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Worried about chances of prostate cancer

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Q. I am 48 and recently did my medical check-up. I was alarmed at my high prostate-specific antigen (PSA) level. My total PSA is at 3.21 micrograms per litre (ug/L). The medical report also stated that my PSA level is high. Is prostate ultrasound an option? Is it accurate and safe? What further evaluation tests should I consider?

A. The prostate-specific antigen, as its name implies, is a prostate gland marker.

A common misconception is that abnormalities with PSA signify the presence of prostate cancer.

However, there are other benign conditions that may lead to a rise in blood PSA levels, including prostate enlargement (benign prostatic hyperplasia, or BPH), recent urinary tract infections or recent procedures done in the urinary tract.

It is also important to understand that some laboratories may have different reference ranges for normal serum PSA levels. Therefore, serial PSA tests should be performed in the same clinic or laboratory, so that comparisons are possible.

You should consider visiting a urologist, a specialist who deals with disorders of the prostate and the lower urinary tract.

The urologist will ask some questions on whether you experience urinary symptoms, including frequent urination, difficult urinary flow and a feeling that you still need to go after passing urine.

You will also be asked about the presence of bleeding in the urine or abnormal bleeding in the semen.

This will be followed by physical examination of the abdomen and the external genitalia. A finger will then be placed into the anal passage to feel the prostate gland (digital rectal examination) for nodules or other abnormalities.

A bedside ultrasound scan may be performed by the urologist to look for abnormal swelling in the kidney (hydronephrosis) and also to measure the size and protusion of the prostate gland.

Specifically, an ultrasound of the prostate is a safe procedure, but its accuracy is limited when it comes to detecting abnormal growths in the prostate gland.

You may also be asked to perform a urine test, to look for the presence of infection, and a uroflowmetry test to assess the speed of your urinary flow.

In the event that the digital rectal examination of the prostate is abnormal, this would raise the suspicion of the presence of prostate cancer. Therefore, you may be advised to undergo a prostate biopsy where some samples of tissue are taken for a formal analysis.

You would also undergo magnetic resonance imaging (MRI) of the prostate gland to assess the entire scale of the disease.

The optimal treatment of prostate cancer depends on the stage and the risk profile of the cancer detected. If you have BPH, your urologist will advise you on the need for treatment, depending on the severity of the obstruction of the bladder opening by the prostate gland. You will also be monitored for any changes to your blood PSA levels.

Bear in mind that there is no concrete evidence in medical literature that supplements marketed for prostate health are of benefit.

Clinical trials looking at the role of vitamin supplements and selenium have also not shown these food classes to have any advantages.

The diagnosis of either BPH or prostate cancer in men is more likely to be related to genetic factors.

Nevertheless, if you care for your health with regular exercise and a healthy diet, these lifestyle habits will provide you a better standing in the event that you need to be treated for prostatic disease.

Dr Lee Lui Shiong
Consultant in the department of urology at Singapore General Hospital


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A version of this article appeared in the print edition of The Straits Times on September 22, 2015, with the headline 'Worried about chances of prostate cancer'. Print Edition | Subscribe