New technologies make it possible for patients to test for prostate cancer from home. PSA testing measures the volume of prostate specific antigen in the blood and this method can partially indicate your risk for prostate cancer.
Before I tell you how you can go about this process, I want to talk you through everything you need to know ahead of screening.
Prostate cancer is a topic that's near and dear to my heart both professionally but also personally. Professionally because, the majority of my career has been focused on the diagnosis and management of the disease and personally because my father has prostate cancer and and I know that because of that family history, I myself am at high risk to get the disease down the road.
Dr. Robert Mordkin is Chief Urologist, Director of Robotic Surgery At Virginia Hospital Center and U.S. Medical Director for LetsGetChecked
As Chief Urologist at Virginia Hospital Center, my role is to ensure that patients get screened before the potential symptoms of prostate cancer become apparent.
Let’s take a look at some of the most important questions out there when it comes to prostate cancer.
- What Is Prostate Cancer?
- What Causes Prostate Cancer?
- What Are The Early Signs Of Prostate Cancer?
- What Are The Screening Processes For Prostate Cancer?
- What Can You Do To Prevent Prostate Cancer?
- What Is A Normal PSA Level By Age?
- How Do You Test For Prostate Cancer From Home?
What is Prostate Cancer?
Your prostate gland is a walnut shaped little gland that sits within your reproductive system, just below the bladder.
I think one of the things that makes prostate cancer particularly challenging for men is that many men have no idea what their prostate is, and that is something that we need to tackle.
Prostate cancer can be a lethal disease, it is an incredibly prevalent disease. There's a lot of it out there.
Today, if you were to compare men's comfort levels with talking about prostate cancer versus a woman's comfort level in talking about for example, breast cancer, men are always going to be lagging behind.
We're very very good at ignoring many many subjects in our lives including and not limited to our own health. I'm certainly guilty as charged!
Another contributing factor is that a lot of men are aware that part of what goes into screening for prostate cancer is going to require that a rectal exam be performed.
There is a obvious inherent bias about everyone wanting to walk into the office and have that performed electively although I will say that once they've had it performed they realize that it's not nearly as difficult as their mind had imagined
In saying all of this, I think men are certainly more willing to talk about their health now. More and more information has come out about the fact that it's important to be screened.
The prostate gland sits just on top of the rectal wall which is why when we do a rectal exam in the clinic. We're able to actually feel the outside texture of the prostate on exam and the exam itself in terms of doing that rectal exam should take no more than 30 seconds.
What Causes Prostate Cancer?
There is no one singular cause of prostate cancer.
One of the questions that I'll see a lot in my clinical practice will be; “What can I do to prevent prostate cancer?”
There is a number of factors that will certainly increase the likelihood of developing prostate cancer. These include family history, ethnicity and lifestyle choice.
The number one answer, the real answer here is family history.
I say often to my patients that you can’t outrun your DNA. Your genetics are what they are and we absolutely know that having a first degree relative with a family history of prostate cancer puts you, the individual, at significantly higher risk to get the disease compared to a person who has never had any signs of prostate cancer.
Men of African descent are more likely to get prostate cancer and more chilling is that, they are not only more likely to get prostate cancer but they're likely to get a more virulent form of prostate cancer, meaning that the prostate cancer man-for-man compared against other races will tend to be a bit more aggressive in African men.
There is a correlation between prostate cancer and tobacco use, just as there is a connection between lung cancer and tobacco use. Neither will ever be good for you. “What can I do to prevent prostate cancer?”
“What I'm really going to tell my patients is: I want you to try to do everything you can to live as healthy of life as you can based on all of those other factors, that might also be good, for say your heart.”
Family history will probably carry the day in terms of risk factors.
Trying to eat as healthy as you can: it's gonna be your best strategy there - but whether you have a first degree relative, or you have no relatives with prostate cancer, getting checked on a regular basis and early detection is vitally important because you can't look to any one symptom and say “Okay, now I need to go get checked, you need to be looking at that in a proper way and doing it on a regular basis to try to you know detect any issues early on.
What Are The Early Signs Of Prostate Cancer?
Prostate cancer is in a very insidious disease and what I mean by that is men will not have overt symptoms or signs of prostate cancer until the train is well out of the station so there are no symptoms prior to that.
There is a misinformation piece that we that we swim upstream against every day which is this idea that until I've got one of those things or any other variety of symptoms like blood in my urine or you know difficulty voiding or something like that, until I've got that, I don't have to
worry about it.
The point of the matter is by the time you've got those symptoms, not only do you have to worry about it but that ship has in many ways already sailed, when you needed to be worried about it was ten years before those symptoms arrived, at the time when that the disease could have been detected early enough so that none of those symptoms would ever be allowed to develop.
Cancer inside the prostate, that creates any symptoms typically occurs once that cancer has had an opportunity to escape from the prostate and spread to distant parts of the body most notably into the bones.
