Welcome to the Age of Detecting Cancer Early. Sometimes, early-stage cancer shows up as a chance result of a test or procedure for something else. For example, a gall bladder CT scan may pick up suspicious spots on the liver. This is called incidental discovery. It may be a lifesaving silver lining for many patients, but sadly it’s a small number of early detections. Only 4% of cancers are found this way.
More often, early cancer detection occurs because of recommended screening tests like colonoscopies. The National Opinion Research Center (NORC) tells us, “Improved cancer screening has the potential to detect cancers earlier when treatment is more likely to improve outcomes and save lives.” That should be a win, but NORD reports that it’s still just 14% of cancer cases. In fact, most cancers are found as the result of symptoms, suggesting that the disease is often diagnosed at a later stage when it’s difficult to treat successfully.
Prostate cancer (PCa) is the most common non-skin cancer in men, and in its early stages there are virtually no symptoms. This means as many as 1 out of 8 men can have PCa growing in his body and yet be completely unaware. By the time there are symptoms like urinary problems, blood in urine or semen, or pain in the hips and lower back, the odds are that it has advanced beyond the prostate gland. At that point, it can be managed to prolong life, but there is no cure once PCa spreads to other parts of the body. In short, why not find the small problem before it becomes a big problem?
How to detect PCa when it’s early
Currently, there are only four cancers for which screening is approved: colon (colonoscopy), breast (mammography), cervical (Pap smear), and lung (CT scan). What about prostate cancer? Most men have heard of the PSA blood test, which is easy and relatively cheap in terms of healthcare dollars, but there’s a catch: it’s not specific for PSA. It has a poor track record of leading to needle biopsies and overly aggressive treatments that result in harmful side effects. And yet, studies have shown that countless lives have been saved because it the PSA test picks up a red flag that PCa may be present.
I want to make a case for the importance yearly checkups that include a PSA test—and what can be done to make sure they don’t lead to needless harm! I’m not saying an annual blood draw is essential for detecting PCa, but rather it’s essential for detecting suspicion of prostate cancer (PCa). Big difference!
PSA stands for Prostate Specific Antigen, a protein on the surface of prostate cells as well as prostate cancer cells. Many things can cause these cells to “shed” their surface proteins into the bloodstream, where the amount can be measured by blood draw. Here are some causes: an infection in the gland, a normal aging-related prostate enlargement called BPH, riding a bike or having sex the day before the blood draw—even a digital rectal exam (that rectal finger exam that guys dread) done before the blood draw! Because of such possibilities, there’s no need to panic if the blood test returns a high result.
In the past, though, the standard of care was to immediately refer a patient for a needle biopsy. That’s because there was no other way to interpret what the PSA number meant. In turn, biopsies often led to whole-gland treatments with their risks of urinary, sexual and bowel side effects. But thankfully, there’s good news when it comes to prostate cancer.
The Age of Detecting Cancer Early is also the Age of Better Prostate Information. For men, there are three noninvasive steps to find out what a high PSA result really means:
- Step 1 – Wait several weeks and repeat the PSA test—this time, don’t ride a bike or have sex the day before. This can rule out things like previous lab error, bike riding, or sexual activity. If it’s still high, proceed to step 2.
- Step 2 – Have a scan using multiparametric MRI (mpMRI) done on a powerful 3T magnet. Studies show it can avoid unnecessary biopsies altogether by selectively revealing areas of the prostate gland that have a high probability of containing potentially life-threatening PCa that should be biopsied.
- Step 3 – If a prostate biopsy procedure is indicated, have a targeted biopsy guided by real-time mpMRI. This is the most accurate method using a minimal number of needles to sample the precise area likely to harbor dangerous PCa cells.
Here’s what’s important to remember. A high PSA blood test result does not accurately tell if PCa is present. However, when repeated to rule out earlier error or activity, and followed by mpMRI, it has huge benefits:
- It provides the earliest warning that PCa may be present
- It signals a need for mpMRI to rule a biopsy in or out
- If a biopsy is needed and proves positive for PCa, the combination of the PSA result and the mpMRI scan are two key factors for planning a treatment strategy tailored for the patient.
I hope I’ve made the case for why an annual checkup and PSA test are keys to early and accurate detection of PCa. To put it another way, avoiding a doctor visit raises the chances for diagnosing PCa at a later stage, when aggressive treatment is necessary. Guys, ignorance is not bliss! Not knowing if you’re walking around with PCa is a setup for greater anxiety and unhappiness than any routine checkup will ever be. When it comes to PCa, an ounce of detection is worth a pound of overtreatment.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you have health concerns or questions of a personal medical nature.
