Prostate Cancer Awareness: Men, now is the time to get screened

St. Joseph’s/Candler Medical Oncologist Dr. Ajaz Bulbul explains everything he looks for when analyzing the results of a prostate screening

Men, if you’re 50 or older and average risk for prostate cancer, you should get screened every one to two years.

Prostate cancer is a slow-growing but very common cancer in older men. As with every cancer, the earlier with find it, the better. This is why we preach screening. But let’s talk about risk first.

Men who are at high risk include: African-American men, those with a family member diagnosed with prostate cancer under the age of 60 or those with a known genetic mutation that confer risk of cancer (BRCA 1/2, Lynch syndrome).

For those at high risk, you should start screening between 40 to 45 years of age. Men of average risk should start screening at 50. You can get screened at your primary care office.

What is screening?

A prostate screening typically includes a digital rectal exam and then a PSA blood test. However, there are other factors involved in early detection of prostate cancer, including a patient’s own risk factors and the physician’s understanding of the test results.

Dr. Ajaz Bulbul, medical oncologist with St. Joseph’s/Candler Infusion Center in Hinesville, a partnership with the Lewis Cancer & Research Pavilion and Liberty Regional Medical Center, wants to make sure all men are fully informed about prostate cancer screening.

“I want you to know what to expect and to take away any fear or misunderstanding you may have if your PSA is high,” he says.

PSA stands for Prostate-Specific Antigen. It is a protein made by normal and cancerous cells in the prostate gland. A blood test will determine a patient’s PSA level in units called nanograms per milliliter, or ng/mL.

“As a man ages, his prostate gland enlarges, which results in a higher PSA,” Dr. Bulbul says. “So what is considered the normal range for your PSA level will rise as well. If you are between 40 to 50 years old, a normal PSA is typically less than 2.5. But the same man at 70 to 80 years old will be considered in the normal range if his PSA is below 6.5.”

Age is just one of the factors that Dr. Bulbul includes in his analysis of a PSA test. He will also consider:

• PSA density: Men with large prostate glands will have higher PSA levels, so physicians must factor this variable in when deciding whether or not the patient needs a biopsy.
• PSA velocity: Multiple tests can show doctors how fast a PSA level rises over time. Typically, PSA levels go up slowly.
• Free-to-total PSA ratio: There are two forms of PSA in the blood. One is attached to blood proteins, while the other is unattached, or free. The percentage of free PSA is lower in men who have prostate cancer than in men who do not. For men with a PSA somewhere in the middle range, between 4 to 10 ng/mL, the free-to-total PSA ratio can help determine if a biopsy should be performed.

All the technical talk is only to say there is more relevant data than just the PSA level. Physicians must analyze the nuance and complexity of a PSA test to avoid an unnecessary biopsy and the anxiety that comes with it. This is why it’s been difficult to write hard and fast guidelines on screening age for prostate cancer.

In addition to screening and PSA testing, a biopsy may be needed to diagnose prostate cancer. There is now advanced imaging that can help specifically target the areas that need to be tested for cancer.

“Through the use of a new, special MRI called the multiparametric MRI, we can detect abnormalities in areas that could not be reached by ultrasound alone or missed by ultrasound, such as in the anterior zone of the prostate,” Dr. Bulbul says.

In some cases, if the PSA is elevated but nothing is found on the multiparametric MRI, the patient can be considered for active surveillance, which includes more frequent regular testing to make sure nothing is growing.

If cancer is diagnosed, and it’s found early, it can be very curable. At the Lewis Cancer & Research Pavilion, we use personalized medicine to determine your best course of treatment. That could include surgery, radiation therapy, chemotherapy, target therapy or immunotherapy, or a combination of those modalities.

“Personalized medicine is an essential part of the detection, diagnosis and treatment of prostate cancer,” Dr. Bulbul says. “There is not just one course of action to take if you have an elevated PSA level. I encourage all men ages 50 and older to get screened every year so that we can have that discussion. Or if you are at high risk, get screened between 40 to 45 years of age.”

Related Article: What is personalized cancer care?

You can get a prostate screening during your annual physical exam with your primary care physician.

Getting support

If you do get diagnosed with prostate cancer, it can come with a lot of emotions for both you and your loved one. A Prostate Cancer Support Group is held at the LCRP every other month. You can join other patients, survivors and caregivers for discussion and answers to any questions you have. Light refreshments also are served.

The meetings are in the second-floor conference room at the LCRP from 6 p.m. to 7:30 p.m. The next scheduled meeting is for Wednesday, July 10.

For more information, contact Jerry Thomas at savprc@gmail.com.

Coming Thursday: If you do get diagnosed with prostate cancer, there are more treatment options than ever. Learn how radiation therapy is one such option.