My main charge in life is to make sure that nobody ever gets to that point, in other words what we're really after is early detection when the prostate cancer is still contained in the prostate and has not had an opportunity to spread.
We want to catch prostate cancer at a point well before men have any symptoms at all, and make sure that we're then able to diagnose them properly based on that diagnosis.
If patients are at risk eventually to have metastatic disease meaning to get to that point where the cancer has spread, we want intervene well in advance of when that has happened so that they never have any symptoms, sufferers really won't have symptoms from their prostate cancer which is why early screening and early detection are so vitally important.
We can't give somebody a ‘what to watch out for’ list and tell them that when you start having symptom A, B or C, then they need to start worrying.
“Now is the time to come in. In fact what we want is patients in the office a decade before they would have symptoms, so we can start that screening process on a regular basis and catch them well before they have any problems.”
What Are The Screening Processes For Prostate Cancer?
Screening is a challenging topic in terms of prostate cancer in that you know a rectal exam is a crucial piece of that screening process but hand in hand with that, no pun intended is the idea that we also need to be doing some blood testing in this area. It's very controversial and what I'm talking about here is is PSA testing.
A PSA blood test is a controversial test and that controversy is absolutely well founded and well deserved. In other words PSA is not a marker of prostate cancer, it is not produced solely by prostate cancer cells and really what I'm saying here and this kind of gets to the heart of the controversy about the blood test is that a man can have “elevated PSA” and still not have prostate cancer and perhaps a little more scary is that a man could have “normal PSA level” and actually have prostate cancer.
PSA stands for prostate specific antigen, it is a protein. The PSA molecule is a protein that is manufactured by prostate cells.
A blood test is available and that test can measure how much PSA a man has in their bloodstream. There is correlation between that PSA level and the potential for that individual to
have prostate cancer but they are not directly linked.
There's a correlation between the blood level and the potential for the disease, but abnormal levels don't mean you've got the disease and absolutely normal levels don't completely rule out the potential for the disease so this is why it gets hard. You can't completely rely on the blood
test but looking at the blood test in the context of “What's the patient's family history?” or “Do they have a family history of prostate cancer?”
“It's helpful and certainly that PSA level and trying to correlate that to what does the prostate feel like on rectal exam is very helpful but there's no absolutes, it's not black and white by any means.”
You might be asking now, what does a rectal exam include?
When we’re carrying out a rectal exam, what we're really feeling for is the surface of the prostate through the rectal wall.
We're feeling for both the size of the prostate including the volume of the gland and asking, “Is it big?” or “Is it small?”
What is really more important as it relates to diagnosing prostate cancer is “What is the surface of the prostate? Does it feel like is it smooth and somewhat consistent in its texture or is it lumpy and bumpy?”
If we start feeling “lumpy bumpy”, also known as modularity that's where we become more concerned about the possibility of prostate cancer. That is the biggest sign of internal prostate cancer.
What Can I Do To Prevent Prostate Cancer?
The honest answer will probably not offer a whole lot of certainty, or not a whole lot in terms of specifics, more in generalities and the generalities really relate to things that we would otherwise know are recommended to live a good healthy life.
Things that are good for your heart tend to be good for your prostate. In other words trying to implement a plant based diet seems to be helpful.
There's not going to be “Oh here I want you to take this vitamin or I want you to refrain from certain activity or certain environmental exposure.”
It's going to be much more difficult to make those recommendations.
Fish oil supplementation gets a lot of publicity, the lay press talk about about the benefits of fish oil but there was an interesting study that in fact fish oil supplementation may actually increase the risk of prostate cancer.
There's no question that higher intake of fish oil actually can be preventative for cancers in general and even with prostate cancer. The problem comes in is when you're trying to supplement it so that it has something to do with taking the supplement rather than getting fish oils through natural sources.
If you increase dietary intake of fish oils, you increase how much fish you're eating on a regular basis, particularly things like salmon for example that may be preventative but if you're actually just trying to take a vitamin to supplement your fish oil that may be harmful and so there's probably something that comes with that fish oil when you eat it through natural sources.
Fish may be preventative in addition to the fish oil but if you're taking fish oil as a supplement and you don't have any of those other factors that are occurring naturally with them, it may in fact be harmful so while I tell people yes increase your fish oil, I tell them to do it by eating fish, not by taking fish oil.
I'm saying eat a more plant based diet, get some of those higher sources of vitamins and stay away from processed refined foods, refined carbohydrates and things like that which ultimately have very little in the way of some of those vitamins that we're talking about but it's hard to make a statement that says: “Yes you need to be taking X amount of this vitamin supplement or X amount of that oil supplement or things like that .
“There's loads of conflicting information out there and I think that you know where you try to really have to make sense of it, it’s best to
say moderation is going to be the common thread and getting at your natural sources is going to be your best strategy.”
Nature typically doesn't fail us and if you look back and you think about it from
the perspective that our bodies have evolved over millennia to get to where they are, your best way to live a healthy life and that is again trying to get your vitamins and minerals as naturally as you can.
