The Facts

• What is a ‘normal’ PSA reading?

  PSA is a blood test, developed in the 1980s, which measures the ‘prostate specific antigen’. This antigen is a marker of the response of the body (the immune system) to a foreign and possibly malign intruder in the prostate.
  If your reading, assuming you have a prostate, is below 4 (nanograms per millimetre of blood), things look good.
  If it is above 4, you need to have it checked further. Do not delay.

• Is a high PSA a sign of cancer?

  Not necessarily. While cancer can be one cause of an elevated PSA, it is not the only cause. That can be caused by an infection, or an enlarged prostate or other things. It is however a sign that you need to get checked up.

• Can you rely on the DRE (digital rectal exam) to detect cancer?

  No. There are too many chances of what are called ‘false negatives’. These are when the doctor, who is trying to feel the prostate (through the wall of the bowel) can’t feel anything wrong. However, and this is crucial, there may well be something out of the reach of his digital examination (which is one side only, the side closest to the bowel).
  Regrettably, a number of men have been ‘cleared’ by incautious doctors, despite an elevated PSA, and learnt later that the DRE was inaccurate.
  If the PSA is up, other tests need to be taken – a TRUS (probe in the bowel), MRI, bone scan or PSMA PET. The last three are much more accurate.

• What is a biopsy?

  It is a way of taking samples from the prostate tissue, if a tumour is suspected. The normal way to do so these days is through the perineum. A set of ‘cores’ is removed for examination under the microscope. If a tumour is detected, it is time to move forward ‘with curative intent’.

• Why do doctors ask for a bone scan?

  They are worried that the tumour might have migrated outside the prostate. If it has, it may have travelled to nearby regions, such as the pelvis or spine. The bone scan is to see if there are any ‘hot spots’ nearby.

• What is a PSMA PET?

  This revolutionary technique is a very recent advance. PSMA (prostate specific membrane antigen) is a sort of super PSA, a substance that is ‘expressed’ (visibly present) in patients with prostate cancer. PET (positron emission topography) is an imaging technique with a 95% accurate reading on prostate cancer. It is a high tech way of checking what is going on in a man’s body if doctors suspect cancer.

• What is the Gleason score?

  This is a way of measuring how dangerous the cancer is. It is named after Donald Gleason, an American pathologist who invented the test. He used a 10 point scale. The higher the score, the more challenging the tumour is likely to be.

• What is staging?

  This is a way of defining how serious the tumour is, and what the likely best treatment options are.
  The normal one used is the TNM system: T stands for the ‘tumour’ (how big it is), N for ‘node’ (whether it has spread to the nearby lymph system) and M for metastasis (has it moved elsewhere in the body?).

• If a man has prostate cancer, what are the treatment options?

  The primary options for ‘early stage’ cancer, that is when it is confined to the prostate, are two: surgery and radiation. Sometimes it is surgery plus radiation. Rarely it is the other way around.In whole gland prostate surgery, the organ is removed entirely, and the urethra reattached to the bladder (bridging the gap where the prostate used to be). In radiation, the area of the prostate is irradiated over a number of weeks, to mop up the cancer.
  There are other treatments, such as brachytherapy (insertion of radioactive ‘rods’ in the prostate), focal therapy (destruction of the tumour with heat or electricity) or cryoablation (a freezing treatment). However these are a small percentage of all treatments.

• What are the side effects of treatment for prostate cancer?

  There are two major ones: erectile dysfunction (ED) and incontinence.Even with ‘nerve sparing’ surgery, the erectile mechanism can be compromised. There are however ways of coping with such effects. A man can get back his sexual functioning through medical intervention (chemical or surgical).
  Incontinence is to be expected in some form, for a while at least. Again, there are ways of coping. Exercise and therapy can help most men. And for the small number who continue to have problems, there are medical solutions.

• What if the cancer has spread? Or if it comes back after initial treatment?

  In such cases, a typical solution is ‘hormone therapy’, also known as ADT (androgen deprivation therapy). This sees the man injected with female hormones, to lessen the effects of testosterone (which is inclined to act as a fuel for the cancer).Other potential treatments are immunotherapy or chemotherapy.

• How important is it for men to get tested?

  Incredibly vital. If prostate cancer is picked up in the early stages, the chances of cure are remarkably good. We are talking a 99% cure rate!If however, it is let go, the chances of cure diminish. It is essential that men get tested from 40 onwards. If there is any upward trend in the PSA, action has to be taken.