What You Need to Know About Prostate Cancer and Laboratory Tests

Prostate cancer is a condition characterized by the uncontrolled growth of cells around and in the prostate gland. This is the organ responsible for producing prostate fluid, which makes part (70%) of semen produced in the testes.  This type of cancer affects cells responsible for generating the prostate fluid- hence known as adenocarcinomas.

According to research, 1 in 9 men is at risk of developing prostate cancer – this can happen at any point in his life. That said, prostate cancer is believed to be among the common types of cancer affecting men – this is after skin cancer.  At least 160,000 men are diagnosed with prostate cancer in the United States alone, with as many as 29,000 dying from the condition. This is according to statistics collected by the American Cancer Society (ACS)

While most types of prostate cancer are slow growing, some types grow and spread at a faster rate, hence more dangerous.  Slow-Growing cancer does not, however, pose a significant risk to most men.  Many older men, and even some younger ones, who died of other causes, also had slow-growing prostate cancer, according to the American Cancer Society. Most of these men had no idea they had prostate cancer in the first place.

Risk Factors

Among other risk factors, those from families with a history of prostate cancer, African American ethnicity, and aging men are at the highest risk of developing prostate cancer.  Studies also show that more than 60% of all prostate cancer patients are aged 65 years and above.

There is also more to learn about the link between genetics and prostate cancer. Men predisposed with specific disease-causing variants (BRCA1 and BRCA2), however, show an increased risk of developing prostate cancer as compared to other men. Such mutations, however, only occur in a small percentage of overall prostate cancers, one of the reasons most men aren’t tested for BRCA mutations.  Men who choose to be tested for such mutations, however, make screening and treatment options easier.

Signs and Symptoms of Prostate Cancer

Prostate cancer may not spread to other parts. Hence it can be confined within the prostate gland for many years with few to no symptoms. Slow-growing types of prostate cancer will only start to show signs if the tumor mass is large enough to affect other parts, and especially the urethra.

Some of the most common signs and symptoms include:

  • An interrupted or weak urine stream
  • Frequent urination
  • Blood and/or pus in semen or urine
  • A burning sensation (pain) when ejaculating or passing urine
  • Discomforts in the upper thighs, pelvis, and lower back

Most of the symptoms outlined here are common other health conditions as well. Other conditions, such as acute inflammation of the prostate, an STI, UTI (urinary tract infection), and benign prostatic hyperplasia (BPH) will have similar symptoms.

Benign prostatic hyperplasia (BPH) is commonly mistaken for cancer, which isn’t the case.  The condition is very common with men over the age of 80 and only characterized by an enlargement of the prostate. Studies by the American Urological Association show that 90% of patients with BPH are over 80 years old.  Both BPH and Prostate cancer may, however, be found together, one of the reasons you should have tests done for both. The tests may involve a digital rectal exam (DRE), Lab tests (PSA), or a prostate biopsy.

Prostate Cancer Screening

Health experts recommend going for prostate cancer screening even before the signs and symptoms can show.  Men are also encouraged to discuss the pros and cons of screening with their health practitioners as well. This helps one make a more informed decision on the route to take.

The following tests will be done (recommended) should you choose to get screened:

  • Prostate-Specific Antigen (PSA) – The test involves testing your blood PSA levels.
  • Digital rectal exam (DRE) – This is a physical exam whereby the health practitioner examines the prostate gland manually. To do this, he/she must insert a lubricated, gloved finger into the rectum to feel the prostate gland, as well as to detect any abnormalities.

Considerations

One’s risk of developing prostate cancer is the first and most important factor to consider, and especially if debating on whether to undergo screening or not. 

a. Average risk – This is for men with perfect health with no known risk factors

b. Increased risk – individuals of African American ethnicity, if a family member was diagnosed with prostate cancer before attaining the age of 65, and men with genetic variants (mutations)

c. High risk- Men with several relatives diagnosed with the condition

Other considerations, including potential benefits and disadvantages.

There is no guarantee that PSA testing will improve prostate cancer survival rates. This is because PSA tests alone aren’t enough to detect all types of prostate cancer. On the flip side, PSA screening makes it possible to detect cancer at its early stage, thus easier to contain.  This method of testing, however, helps men to be aware of their prostate-cancer status.

Reasons for elevated PSA levels

Although higher than normal PSA levels may raise a red flag for cancer, the elevated levels may be due to another condition. Inflammation of the prostate, benign prostatic hyperplasia, etc. do trigger increased blood PSA levels.  These can cause a false-positive result leading to unnecessary tests, stress, and even prostate biopsy.

A repeat PSA test is, however, recommended to ascertain the initial result. The repeat tests should be done after some time for proper diagnosis.  Most healthcare practitioners will suggest having a series of PSAs done to not only detect the cause, but also determine if the levels remain the same, go down, or continue to increase. These tests are recommended to prevent overdiagnosis.

