Prostate Cancer: Beyond the PSA Test—What Every Man (and His Family) Needs to Know About Early Detection

The Prostate-Specific Antigen (PSA) test is a familiar term for many men, often the first thing that comes to mind when thinking about prostate health. But is it the only thing men should be thinking about? Understanding prostate cancer detection goes much deeper than a single test. It's about understanding what PSA levels really mean, recognizing your individual risk factors, and having informed conversations with your health care provider. So, what does it really take to proactively manage your prostate health, and what should every man (and his family) know about early detection? Dignity Health is committed to providing dedicated care and supporting you on your journey to better prostate health.

Is It Just Aging, or Something More? Common (and Uncommon) Symptoms

Many men mistakenly believe that prostate cancer always presents with obvious urinary symptoms. While urinary issues can sometimes be a sign, it's crucial to understand that early-stage prostate cancer often has no symptoms at all. This is why proactive screening is so vital.

Here are some typical symptoms that can be associated with prostate cancer, though they can also be caused by other, less serious conditions:

• Difficulty urinating

• Frequent urination, especially at night (nocturia)

• Weak or interrupted urine flow

• A sudden urge to urinate

• Blood in the urine or semen

• Discomfort or pain when sitting, caused by an enlarged prostate

It's important to remember that these symptoms can also be caused by benign prostatic hyperplasia (BPH), also known as an enlarged prostate, or other conditions. However, if you experience any of these symptoms, it's essential to talk to your health care provider to determine the cause.

In more advanced stages, prostate cancer can sometimes cause:

• Bone pain (especially in the back, hips, or ribs)

• Unexplained weight loss

• Fatigue

These symptoms are less common but highlight the importance of early detection, before the cancer has a chance to spread. Dignity Health encourages men to be aware of their bodies and report any unusual symptoms to their health care providers.

Decoding Your PSA: What the Numbers Really Mean (and Don't Mean)

The Prostate-Specific Antigen (PSA) test is a blood test used to screen for prostate cancer. PSA is a protein produced by both normal and cancerous cells in the prostate gland. When PSA levels in the blood are elevated, it can be a sign of prostate cancer, but it's important to understand that it's not a definitive diagnosis.

An elevated PSA level can also be caused by:

• Benign prostatic hyperplasia (BPH)

• Prostatitis (inflammation or infection of the prostate gland)

• Recent ejaculation

• Certain medications

The "normal" range for PSA levels is generally considered to be below 4.0 ng/mL, but this can vary depending on age and other factors. Some men with prostate cancer have PSA levels below 4.0 ng/mL, while others with elevated PSA levels do not have cancer.

That's why it's important to consider trends in PSA levels over time, rather than just a single reading. A sudden increase in PSA levels, even if they are still within the "normal" range, may be a cause for concern. Your health care provider will also consider your age, race, family history, and other risk factors when interpreting your PSA results.

Beyond Age 50: Understanding Your Personalized Risk Factors

While age is the primary risk factor for prostate cancer, with risk increasing significantly after age 50, it's important to understand your personalized risk factors to make informed decisions about screening.

Here are some key risk factors to consider:

• Age: As mentioned, the risk of prostate cancer increases with age, particularly after age 50.

• Family History: Having a father or brother with prostate cancer significantly increases your risk, especially if they were diagnosed at a younger age (before age 55). This may indicate an inherited genetic predisposition. There are also connections to other cancers, such as breast, ovarian, and colon cancer, which may be linked to genes like BRCA1, BRCA2, and Lynch Syndrome.

• Race/Ethnicity: Black men and men of African ancestry have a significantly higher risk of developing prostate cancer than men of other races. They also tend to be diagnosed at a younger age and with more aggressive disease. The reasons for this disparity are not fully understood but may involve genetic, environmental, and socioeconomic factors.

• Lifestyle Factors: While less definitive than age, family history, and race, certain lifestyle factors may also play a role in prostate cancer risk. These include a diet high in fat, obesity, and exposure to certain environmental toxins.

The Screening Conversation: When, Why, and With Whom to Talk About It

The decision to undergo prostate cancer screening is a personal one and should be made in consultation with your health care provider. It's important to have an open and honest conversation about your individual risk factors, the potential benefits and risks of screening, and your personal preferences.

General guidelines suggest that discussions about prostate cancer screening typically begin around age 50 for men at average risk. However, men at higher risk (e.g., those with a strong family history or Black men) may want to start the conversation earlier, around age 40-45.

During your screening conversation, be sure to discuss the following with your health care provider:

• Your individual risk factors for prostate cancer

• The pros and cons of PSA screening, including the potential for overdiagnosis and overtreatment

• The possibility of false-positive and false-negative results

• What next steps would be recommended if your PSA level is elevated, such as a digital rectal exam (DRE), follow-up PSA tests, or a prostate biopsy.

Dignity Health encourages men to have these important conversations with their health care providers and to make informed decisions about their prostate health.

What's Next After PSA?

If your PSA level is elevated or prostate cancer is suspected, your health care provider may recommend further testing to determine if cancer is present.

Some of the more advanced diagnostic tools that may be used include:

• Multiparametric MRI of the Prostate: This imaging test can help identify suspicious areas in the prostate gland and guide targeted biopsies.

• Newer Blood or Urine Biomarkers: Tests like PCA3, 4Kscore, and the Prostate Health Index (PHI) can help refine risk assessment and reduce the need for unnecessary biopsies. These tests measure specific proteins or genetic markers associated with prostate cancer.

These newer technologies are helping to improve the accuracy of prostate cancer detection and reduce the risk of overdiagnosis and overtreatment. Dignity Health is committed to utilizing the latest advances in prostate cancer diagnosis and treatment to provide the best possible care for our patients. Contact your local Dignity Health facility to learn more about specific services available in your area.

Dignity Health: Your Partner in Men’s Health

At Dignity Health in California, we are dedicated to providing specialized care to our communities. If you have concerns about your prostate health or are interested in learning more about prostate cancer screening, we encourage you to schedule an appointment with your primary care provider to determine if a referral to a urologist is recommended. Find a Dignity Health urologist near you today and take the first step towards better prostate health.