For a lot of men, the thought of going for a prostate-specific antigen (PSA) screening test causes a great deal of stress — which can turn into panic if the results come back higher than normal. After all, prostate cancer is one of the most common types of cancer among men. And though it is usually treatable, prostate cancer is still a serious, potentially-fatal disease.
 

To better understand PSA screening, and what PSA test results mean, we sought the expertise of Dr. Charuspong Dissaranan , a urology specialist at Bumrungrad International Hospital.
 

Q: What is the purpose of PSA screening, and what do the results mean?

Dr. Charuspong: We use PSA screening to check for a protein that can indicate the presence of prostate cancer. The PSA test doesn’t determine whether cancer is or is not present. Prostate cancer doesn’t usually produce physical symptoms in its earlier stages, but it tends to raise PSA levels. So PSA screening provides a non-invasive method for measuring an important indicator connected to prostate cancer.

Q: How often should men go for PSA screening?

DC: I recommend testing once a year in most situations, and especially for men 50 and older. If results are above normal, your doctor may suggest screenings every six months as a way to look for possible changes.

Q: What is considered a normal PSA level? And if my PSA level is high, does that mean I have cancer?

DC: In general, a normal level would be 4 or lower. Higher PSA levels can be related to a number of possible causes besides cancer. PSA levels can increase with age, and medical conditions such as BPH , prostatitis , urinary tract infections, an enlarged or inflamed prostate, and prostate injuries can also raise PSA levels. If the PSA test shows levels higher than normal, then we need to investigate further to see whether cancer is present or not.

Q: Is it possible to have normal PSA levels but still have prostate cancer?

DC: Yes, you could have normal PSA levels but still have cancer, probably in its very early stage, or a type that is dormant and not growing.

Q: Is the PSA test the only way to screen for prostate cancer?

DC: Besides PSA screening, we also check for cancer using digital rectal examination (DRE). This is where we insert a finger into the rectum to examine the prostate and check for the presence of nodules. If the prostate is smooth, we do not suspect cancer. But, if we notice any irregularities or feel any nodules, then we will want to investigate further for the possibility of cancer.

Q: How long does it take to get the results from a PSA test? And what is the next step if the results show high PSA levels?

DC: The results are usually available in about two hours. If the PSA levels are high, I would probably recommend an MRI , which scans the prostate and surrounding areas to create a detailed image. If the MRI reveals an abnormality, the likely next step is to perform an MRI ultrasound fusion biopsy to obtain tissue samples that will then be tested for the presence of cancer cells.

Q: What treatment options are available for prostate cancer?

DC: Treatment options will depend on the stage or progression of the cancer. The earlier the stage, the more options we have. Removal of the prostate is one option, but we have to weigh the benefits along with the potential side effects, such as injury to the sphincter or surrounding nerves which can lead to incontinence or erectile dysfunction.
A second option is Radiation therapy, IMRT (intensity-modulated radiotherapy) or Brachytherapy treatment, which involves implanting radioactive seeds directly to the affected area of the prostate. IMRT is external beam radiation therapy using linear accelerators to safely and painlessly deliver precise radiation doses to a tumor while minimizing the dose to surrounding normal tissue. A third option is hormonal treatment to suppress production of testosterone to cause cancer cells to die.

Q: What if the cancer has already progressed significantly?

DC: It is still possible to treat prostate cancer, even if it wasn’t detected until a late stage. As an example, a patient who came for a regular check-up showed an extremely high PSA level of 1,500. His prostate cancer had already metastasized to other areas of his body. We were able to treat him successfully, and he still enjoys a very good quality of life. Even during the late stages of prostate cancer, we have treatment options available with the potential to control the disease.
 

Bumrungrad's Urology Center is staffed by a team of experienced urologists who provide expert consultation, diagnosis, and treatment for a wide range of urological and genital problems affecting men and women. For more information, or to make an appointment, contact the center by phone at +66 2011 2222, via online appointment , or send an inquiry by email.