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Understanding Elevated PSA Levels
(05/04/2004) by Richard Spark, MD
How Do You Know Whether an Elevated PSA Means You Have Prostate Cancer or Prostatitis?
Men who have PSA values greater than 4 ng/ml invariably have additional diagnostic studies. Most have already had a careful digital rectal exam to check for prostate lumps. Those men with both prostate lumps and elevated PSAs are the ones most likely to have prostate cancer. If a man has prostate lumps (nodules) and/or an elevated PSA level, prostate biopsy is usually the next step. If the prostate biopsy reveals the presence of prostate cancer cells, then the diagnosis of prostate cancer is secure.
The next step is to decide on whether the prostate cancer should or should not be treated.
Whaddya mean not treat my prostate cancer? I don't wanna die. Get rid of my cancer!
Of course! Nobody wants to know that he has a cancer -- a time bomb -- lurking in his body. Logic would lead us to believe that for prostate cancer as for all malignancies, early detection and prompt treatment should increase the chance of survival. But on occasion, logic and reality clash. The diagnosis and treatment of prostate cancer is one of those occasions.
The problem is that prostate cancer is not like other cancers. Prostate cancer is a mercurial malignancy, totally innocuous in some men, devastating in others -- spreading rapidly beyond the confines of the prostate bed to ravage local lymph nodes, the spine, and beyond, eventually causing death. The majority of men, however, harbor slow-growing cancers that remain within and do not spread beyond the prostate area.
Often the appearance of the prostate cancer cell provides a clue to indicate if it is programmed to be slow growing and relatively harmless or more aggressive and lethal.
Those who press for treatment of all men with any cancerous cells in their prostate believe that the slow growing cells invariably progress to aggressive cells. Others argue that if this transformation occurs, it does so slowly and over many years.
Exactly how many men actually have prostate cancer is not a matter of conjecture. We also know that the chance of discovering this specific cancer increases with age. Thus, men who die from heart disease, accidents, strokes, and any illness other than prostate cancer may also have a touch of cancer in their prostate glands. Cancerous cells are likely to be found in the prostates of 22% of those age 50-59, in 37% of men 60-79, and in more than half (53%) of those living to 80 and older. Applying these percentages to current U.S. census data tells us that more than 9 million men age 50 and older have prostate cancer. Working with these figures and knowing that there are about 40,000 prostate cancer deaths each year indicates to some that more men have and live with prostate cancer than die from this malignancy.
From the book,
Sexual Health for Men: The Complete Guide. © 2000 by Richard
F. Spark, M.D. Reprinted by permission of Perseus Publishing. All rights reserved.
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