The Prostate Gland
The prostate is a small organ about the size of a walnut. It lies below the bladder and surrounds the urethra, the tube through which urine and semen exit the body. Its main function is to produce seminal fluid in order to transport sperm through the urethra. Prostate problems are common in men aged 50 and older. Problems that my arise in the prostate may be detected at an early stage by having a prostate-specific antigen test or PSA test.
Prostate-specific antigen (PSA) is a substance produced by the prostate gland. PSAs seep from the prostate into the blood and can be detected in all men. A rise in PSA levels is an indication that there may be some abnormality in the prostate. This abnormality may be due to cancer. If this is true the higher the PSA level the greater the risk of cancer
PSAs are measured in nanograms per millilitre (ng/ml). The guidelines for each age group are shown below.
40–49 up to 2.5 ng/ml
50–59 up to 3.5 ng/ml
60–69 up to 4.5 ng/ml
70–70+ up to 6.5 ng/ml
PSA is not a perfect test. It is important to be aware that high levels of PSA do not always indicate cancer. Also men with low levels of PSA may actually have cancer. Therefore, a high PSA test for your age only indicates that there may be a problem with your prostate and could possibly be cancer.
Elevated PSAs may also be caused by;
- Enlarged prostate or Benign Prostatic Hyperplasia (BPH), which will likely require treatment, but is not cancerous
- Recent Ejaculation
- Infection of the prostate (prostatitis)
- Male hormone medications
- Prostate trauma/injury
- Vigorous exercise
- PSA levels slowly rise as we get older
Male reproductive System showing Prostate Gland
In my case I started having PSA tests done every 2 years from age 50 – 56. Towards the end of my 56th year my older brother was diagnosed with prostate cancer and from then on (2006) I had a PSA test each year. Because of my brother’s diagnosis, I made myself more familiar with the significance of the PSA test and levels it should be at for my age. From 2006 I didn’t just accept my doctor telling me “I was fine” I actually recorded the figure for my PSA each year so I was aware of any changing signs. In 2014 a younger brother was dignosed with prostate cancer. In 2015 my PSA test result was 3.5 ng/ml but in 2016 (when I was diagnosed) my PSA test result was 5.4 ng/ml and six weeks later it was 5.8 ng/ml.
As stated above, high elevated levels of PSA may not be due to cancer so an additional test is recommended each time you have a PSA test. This test is a Digital Rectal Exam (DRE).
During a DRE, the doctor inserts a gloved, lubricated finger into the rectum and examines the prostate for any irregularities in size, shape, and texture. Often, the DRE can be used by Urologists to help distinguish between prostate cancer and non-cancerous conditions such as Benign Prostatic Hyperplasia (BPH). This test should be done in the first instance by your GP. Men should not be concerned by having this procedure as there is no pain or discomfort and modesty should not be an issue. Fortunately for me, in late 2015, I moved home and had to change my doctor. Early in 2016 I had a check-up with my new doctor who routinely carried out the DRE, in conjunction with PSA test, on his patients. I was not aware that this procedure was recommended in conjunction with the PSA test especially after the age of 50. My former GP never suggested I should have this test done over the previous nine years. When my new doctor performed the DRE he found a small nodule on my prostate. The presence of the nodule, as well as elevated PSAs, convinced my doctor and me that I should go have a biopsy.