Now take a seat and real and read this article carefully. There is an almost 85% chance we are NOT dealing with cancer at this stage. So sit back, relax and grab a drink of your choice whilst I take you thru somethings in a simplest way I can. The PSA is a protein that circulates in ever mans blood. Its a by product of a dead prostate cell, which men have many at any given time.
Now the other point to note is that the more dead cells you have, the higher the PSA will be isn't it. So its not difficult to understand that if you have a more enlarged prostate then your best friend, then its possible, though not necessary, your spa could be higher.
The Prostate is a dynamic organ, which is in a constant flux of regenerating cells and also those that are dying. Thus the PSA can remain in a sort of constant which once again is no real concern to you unless the PSA crosses that safety level of 4.
Now why this level of 4 and not 4.5 or 6 etc is a little complicated for me to explain now but be assured there is a pretty good reason for that and a consultation with your urologist of choice should be on the agenda soon.
- So now note the likely 85% reasons your PSA could be high.
- Prostate enlargement
- Urinary tract infections.
- Riding a bicycle
- Recent sexual intercourse
- Recent urology procedure/Surgery
- Recent urethral catheterisation
- Idiopathic (Only god knows!!)
Now I remind you again that there is a 15% change that you could have cancer. So where possible do consult a specialist to then help you asses whether you need to have further tests or adopt a watch ,wait and repeat strategy.
So how do you then now confirm whether its a cancer or not. It is seen that almost always at a PSA level below 10 the cancer is likely in its earliest stage and thus no clinical examination can help to clinch a diagnosis.
The standard test till recently would be Transrectal ultrasound guided biopsy of the prostate. This is a relatively simple day care procedure but is invasive and has a recognised set of unpleasant complications associated with it. So I guess its not wrong to think that you would want to avoid it if possible.
Now with new advances in science and research we have found the there is a role in doing a pre biopsy Multi-parametric MRI. Now remember that a standard tranrectal ultrasound guided biopsy is not a 100% able to actually rule out whether you don't have Prostate cancer! There is a chance that during the biopsy the urologist will not remove the cancer cells for the pathologist to find them!
Thats the difficulty picking out the cancer on biopsy as it cannot be felt or seen when we are doing the biopsy and the technique we employ is a so called ‘carpet bombing’ concept to sample the most of the gland so that we have the highest probability of catching the cancer.
But we do miss it and then you may need a repeat biopsy a few months later depending on your PSA dynamics.
So now to help refine this further scientist have found that a Multiparametric MRI done in an experienced centre will help improve the yield of cancer in those biopsies done and may also prevent unnecessary biopsies from having to be done in the first place.
Interesting isn't it? So quite simply the radiologist will mark on the MRI areas which clearly don't look normal and give them a score called the PIRADS score. this is from 1-5.The higher the score the more likely that part of the prostate harbours cancerous cells.
Now if your entire prostate is normal on the MRI and there is just 1 single portion which contains some abnormal tissue and is scored 5. Now all your urologist would probably need to do is just biopsy that part taking 1-2 tissue pieces only which when compared to removing the standard 12 when we employ the ‘carpet-bomb’ system, is so much safer and associated with very little complications!
So please don't worry too much when your prostate cancer maker is raised. Don't sit on it however but get someone to take you thru managing it as there is a very very large possibility it is noting sinister and deadly!