Prostate cancer is now the commonest cancer found in men. If a man lives long enough he stands a very good chance of eventually developing prostate cancer.

The fact that more such cancer is being detected and then treated nowadays is a tribute to the effectiveness of regular medical screening.

PSA is an abbreviation for Prostate-Specific Antigen. This is a protein produced by prostate cells. The PSA level in an individual is measured with a simple blood test.

If cancer develops in prostate cells, the level of PSA in the blood usually increases above what is considered a normal figure for that man's age.

There is a great deal of controversy as to the effectiveness of the PSA level in the process of diagnosing prostate cancer. In our support group, we have members who had very low PSA levels when prostate cancer was discovered. On the other hand, I know several fellows who have what are considered very high PSA levels for their ages, but no cancer has been found. Also, the PSA level in an individual may vary significantly from one week to the next on issues unrelated to cancer.

In the absence of a better test, PSA testing now is the best indicator we have that the patient just might have cancer, and so then further medical examination is indicated.

One such further test is the DRE, or digital rectal examination, which can easily be done in the office of the family physician or urologist. The doctor is feeling the prostate particularly to see whether there are irregularities in the smoothness or hardness of the gland. (An enlarged prostate may be due to reasons other than cancer.)

Another test is a biopsy. Samples of prostate cells are removed using a very fine needle; the samples are visually examined by experts who can assess whether the cells are normal or cancerous. For quality control, this visual assessment is normally done by two persons.

Other tests may include various scans.

Medical opinions vary as to when to start PSA testing. Generally routine annual testing commences at age 50. While prostate cancer is not common at 40, it does happen. If there is a family history of prostate cancer or breast cancer, testing should likely begin at 40. (There is apparently some indication of a genetic link between these two types of cancer, and increased cancer risk in families.) Such routine testing should be done even if the cost is not covered by a health plan; the cost is relatively minor.

Since the PSA test can give variable results from one test to another, what we are looking for is an upward trend in the readings. Either an upward trend or a sudden very large increase should trigger further medical testing.

Testing continues on a regular basis set by your physician to ensure the cancer has not returned.

And yes, each time you go into the doctor's office to hear the results of a PSA test, you will likely feel a knot in your stomach. We all do. But doing positive steps to protect our health and knowing the results are always better for survival than blind ignorance.

Keep positive. We're rooting for you.

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