Family Physicians.
It recommends that patients and physicians engage in shared decision-making to decide whether to get a PSA test.
U.S. Preventive Services Task Force.
They say evidence of testing is not strong enough for doctors to make recommendations to patients. Doctors should inform patients of the pros and cons of testing and let them decide. Recommends doctors not to test men over 75.
Prostate Conditions Education Council (PCEC)
Recommends a baseline test for all men at age 40 and at 35 for men at high risk.