This may seem like a silly question: I mean, why would you be searching this web site if you didn’t? But it’s not as silly as you may think. While most men who live to 80 or 85 will have some degree of prostate cancer eventually (we know this from autopsies of thousands of men who died with prostate cancer, but not of it), you may be here simply because your urologist told you that you have an elevated PSA. As you probably know, PSA stands for Prostate Specific Antigen. An antigen is something that shouldn’t be in your body. This particular antigen shows up in blood samples when there are cancer cells in your prostate gland. And I’m here to tell you that not everyone with a PSA over 4 or 5 (anything over 4 is generally considered “elevated”) has cancer. You have come to this site looking for information. And you may be scared -- no one wants cancer, especially in his reproductive system – but don’t jump to any conclusions!
You need to take note of some of the more recent data coming out about the PSA. It’s been discovered that the mere elevation of a PSA doesn’t mean you have cancer. And the number 4 is not necessarily a “normal” PSA. So, how do you know if you have cancer?
First of all, competent urologists generally are concerned if your PSA starts climbing over time. If, for instance, you had a 3 last year, and this year you have a 7, your doctor would be quite worried. If you had a 6 last year, and it didn’t climb at all, your urologist might take a different tack: a wait-and-see attitude.
But even if you had a climbing PSA – or a “high” one right off the bat – that doesn’t mean you have a cancer that needs treatment. Your urologist is clearly right to alert you to this change in your body’s status, but until a biopsy is done, you won’t really know if you have cancer – or cancer that needs to be treated.
These days, especially in Europe, a lot of doctors aren’t even suggesting a biopsy right away, even if someone has a PSA that climbs over a year’s time, or even six months. It depends, in part, on the starting number, the amount it’s climbed over time, and what the doctor’s philosophy is. Here’s what some physicians are saying: Since prostate cancer is a slow-growing cancer, and since the PSA is not yet an accurate gauge of whether you have cancer, it may be best to take a “watch and wait” (or “watchful waiting”) attitude.
In fact, even if a biopsy shows you have a Gleason Rating over 5 (for more on the Gleason, type that word into the search engine on this page), there are many urologists and oncologists who would say, “Let’s not rush into treatment.” Why? Because the research hasn’t yet shown that treatment for slow-growing, low or medium level prostate cancer actually keeps you alive any longer than letting it alone.
I know that sounds ridiculous. Who wouldn’t want to get cancer “out” if he could? Who would want it continuing to grow in his prostate gland? Lots of people, actually. Once they get over the shock of having cancer, once they learn the pros and cons of all kinds of treatments, once they learn the statistics, a watchful waiting attitude may begin to seem reasonable or at least something to be considered.
To find out more about this very tricky and controversial subject, I’d go first to the National Cancer Institute. Then, once you see what they have to say, go over to the American Cancer Society – they have a different take on it.
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Published On: June 22, 2006