High values in the test result prove the presence of a prostate gland disorder: it can be inflammation (prostatitis), an increase in volume (hypertrophy), an infection or carcinoma. a diagnosis of prostate cancer
Prevention is better than cure and detecting an early stage disease means both having less invasive treatments and having more likely to heal. following these principles the European Commission has recently updated the recommendations on recommended exams for the early diagnosis of cancerincluding the PSA test for prostate cancer in males aged 50 to 70 years.
The controversy
For years, experts have debated the pros and cons of this exam. If on the one hand, in fact, it has the advantage of being simple to carry out because it takes place through a regular blood draw that measures prostate specific antigenon the other hand it can lead to an excess of further diagnostic tests and therapies. Why? High values in the result of the examination prove the presence of a disorder of the prostate gland: it can be an inflammation (prostatitis), an increase in volume (hypertrophy), an infection or tumor he replies Sergio Bracarda, president of the Italian Society of Uro-oncology (SIUrO) —. For this reason, before becoming alarmed and deciding on any intervention, which could lead to useless treatments, it is necessary to evaluate the results well and proceed, if necessary, with other investigations. To better understand the history of PSA, one can resort to large American surveys conducted on several thousand men: since the 1990s this exam has had a great diffusion especially in the United Stateswhere the scientific societies American Urological Association and American Cancer Society have begun to recommend it as a screening test, like mammography for the early detection of breast cancer, to all males aged 50 and over.
Too many biopsies
The widespread use of Psa on healthy men has however led to the discovery of many cases of indolent tumors, or less aggressive, which grow slowly and which can rarely become a problem for those concerned. Millions of men over several decades underwent further examinations (the altered PSA result inevitably led to multiple sampling biopsy) it’s at excess therapy (with major side effects such as impotence and incontinence) — he explains Alberto Lapini, who has just finished the SIUrO presidency and director of the Prostate Cancer Unit at the Careggi hospital in Florence -. Today we know that this type of cancer is “good” and can only be kept under control. Cos in 2008 in the USA there was a stop to the “indiscriminate” use of the test on healthy males. However, this led, in the following years, to an increase in tumors discovered late, in a locally advanced or metastatic stage.
Tailored exams and therapies
Meanwhile for scientific research highlighted the usefulness of a particular type of magnetic resonance, called multiparametric, which allows to reduce the number of useless biopsies and due to its characteristics it allows to highlight the cases that deserve to be biopsied and those considered not dangerous. The new European recommendations therefore arise from these assumptions and from the best scientific knowledge available today – continues Lapini -: we have various in-depth examinations that allow us to avoid useless biopsies and we know better calculate who are the men at risk. Not only that, for those tumors that we have learned to classify as “not clinically significant” we have developed active surveillance programs to keep the tumor under control, postponing any treatments until the disease changes its attitude, if it does. Thus putting off, for years or for a lifetime, together with the therapies, theirs too possible side effects.
Who has to do the PSA and when
On balance, however, in life one in eight men in Italy will be diagnosed with prostate cancer. With 36 thousand new cases every year the type of cancer is most common in men after the age of 50, but the numbers are also increasing among younger people. The good news is that, if identified early on, today over 90% of patients are able to recover or even live with the disease for decades. But then who should do the PSA and when? useful and should be recommended to men who have prostatic symptoms, ie urinary problemsstarting at 50, and those who are familiar should start between 40 and 45 — he clarifies Journal of Accounts, secretary of SIUrO -. Explaining well what are the advantages and limitations of the method and what might be necessary to carry out if this examination is not within the normal limits.
Symptoms
Difficulty initiating urination, weak urine stream, need to “push” while urinating, incomplete emptying of the bladder, frequent urination, urgency to empty the bladder and presence of nocturnal urinations. These are symptoms that accompanyBPHvery common in males over 50 and which therefore shouldn’t be alarmed, but which shouldn’t be underestimated or ignored. Just talk to your family doctor who will evaluate if a visit to the urologist specialist is necessary. Patients need to know that the diagnosis of all tumors, both “good” and “bad”, aggressive or not, is anticipated – concludes Conti -. Men must be informed correctly (before undergoing the PSA voluntarily) of the possible results and that, in the event of a diagnosis of carcinoma, they are treated within multidisciplinary structures. This is enough to solve the problem of excess therapies: inform him of all the options available to him in his case. If the team consists of several specialists, the patient will really be at the center of the discussion and will receive all the necessary information.
What can distort the outcome of the PSA
There is no normal value of Psa valid for all men, therefore a universal alarm threshold. The PSA level increases with age and with the presence of other prostatic diseases or dysfunctions (urinary infections or benign prostatic hypertrophy) and can be normal in 30% of patients with prostate cancer. The PSA level may be slightly affected by a number of conditions: recent sexual intercourse, digital rectal examination, transrectal ultrasound, catheter insertion or cystoscopy, minor trauma, for example by bike or prolonged motorcycle riding. Additional tests such as the Psa density and/or velocity or markers such as Pca3 (which is performed on urine) which however have not been shown to be effective in selecting candidates for biopsy – he clarifies Sergio Bracarda, who is also director of the Department of Oncology at the Santa Maria di Terni Hospital —. The doubling time of the Psa (doubling time) instead useful in certain situations, in particular in the event of disease progression, not at diagnosis.
December 1, 2022 (change December 1, 2022 | 14:08)
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