Leave the tobacco products to the side. Not to open up a whole other Pandora's Box here but that doesn't mean just don't smoke. It means stay away from e cigarettes and know the sources of things, which are purported to somehow be better. The reality is you're still putting the same carcinogens in your body. You need to stay away from them.
What Is A Normal PSA Level By Age?
That’s actually a hard question to answer because it depends on a variety of factors. The short answer for “normal” is anywhere between 0 - 4.0. Unfortunately, this short answer can be misleading. Age matters a lot, as a man ages, their PSA will naturally increase because the overall size of their prostate will naturally increase as a regular part of aging.
So, a 70 year old man with a large prostate who has a PSA of 3.7 may be very normal but a 50 year old man with a small gland a PSA of 3.7 is actually concerning, even though the 3.8 falls within the lab’s defined “normal” range.
Lifestyle factors don’t play a big role. In other words, you can’t really help your PSA levels by eating a certain diet or committing to a specific exercise program.
There are certain things that really make PSA go haywire, such as a urinary tract infection. A person with a UTI should never have a PSA checked since it will almost always be dramatically high.
One way to determine an individual man’s “normal” is to track their PSA levels over time. In other words, if a man has a stable PSA year to year then this is less concerning than if there is a significant rise in the PSA year after year. Generally, we expect the PSA to increase slightly, again as a natural part of normal prostate growth, but it really shouldn’t rise more than 0.7 per year. For example, if a man has a PSA of 2.0, 2.0, 2.2 and then suddenly it jumps to 3.9, I’d be worried about the person.
When it comes to screening...
I counsel my patients based on a lot of the position papers and and best practice recommendations from the American Urological Association so you know the best answer to that question is if there is no family history for the disease if you're not of African descent, then probably, baseline PSA blood test and rectal exam at about age 45 is a good starting point. That screening is going to be a PSA test and a rectal exam.
Both are important, I want to make that point very clear.
"I know men don't want to run in and have a rectal exam but it really is not just enough to have a blood test. It's just not enough to have the rectal exam either. You really need both of these and we assume that's all at that initial stage."
If you've got a family history of the disease, such as a first degree relative, if you're of African descent. Moving that timeframe forward a bit would be good, perhaps a baseline test at age 40 and then maybe every other year or every few years, particularly if there's a first-degree relative with the disease particularly, of people who have actually died from prostate cancer so digging a little bit deeper into that history is important, but not just saying “Yeah my dad had prostate cancer but my dad had prostate cancer and died from it, my grandfather had prostate cancer and died from it, my uncle had prostate cancer and died from it.”
"That person, genetically, is someone, we’re going to be very very worried about so earlydetection in that age group is going to be paramount."
I think that's where annual testing, again PSA blood test and rectal exams are going to be crucial.
Watch this video to learn about PSA Testing in just 5 minutes!
How Do You Test For Prostate Cancer From Home?
LetsGetChecked offer at home health testing so you can test your health from the comfort of your own home.
Your PSA Kit includes:
- Sample collection instructions
- Anonymised patient ID
- Blood sample collection tube
- Finger prick lancets
- Plasters & alcohol wipes
- Bio-hazard sample bag
- Prepaid return envelope
Wash your hands with warm soapy water before you begin. Warm hands will make it easier to collect your sample.
Prick your finger using the provided lancet.
Note: The best location for collecting is from the 3rd or 4th finger on your non-dominant hand. Clean your selected finger using the alcohol wipe provided and then dry with a tissue.
To prick your finger, you need to position the lancet on the rounded end of your finger, and press down. While some may be squeamish about drawing blood, this device only creates a minuscule piercing of the skin which is virtually painless, so there’s no need to worry.
Fill the blood collection tube.
Gently squeeze your finger to help the blood flow into the collection tube. If you’re unable to collect enough to fill the tube, just use another lancet on another finger.
Once completed, apply the provided plaster to your finger.
Return your sample by prepaid post.
Once you’ve collected your blood sample, place the tube inside the bio-hazard bag and place the bag back in the testing kit box. Package the box in the supplied return envelope, and send back to our laboratory partners as soon as possible.
Check your results privately online.
A few days later, you will be able to login to a secure web portal to view your results.
If you test positive, LetsGetChecked’s nursing support team will contact you and provide a same day consultation within a private clinic. You will be seen by a specialist doctor and the required treatment will be prescribed.
Does This Test Tell Me If I Have Prostate Cancer?
No. This test measures the amount of Prostate Specific Antigen (PSA) in your blood. This is a protein produced by both normal and cancerous prostate cells. If your sample shows a raised level, it may indicate a problem with your prostate but does not mean that you have prostate cancer. This test simply indicates whether you are showing signs of possible prostate cancer, in which case you will redirected to a private clinic.
This PSA test is one of your first line of defences in the early detection of prostate cancer, why not make today the day you take that step forward and get yourself checked?
Written by Dr. Robert Mordkin | Edited by Hannah Kingston