A Few Realistic Words about PSA and Prostate Cancer                                Chin-Ti Lin, M.D.


    PSA stands for prostate specific antigen - a protein specifically coming from the prostate, so it's organ-specific (not cancer-specific).

    Over the past 45+ years since its discovery in 1970, PSA has been used as a reasonably useful tool to alarm men if they have a high
    suspicion for prostate cancer.

    However, its accuracy for telling us about prostate cancer has been confusing and conflicting.

    As a result, many men have been living under the siege of anxiety and fear for prostate cancer and falling victims to modern medicine.

    Therefore it's important to know more about the currently available truth and facts of PSA as follows:

    1.  A rise of PSA occurs not just with the presence of prostate cancer but also with increasing age, prostate enlargement, urinary tract
        infection, or any sorts of inflammation of the prostate.

    2.  Besides, it would be useful to know how common prostate cancer can be found in men. For example, if men who died of the reasons
         other than prostate caner at age of >60, >70, and >80 years and we examined these men's prostates  from autopsy under
         microscope carefully, we still expect to find the presence of prostate cancer up to as high as >65%, >75%, and >85% respectively.

    3.  In other words, most elder men walk around with tiny prostate cancer although their prostate cancer never grows to a size or degree to
        bother their life.

    4.  Despite testng PSA to diagnose more men with prostate cancer (P-Ca), most patients with P-Ca will still die of other causes, not
        prostate cancer, and their possibility to die directly of it has remained about the same before and after PSA discovery in 1970.

    5.  "Normal" PSA does not guarantee men not to have prostate cancer. At times, doctors still cannot find prostate cancer in men with
         elevated PSA outside its normal range even after 3-5 prostate biopsies.

    6.  The accumulation of experience over the past four decades indicated, in order to save a man dying of prostate cancer (P-Ca), we
        would need to perform more than 25 to 45 radical prostate surgeries.

    7. The "best" use of PSA thus far has been as an effective tool for following the patients after definitive treatments such as radical
       prostatectomy, radiation therapy, cryotherapy, etc. for prostate cancer.

    Despite significant inevitable disturbance from the above truth and facts of PSA and prostate cancer, the bottom-line on the issues of PSA
    uncertainty still lies on:

    Who are the men requiring a timely active attention with further evaluation with prostate ultrasound examination and biopsy as well
    as the treatment for prostate cancer if any?

    To solve these concerns, a qualified medical provider will be able to help you walk through a reasonable process of evaluation and care
    although perfection in life and care would and will never happen.  

    In practice, PSA is the most useful tool to follow the patients of prostate cancer under and after treatment. Of note, PSA will decrease by
    about 50% within 3 months after using 5 alpha-reductase inhibitors such as Proscar or Avodart to shrink the size of BPH (benign prostate
    enlargement), usually be 20-25% in volume.

    For more information from the Internet, please click More Prostate below.

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