Understanding Prostate Cancer
with Ron Tutrone, MD
When should men start with PSA's?
One of the most alarming aspects of prostate cancer is that there are usually no specific signs or symptoms in the early stages. “There really aren’t a lot of signs, which is why prostate screening is so crucial,” says Dr. Ron Tutrone, MD, Division Head of Urology at GBMC.
The best way to identify prostate cancer early on is during an annual physical examination through a prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE). However, even PSAs can be tricky. A PSA score over four can mean a higher risk for prostate cancer. But as Dr. Tutrone explains, “Over a third of those with prostate cancer will have a PSA within a normal range (under four). On the other hand, a score of over four does not necessarily mean you have the disease either. Only 40-50% of men in this range actually have prostate cancer.”
Consequently, the value of a PSA is not in an absolute number. The key is in what Dr. Tutrone terms your “PSA Velocity.” A jump of more than 0.8 a year is a key indication you should get a biopsy. Dr. Tutrone explains, “Two is a low number, but if you tested at 0.9 for five straight years, then jump up to 2.0 the next year, you need to have a biopsy.”
Although the American Cancer Society recommends men start PSAs and DREs in their fifties, Dr. Tutrone believes it’s prudent to start much earlier, “My suggestions may go against the grain, but I think it’s best to establish a baseline PSA score in your thirties, then get tested again at 40, 45 and 50. From then on out, you should be tested every year after that.”
Getting that early baseline score will make future tests much more accurate. Prostate cancer actually starts to develop when males are in their late twenties and early thirties. Dr. Tutrone referenced a study out of Detroit of men in their twenties who died from causes other than illness or disease. One in five had early signs of prostate cancer.These findings suggest that prostate cancer does indeed begin earlier and grows at a slow pace.
Dr. Tutrone compared prostate cancer and breast cancer in prevalence and the number of deaths caused annually. Like prostate cancer, breast cancer also begins to develop in the late twenties or early thirties. However, women have the ability for self-examination, whereas “the prostate is just not accessible.” Also, women tend to be more willing to confront potential health issues than men. Dr. Tutrone adds, “Even though men are sometimes uncomfortable being tested, these procedures really are much less uncomfortable than mammograms are for a woman.”
There are a few signs of prostate cancer. They may include frequent urination, difficulty urinating, blood in urine or semen, pain in the back, hips or pelvis, and erectile difficulties. However, these signs non-specific and may represent other conditions.
The bottom line according to Dr. Tutrone, “Make screening for prostate cancer a part of your life. Without a doubt, the best weapon against this disease is early detection.”