Should the tests reveal a series of elevated PSAs, or an elevated PSA, you will be required to decide to undergo biopsy.  A prostate biopsy is relatively safe, with only a small risk of bleeding, infection, and pain. You can read more on biopsies on Anatomic pathology.

Should you test positive for prostate cancer, consider:

While it is easy to detect prostate cancer, the tests do not tell if the tumor is slow-growing or not. Slow-growing prostate cancer doesn’t, however, have a significant effect on a man’s life expectancy or health. Treatments for the same (slow-growing cancer), however, have several adverse effects on him; these include incontinence and erectile dysfunction, among others.

Some men may choose to avoid treatment for slow-growing prostate cancer and instead opt for ‘active surveillance’ or ‘watchful waiting’ for the same. This approach involved getting PSA tests and digital rectal exams done every six months, as well as a prostate biopsy, is done annually to monitor how the cancer is progressing.

Some types of prostate cancer will grow or spread aggressively around the pelvic region and other parts of the body. A few of these slow-growing tumors may become symptomatic and large, hence require immediate attention. The main challenge, however, is detecting the type of prostate cancer, its growth rate, as well as how fast it spreads. Your health practitioner will, however, help you decide on the best mode of treatment and when to start.

Lab Tests

Lab tests come in handy in detecting prostate cancer, and to rule out health conditions/ailments that may make the situation worse. The tests can also be used to monitor and determine the effectiveness of the current mode of treatment.

Testing may include:

  • Total Prostate Specific Antigen – The tests are done to detect and monitor prostate cancer.  The health expert must evaluate tests based on the volume of the patient’s prostate and PSA levels in the blood.
  • Free PSA – There are two types of PSA in the blood: free PSA (fPSA), which isn’t bound, and complexed PSA (cPSA), which is linked to other proteins. Health experts test for fPSA to determine the need for biopsy to be done. The biopsy can only be done when the total PSA is slightly elevated. Most men with BPH will have higher levels of fPSA, while those with prostate cancer will have relatively lower amounts of the same. Low levels of fPSA increase the risk of cancer despite normal PSA levels.

A patient doesn’t necessarily have to undertake PSA tests to decide on whether he should undergo biopsy or not. New and upcoming testing methods help detect elevated PSA levels hence reduce discomfort, anxiety, and complications related to follow-up biopsies. These include:

  • [-2] proPSA – This test method helps identify the precursor of PSA.  These cells are produced at a higher rate as compared to benign prostate cells. The percentage of [-2] proPSA is relative to the total PSA levels and can be used to help determine if a biopsy is needed.
  • PCA3 protein – This protein is only produced in the prostate glands. This test, therefore, measures the level of PCA3 RNA in the patient’s urine.
  • TMPRSS2-ERG gene fusion – This test helps detect gene rearrangement in one’s urine.  Gene rearrangement can be defined as the rate at which a piece of chromosomes breaks off to reattach itself to another. Gene rearrangement is evident in a little over 50% of all known types of prostate cancers. That said, testing the level of gene fusion may help one determine if prostate cancer is present or not.
  • Prostate health index (PHI) – This test involves combining results from other tests (proPSA, fPSA, and Total PSA) to determine a patient’s risk of developing prostate cancer. The results also help health experts determine the need for biopsy and especially where total PSA levels are higher than usual. Digital rectal examination may not be needed in phi tests.
  • P2PSA – This test involves measuring p2PSA levels in the blood. The percentage of p2PSA helps predict the probability of prostate cancer before the biopsy. This is recommended for men with elevated total PSA levels. Higher levels of p2PSA indicate the risk of aggressive prostate cancer. Combining FPSA, total PSA, and p2PSA test results increase the accuracy of a prostate cancer diagnosis.

These tests are intended to help predict if biopsy would be useful in diagnosis. They thus cannot/shouldn’t be used to determine if one has prostate cancer or not.

Diagnosis and Staging

A prostate biopsy is the only sure way to diagnose prostate cancer. The process involves collecting prostate tissue for examination under the microscope to identify any abnormal cells. The healthcare practitioner uses imaging tests samples (from CT scan or MRI) to diagnose cancer, as well as determine how far it has spread into the body (stage).  The biopsy also helps determine how the cells appear as well. The health practitioner then assigns a Gleason Score based on the results, with the highest number showing advanced stage and such. Be sure to read more about prostate cancer biopsy on the ‘Understanding Your Pathology’ Report, in the Prostate Cancer from the American Cancer Society.

General Lab Tests

Additional tests may be required to ascertain the likelihood of prostate cancer, and to rule out possible other conditions with similar signs and symptoms. These include: