By Jeremy Lieb, MD
Recently there has been increasing controversy over the value of PSA and prostate cancer screening. The prostate specific antigen blood test is a valuable test to help identify several different prostate conditions. This blood test can be elevated as a result of prostate enlargement, prostate infection, or prostate cancer.
Prostate enlargement is an extremely common condition for many older men. The symptoms of prostate enlargement include a weak urinary stream, urgency and more frequent urination, getting up more at night to urinate, and a sense of incomplete emptying. A larger prostate will produce more PSA and the blood test results can often increase gradually over several years. Patients who have a prostate infection usually have flu like symptoms, in addition to burning with urination and terrible frequency. Prostate infections are best treated with antibiotics for several weeks. In these patients we expect the PSA will increase rapidly and then slowly return to normal after adequate treatment.
Prostate cancer can be a very scary diagnosis for many patients. In fact, some prostate cancers are very slow growing and have limited risk for long-term complication. It is most important to identify patients who are at increased risk and provide the highest quality of treatment with a goal of cure. A qualified urologist will be able to use a combination of PSA, prostate exam, and prostate biopsy to help provide treatment recommendations. Prostate biopsies are often necessary to differentiate between enlargement and prostate cancer. Your Urologist will use information gathered from the biopsy to provide advice. In addition, a prostate ultrasound is done at the time of the biopsy and this helps to identify significant enlargement.
Our practice has years of experience with robotic prostatectomy. This is a minimally invasive treatment for surgical removal of the prostate. Previously, many patients had significant urinary incontinence and erectile dysfunction after traditional open incision surgery. The robotic approach has reduced these complications. Other treatment options include external beam radiation, radioactive seed implantation, hormone therapy, medications, and some less common treatments.
Conclusion: PSA is a valuable test to help identify several different prostate problems. A qualified urologist is the best physician to provide further diagnostic and treatment recommendations.