Monday, December 27, 2010

PSA on PSA (The Greenfield Diaries)

Now that you are well versed in the beginning stages of my Prostate ordeal, I think it is only fitting that we go over some important words and phrases that I will be using in the upcoming part 3 of this saga a.k.a. "The Boyfriend I Never Wanted."

Part 2 of the PSA on PSA "The Greenfield Diaries" wasn't originally planned at first. I was just planning on doing some research on WebMD or something to give definitions. However, it turns out a college friend of mine has made something for himself and is a Board Certified Urologist. So on a whim, and not really speaking with him formally in 10 years, I asked if he would be so kind to answer some questions for the site. He did and it was exactly what I wanted: straightforward answers with minimal amounts of conservatism. This saved me tons of research time and time figuring out how to give credit to a website. So, thank you Dr. Jason Greenfield for your professional input here. Also you should be able to tell the difference between Dr. Greenfield's comments and mine.

So on to the show. We'll start at the beginning. How many of you actually know what your Prostate does? I am going to bet that most of you that are under 40 know very little. Maybe general location or that your dad isn't thrilled when he goes and gets it checked. The prostate is a gland specific to the male gender. It is located next to the bladder and envelops the urethra as it begins from the bladder neck. Its main function is to contribute secretions that compose semen and is the entry point of the the ejaculatory ducts where sperm from the vas deferens and secretions from the seminal vesicles enter. So, without this walnut shaped glad, there wouldn't really be a Suburban FATHER Alliance.

Now that we are squared away on its location lets get more into its function. The Prostate produces PSA. PSA stands for "Prostate Specific Antigen" and its major function is to liquefy semen. It can also be found in blood and is currently used as a tumor marker for prostate cancer. Essentially, the higher the PSA level, the more in your blood. It is a better marker of prostate size but doctors use it to screen for cancer because it is still one of the best markers they have right now. Although, in truth, it is terrible in terms of specificity. It is important to know that a lot of other medical problems can cause the PSA to rise such as urinary infections. -- If  I can pause, this last sentence really hits home for me and after talking to Dr. Greenfield, I wished I would have gotten a second opinion with my symptoms. Second opinions only cost a copay but could save you a huge amount of stress.

So a bit more on PSA. When PSA is measured in the blood there is a level associated with it. Now what constitutes a "normal" PSA level is a very complicated answer. A normal PSA level depends on the patient's age, prostate size, and previous levels. For example, most laboratories give a range of 0-4.0 as normal. However, it is definitely not normal for a 30 year old to have a PSA of 3.5. A level of 5.0 may not be abnormal for a man in his 80's. As another example, a very small prostate and a PSA of 3.5 may be concerning whereas a very large prostate and a PSA of 5 or 6 may not be. As a final example, we also look at "PSA velocity". If your PSA one year was 3.9 and the next year was 4.1, that may not be very concerning. If it was 1.5 one year and the following year was 3.0, that can be a red flag. There are also a multitude of other tests involving PSA and it's subtypes. It can be very confusing and one could write volumes of text about PSA itself. Perhaps the best advice is to be aware of what your PSA is and ask your urologist what, if anything, you should be doing about it.

Now, like many substances in our blood stream, PSA exists both bound and unbound to other proteins (mainly albumin). Unbound PSA is often referred to as a "free PSA". Testing for free PSA was developed in the hopes that it would be a more specific test for identifying men who were at risk for prostate cancer. It is given as a percentage and, unlike the test for total PSA, a "lower" value is considered MORE suspicious for prostate cancer versus benign disease. However, it should be noted that the free PSA test has been somewhat disappointing as a tool for identifying higher risk patients. It certainly has not relieved us in our quest for a highly sensitive and specific test for identifying men with prostate cancer.

Finally, one very common complication with Prostates is BPH or an enlarged Prostate. The most important thing to know about an "enlarged" prostate is that a large prostate is in no way a risk for having cancer. It may lead to an elevated PSA but as  mentioned above, that does not mean cancer. An enlarged prostate can eventually cause urinary problems as the prostate grows to obstruct the flow of urine through the prostatic urethra. This is often called "BPH" which stands for "Benign Prostatic Hyperplasia". Note the word "benign". This is not cancer. BPH occurs in the central part of the prostate where the urine passes through. Prostate cancer usually occurs in the peripheral part of the gland.

Ok we covered the location, function, and what doctors measure in the Prostate. We can also confirm that each person's Prostate is going to be different in size and in producing PSA. There's no clear formula on what is going to constitute if you have cancer or not. What Dr. Greenfield does recommend is talking with your doctor briefly about whether or not you wish to be screened. If you decide that you do, the recommended age to start screening for a Caucasian male with no significant family history of prostate cancer is age 50. Men of certain ethnic backgrounds, especially men of African descent, are recommended to start at age 40 as well as men with a family history of prostate cancer.

Overwhelmed with info? Mission accomplished. I really hope you all have taken some time to read & re-read this info. Its a lot, but it is necessary to stay informed as patients and to ask the right questions when we visit with our doctors. I cannot thank Dr. Greenfield for his time on this subject. He has probably opened a Pandora's box by being so open and thorough.

Now, for the the final post of this Trilogy I will talk about my experience when I went to the Urologist for the first time not knowing what any of this was and having some discouraging news dropped on me in the middle of a St. Patrick's Day Parade. Thanks for reading.


1 comment:

  1. [...] January 10, 2011 by John Shepard Well here it is the final episode of my Prostate trilogy. Its been an epic writing journey for me as I don’t think I have written so much about 1 topic since College. I will recap just a bit but you can read the full stories here & here. [...]