Excessive values on this test may be a clue, but not certain evidence of the presence of a tumor. Its “derivatives” are also used for controls in patients who already have a diagnosis of cancer
My husband, 72, was diagnosed with prostate cancer. He is investigating the case, but it seems he is neither too aggressive nor advanced and that he can only remove it. Obviously he has taken the PSA test, both in the past years and now, but looking on the internet we were baffled because there are many different types that he has never performed. How to orient yourself correctly?
He answers Giario Conti, secretary of the Italian Society of uro-oncology (SIUrO)
The Psa test it is easy to perform because it takes place through a normal blood sample (which measures the prostate specific antigen). It is recommended from the age of 50, but men who are familiar should start between the ages of 40 and 45. What we must never forget is that high Psa values do not necessarily mean that there is a tumor, but rather indicate that something is wrong with the prostate: it can be an inflammation (prostatitis) or an increase in the volume of the gland (hypertrophy ), but physiological factors such as sexual intercourse prior to the withdrawal may also be involved. In this regard, there are rules to be respected for a correct sampling that the doctor will explain in detail.
Use the same laboratory
In case of repetition of the test, both for controls in “healthy” people and in those who already have a diagnosis of cancer, it is correct to perform it in the same laboratory due to the differences that may exist between laboratories and which would lead to unjustified alarmism. There is no reason to worry about fluctuations and swings of less than a few decimal places. Everything that is “after the decimal point” must be considered in the set of values measured over time, but often there is no cause for concern. If the PSA test is a good clue (and not a test) for cancer, however, it is not able to distinguish between aggressive and indolent neoplasms and, even in those who have already had a diagnosis of prostate cancer, often alone it is not sufficient to assess the progress of the disease. The so-called “PSA derivatives” are tools that can be useful in different diagnostic scenarios.
What to watch for in cancer patients
Today the most used derivative is the doubling time, or doubling time
(PSA-DT) especially in cases of disease recovery after primary treatment or in the case of onset of resistance to castration even in the absence of detectable metastases. A short doubling time (particularly if less than 10 months) indicates a more aggressive disease and therefore more at risk of progression. The rate of growth of the PSA (PSA-V) indicates instead how much the marker grows in a defined time interval, usually a year: it can be useful in the pre-treatment phase as an additional prognostic factor, although its real reliability is not yet clearly defined. A rate greater than 1.75 ng / ml / year requires attention but always within a clinical data set. The density of the Psa (PSA-D) relates the Psa value to the prostate volume (it is expressed with a number, which should be less than 0.2, even better if less than 0.15). It is understandable that a greater production of Psa is expected from more voluminous prostates, while remaining in a scenario of benignity. Less codified, and more difficult to interpret, it is the percentage ratio between the total Psa is the free one (F / T), and in any case to be considered only within a broader framework, which must always be evaluated by the specialist.
November 1, 2021 (change November 1, 2021 | 17:51)
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