Prostate cancer is one of the five most common cancers in Ireland. Monitoring and screening for this cancer is essential for early diagnosis and treatment. There are a limited number of tests available to efficiently cater for nationwide screening.
Prostate-specific antigen (PSA) is a protein produced by the prostate gland. A PSA test measures the level of PSA in a man’s blood which is then sent to a lab for analysis. The level of PSA is often elevated in men with prostate cancer.
In 1986 the PSA test was approved by the FDA to monitor the development of prostate cancer in men who had already been diagnosed with the cancer. In 1994 a further advancement of this test was developed as the PSA test was used in conjunction with a digital rectal exam (DRE) to test asymptomatic men for prostate cancer.
However a number of benign (non-cancerous) conditions can cause a man’s PSA level to rise. The most frequent benign prostate conditions that cause PSA levels to rise are:
There is no proof that either of these conditions lead to prostate cancer, but it is possible for a man to have one or both of these conditions and to also develop prostate cancer.
Other factors can cause PSA levels to fluctuate:
It is recommended to have yearly PSA screening for men beginning at age 50. Some organizations recommended that men who are at higher risk of prostate cancer ie. men whose father or brother had prostate cancer, begin screening at age 40 or 45. However, any man who is considering getting tested should first be informed in detail about the potential harms and benefits.
If a man’s PSA level continues to rise or if a suspicious lump is detected during a DRE:
If prostate cancer is suspected, the doctor will recommend a prostate biopsy which will be examined by a pathologist.
Limitations of PSA
PSA test can help detect small tumours that do not cause symptoms.
How PSA testing is used in men who have been treated for prostate cancer
The PSA test is used to monitor patients who have a history of prostate cancer to see if their cancer has returned. If a rising trend of a man’s PSA level develops over time, it may be the first sign of a recurrence.
Further Developments - STHLM3
Continuing developments are being made for the screening of prostate cancer. The Stockholm 3 (STHLM3) study presents a new prostate cancer screening model that could reduce the number of biopsies.
"The STHLM3 test is a simple blood test that can reduce the risks connected with (prostate-specific antigen) PSA testing such as over-diagnosis and overtreatment and at the same time identify aggressive prostate cancers earlier," Dr. Henrik Gronberg from Karolinska Institute, Stockholm, Sweden stated to Reuters Health.
The national screening guidelines in Sweden are now being re assessed the current national screening for prostate cancer for a new potential screening test for asymptomatic men.
In the STHLM3 model PSA, single nucleotide polymorphisms (SNPs), clinical variables, and established and novel plasma protein biomarkers are combined.
During analysis, the STHLM3 performed significantly better (AUC, 0.74) than PSA alone (AUC, 0.56) for detection of high-risk prostate cancers based on men aged 50-65. Using the STHLM3 proved to reduce biopsies by 32% due to its high level of accuracy. There was a 17% reduction in the amount of cancers identified with a Gleason score of 6.
"The STHLM3 test may detect aggressive cancers earlier, helping to reduce the number of false positive tests that can lead to unnecessary invasive biopsies," -Dr. Gronberg.
This combination of biomarkers could be a major breakthrough in prostate cancer screening globally.
The benefits of health screening can be felt by both the employer and the employee alike. Health screening is an effective way of increasing employee morale, and leads to reduced sickness and levels of absenteeism.
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