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Understanding Your Prostate Cancer Risk and PSA Level

September 29, 2020Dr. James Mark

Similar to other cancers, the leading risk factors for prostate cancer are family history, race/ethnicity, and genetic abnormalities. While it’s good news that there aren’t many everyday behaviors that contribute to our prostate cancer risk, this also means there isn’t much we can do to prevent it.

This is why proper screening and early detection are so important, says Jefferson Health Urologist Dr. James R. Mark. PSA testing, digital rectal exams (DREs), and more allow for early diagnosis, which decreases the risk for metastatic prostate cancer and prostate cancer mortality, ultimately putting patients on an easier treatment path.

Know Your Risk:

Family history is the strongest, most known risk factor. Studies show that men with one first-degree relative (i.e., father or brother) who has battled prostate cancer doubles your risk, explains Dr. Mark. For those with two or three close relatives, the risk is even higher. It’s essential to make your primary care provider aware of this information as you age. 

Recent research has also shown that genetic mutations, particularly in the BRCA bracket (commonly known for impacting breast and ovarian cancer risk in women) are actually correlated with cases of more aggressive prostate cancer, adds Dr. Mark.

Additionally, black men are nearly twice as likely to develop prostate cancer than white men and should discuss screening with their doctors at an earlier age.

Data on whether or not dietary habits, alcohol consumption, and vitamin deficiencies contribute to prostate cancer risk is still inconclusive; however, this shouldn’t discourage you from living a healthy lifestyle!

“We often tell people, ‘what’s good for your heart is good for your prostate,’” said Dr. Mark. “This leads to the sometimes-frustrating answer of: stay active; eat all things in moderation; and get your annual check-ups. Doing so reduces your risk of illness in general.” 

When & How Can You Get Screened?

Most health institutions recommend prostate cancer screening starting at the age of 50-55 (40-45 for black men). Your primary care provider can start the screening process with a PSA test but may refer you for further examination by a urologist, says Dr. Mark.

The PSA test is a simple blood test that measures the level of PSA (a prostate specific enzyme produced by both cancerous and non-cancerous cells). For men at low risk, it is advised that they repeat the PSA test every 2-3 years. Others with risk factors for aggressive disease or elevated PSA levels should be screened annually.

“There is a growing body of evidence, however, that screening should start earlier,” continued Dr. Mark. “This PSA level is more likely to be impacted for non-cancerous reasons in older men; in younger men, an abnormal PSA level is more directly linked to cancer. While global recommendations have not yet changed, you may see a shift in the future.”

Are There Any Symptoms that Might Warrant Earlier Screening?

Screening is performed to catch diseases that are asymptomatic, such as early-stage cancers; in most cases, symptoms will not present until the cancer is advanced, explains Dr. Mark.

Worrisome symptoms could include urination frequency; urinary retention; blood in the urine; blood in the semen; back pain and other symptoms of renal failure, but these are almost always not prostate cancer.

What Does Your PSA Level Mean?

There is no PSA that is considered “normal” or “high” that tells a man whether or not he has cancer. PSA is more indicative of a risk of having prostate cancer.

Typically, labs will report a PSA under 4.0 ng/mL as normal range, however this can be misleading. Men aged 55-74 with a PSA of 3.0 will have prostate cancer found on biopsy 17% of the time; this is more concerning in a man in his 50s compared to an older man, explains Dr. Mark. However, it’s not always that straightforward; a PSA level can’t be the standalone determinant for cancer.

A change in PSA overtime is very meaningful; for many it points toward a natural increase with age, says Dr. Mark.

“BPH (benign prostatic hyperplasia), or prostate enlargement, is common in older men and causes higher PSA levels. Also, various non-cancerous conditions, behaviors, and even genetic factors can result in an increase, including infection; prostatitis (inflammation); or recent sexual activity.”

This is why other tests, like the DRE, additional biomarker testing,  and medical imaging are necessary to make an accurate assessment and determine when to perform a prostate biopsy.

Keep in mind, diagnosing prostate cancer and determining a treatment route involves a thoughtful decision process among multiple providers, the patient, and patient’s family, adds Dr. Mark.

Don’t hesitate to ask your doctor if and when PSA testing is right for you.

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