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SPONSORED FEATURE that two thirds of men over 50 are not aware of the PSA test.4 BOX 2. RISK FACTORS FOR PROSTATE CANCER


Aging. African–Caribbean men: three times increased risk. Brother with prostate cancer: three times increased risk. First-degree relative who developed prostate cancer before the age of 60: four times increased risk. High-fat western diet.


Diagnosis Currently, the initial test a man is given to detect any problems in the prostate is a PSA test. This is a simple blood test which measures the amount of the prostate-specific antigen there is in the blood. A raised level of PSA can indicate a problem with the prostate. (See Table 3). It is important that before having a PSA test men should NOT have: An active urinary infection (PSA may remain raised for many months). Ejaculated in the previous 48 hours. Exercised vigorously in the previous 48 hours. Had a prostate biopsy in the previous 6 weeks. Had a digital rectal examination (DRE) within the previous week. However there are a number of issues that mean this test is far


from ideal, which is why it is important that men are made aware of the pros and cons before making the decision to have the test.


The advantages of the PSA test It can lead to early detection of prostate cancer which allows for a good chance for curative treatment. It is a simple blood test which is accessible through GP practices. Having a series of PSA tests over time can allow doctors to monitor the behaviour of a cancer and make better predictions for the future.


The disadvantages of the PSA test It is not a diagnostic tool. If a man’s PSA is raised, it merely indicates there could be one of a number of problems with the prostate. It may give a false reassurance – 15% of men with prostate cancer have a normal PSA.2 It may cause undue concern – two thirds of men with elevated PSAs do not have prostate cancer.2 It may lead to over diagnosis and radical treatment of prostate cancers that would never affect a man’s quality or longevity of life.


THE SCREENING QUESTION There has been much debate about screening for prostate cancer using the PSA test, and the UK screening committee has decided against a national screening programme. This is a controversial decision with a variety of recent studies providing contradictory evidence for the benefits of screening.3


The prostate cancer risk


management programme suggests that every man over the age of 50 who requests a PSA test should be given one after careful consideration. The problem with this is that many men who are at risk are still unaware of the significance of prostate cancer and that they are entitled to a PSA test. The Prostate Cancer Charity states


Answer A biopsy would be reasonable in all three cases as long as the patient is well-informed about the risks of a biopsy and aware of the possible outcome of cancer diagnosis.


If an


elevated PSA has been identified, a digital rectal examination (DRE) of the prostate and a prostate biopsy could be indicated. Other factors would need to be considered prior to exposing a man to an invasive biopsy.


CONCLUSION Ideally our screening tools will become more sensitive and be able to distinguish between those cancers which will need treating and those which do not. This, along with raising the awareness of prostate cancer and the common risk factors, is important in making the current Prostate Cancer Risk Management Program successful.


REFERENCES 1. CancerHelp. Statistics and outlook for prostate cancer. Cancer Research UK. 2008. Available at www.cancerhelp.org.uk/help default.asp?page=3505.


2. Selley S, Donovan J, Faulkner A, Coast J, Gillatt D. Diagnosis, management and screening of early localised prostate cancer. Health Technol Assess 1997,1(2):i,1-96.


3. Eckersberger E, et al. Screening for prostate cancer: a review of the ERSPC & PLCO trials. Rev Urol 2009(11)3:127-133.


4.


ICM Research interviewed a random sample of 1,000 men aged 50+ by telephone in February 2011, on behalf of The Prostate Cancer Charity.


CASE STUDY: WHICH OF THESE MEN WOULD BENEFIT FROM A PROSTATE BIOPSY?


The following three case studies are common scenarios which require careful consideration post-PSA test.


Case study one Mr Taylor is a 62-year-old gentleman who is very fit for his age and well-informed about maintaining good health. He discussed the pros and cons of a prostate cancer screening with his GP. His PSA result is 12, with a digital rectal examination revealing a hard nodule on the prostate gland. He has no significant PMH. Would he benefit from a biopsy?


Case study two Mr Barrett is a 43-year-old African Caribbean gentleman with a brother who has been diagnosed with prostate cancer recently. Worried about his risk of prostate cancer, he asked his GP for a PSA test. His PSA is 2.7, would this biopsy man benefit from a prostate biopsy?


Case study three Mr Law is a 53-year-old gentleman who has been suffering from nocturia, frequency and urgency. He has asked his GP for advice. He is also well with minimal PMH. The GP discussed the option of PSA testing and performed a digital rectal examination which revealed a large benign feeling gland. His PSA was 9, would he benefit from a biopsy?


38 Nursing in Practice March/April 2012


www.nursinginpractice.com


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