Initially a taboo subject, not discussed amongst men when having a beer, prostate cancer has been under the medical research spotlight in a big way for a little more than a decade, and the flurry of activity is starting to show good resul ts through testing and diagnosis refinements and the development of effective new drugs.

The primary function of the prostate gland is to secrete the fluid that moves sperm forward during ejaculation. The prostate is highly prone to cancer, and the American Cancer Society estimates the number of deaths resulting from prostate cancer at 30,000 each year. But recent years have shown a dramatic drop in the number of men present with the disease in its advanced stages.

Changes in the way prostate cancer is diagnosed are hot topics for study and discussion among health care practitioners. PSA (prostate specific antigen) blood testing is the front line screen for prostate cancer. As prostate cancer develops, a protein measured by the PSA test goes up. The optimal age to begin PSA testing, the frequency of testing, as well as the optimal value to detect cancer, remain under investigation. At present, it is recommended that men over 50 be checked annually.

According to Dr See, a leading researcher, "Historically, 50% of men with prostate cancer presented a disease that had already spread throughout the body. Today, fewer than 5% present what we would term advanced disease. The reasons for that are twofold. One is the heightened public awareness. The second is the availability of the PSA blood test. Widespread use of PSA screening has really shifted the stage of disease which men present."

PSA testing is available in Phuket at most hospitals and costs around 900 baht. It is a simple blood check, and whilst it does not replace the older method of testing the prostate, the digital examination, it is a very useful diagnostic tool. PSA is an enzyme produced in the prostate that is found in the seminal fluid and the bloodstream. An elevated PSA level in the bloodstream does not necessarily indicate prostate cancer, since PSA can also be raised by infection or other prostate conditions. Many men with an elevated PSA do not have prostate cancer. Nonetheless, a PSA level greater than 4.0 nanograms per milliliter of serum was established initially as the cutoff where the sensitivity for detecting prostate cancer was the highest and the specificity for detecting non-cancerous conditions was the lowest. A PSA level above 4.0 ng per milliliter of serum may trigger a prostate biopsy to search for cancer.

It is important to note that the PSA test is an imperfect screening tool. A man can have prostate cancer and still have a PSA level in the “normal” range. Approximately 25% of men who are diagnosed with prostate cancer have a PSA level below 4.0. In addition, only 25% of men with a PSA level of 4–10 are found to have prostate cancer. With a PSA level exceeding 10, this rate jumps to approximately 65%.

More sophisticated forms of the PSA blood test can be used to further improve the precision of the test.

There are other factors that can influence the development of prostate cancer, age being an important one. It is extremely rare for a man under the age of 40 to have prostate cancer, but the likelihood increases considerably after the age of 50. About 80% of prostate cancers are diagnosed in men over 65. Other factors include race, with a higher rate in Caucasians than Asians. Family history also plays a part, with a higher occurrence if the disease is within the family. Diet and obesity may also play a role.

What is clear, and what the medical experts are telling us men is that PSA testing remains the most widely used screening assay for prostate cancer. If you are male, near or over 50 years old, and you do not know your PSA level, you should immediately have the test.

Peter Davison is the Manager International Services
at Phuket International Hospital.
Tel: +66 (0)76 249400. Email: info@phuketinternationalhospital.com.