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Prostate Problem Guide

PSA Scores Linked To Aggressive Prostate Cancer

The Prostate Specific Antigen (PSA) test is a simple blood test which is commonly used as a screening test to detect the presence of an enlarged prostate and of prostate cancer. Although the test cannot in itself be used for diagnosis it is a good indicator and, along with other screening tests, PSA scores can point to the need for further investigation.

The test is generally recommended for men in high risk groups (such as those with a family history of prostate cancer) from the age of about 40 to 45 and for men in general over the age of 50.

A single test in isolation will provide a snapshot of prostate specific antigen levels in the blood and may indicate a problem immediately if you record particularly high psa numbers. However, in most cases, and where a prostate problem may be in its early stages of development, a single test result will prove to be inconclusive and a further test will normally be recommended in a few weeks time. Indeed, ideally PSA testing should be carried out at regular intervals 2 or 3 times a year so PSA levels can be plotted over time.

As long as you record a PSA normal score all is well, but as soon as your PSA scores begin to rise they need to be monitored closely. The speed at which PSA scores increase is often referred to as the 'PSA velocity' and as long as the rise is gradual and the velocity slow then it is again often sufficient just to monitor the situation as many things can influence PSA levels and apparently rising levels will often be seen to fall back to normal over time.

However, when PSA readings start to rise rapidly and the velocity is said to be high then further investigation is needed.

This pattern of PSA testing and monitoring has been followed for some time but, while the test has always been considered to be a good indicator of the need for further investigation, it was not until very recently that we have been able to link specific PSA velocity to prostate cancer in a manner which can predict the aggressiveness of that cancer.

In a recent study data from 950 men who had been diagnosed with prostate cancer and undergone either surgery of radiation treatment at four hospitals between 1988 and 2004 was analyzed.

In all cases each patient had been diagnosed with aggressive prostate cancer on the basis of a single very high PSA score, the results of a biopsy indicating an aggressive cancer at cellular level, the presence of a advanced stage tumor, a noticeable increase in their PSA velocity during the year prior to diagnosis or a combination of two or more of these indicators.

The study also looked in detail at the post-treatment outcomes for all 950 men and found that a rapidly rising PSA score which jumped by 2 or more points in a year was the clearest indicator or the presence of an aggressive cancer.

Until now we have been able to associate rising PSA levels with an indication of the possible presence of prostate cancer but have had to guess to some extent about whether or not such a cancer is likely to be aggressive and require correspondingly aggressive treatment.

Now however we can say with a fair degree of certainty that if a PSA score increases by more than 2 points in a twelve month period then prostate cancer is almost certainly aggressive and needs to be treated speedily and vigorously.

Further information on PSA scores:

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The West Australian

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