Prostate cancer and Prostate Specific Antigen (PSA)

Prostate cancer is the most commonly diagnosed malignancy affecting men beyond middle age, and is second only to lung cancer as the cause of deaths in men. There is a worldwide increased in the incidence of prostate cancer and the lifetime risk of developing microscopic prostate cancer is estimated to be around 30%, and this figure increases with age.

Apart from age, there are other risk factors for prostate cancer. Men in North America (especially African American) and Northern European countries have higher risk for prostate cancer. Approximately 9% of all cases of prostate cancer have a genetic basis (Hereditary Prostate Cancer, HPC genes) and the risk of developing prostate cancer becomes higher with stronger family history of prostate cancer. Obesity, western diet high in animal fat, protein, meat and processed carbohydrates, as well as hormones such as testosterone and its more potent metabolite dihydrotestosterone (DHT), may play a role in the development of prostate cancer.

The diagnosis of prostate cancer

If you have strong risk factors for prostate cancer or if you are older than 50 year old, you should see your doctor for prostate cancer screening. A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate. PSA is a useful tool for diagnosing and monitoring prostate diseases, but further tests are required to confirm which condition is present. Based on your history, digital rectal examination and PSA test, your urologist may organise for you to undergo further tests such as prostate biopsy.

Prostate cancer is graded using the Gleason system and recognizes five levels of increasing aggressiveness (Grade 1 to 5) and the sum of two of the most common pathological patterns forms the Gleason score. Men with Gleason score of 2-4 have a 4-7% chance of dying within 15 years of diagnosis while men with a score of 8-10 had a 60-87% chance of dying from prostate cancer. Depending on the outcomes, your urologist will advice you on the available treatment options.

Currently it is not possible to distinguish between those tumours that will remain latent throughout your life and those that will definitely progress to clinical significant disease. Elderly men with lower grade and stage of prostate cancer are more appropriately managed by watchful waiting, while younger men with similar prostate cancer profile, may be considered for more aggressive, potentially curable therapy.