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What Everyone Should Know
About Prostate Cancer

Prostate cancer is a disease that affects many Canadians. In fact, it ranks fourth on the list of most common cancers in Canada and it’s the most common cancer found in Canadian men. As surprising as it sounds, 1 in 9 men will develop prostate cancer in their lifetime and approximately 23,000 men will be diagnosed with prostate cancer this year alone.

The good news though, is that thanks to advances in screening, diagnosis and treatment options, deaths from prostate cancer have decreased over the last two decades. By detecting prostate cancer early, it’s now possible to identify and monitor people who are at risk and positively impact their outcome by keeping a close eye on those with a slow progression as well as treating those with more aggressive forms. The key to achieving these positive outcomes is by increasing disease awareness and using diagnostic tools like the prostate-specific antigen (PSA) test and SelectMDx®, a genetic prostate cancer biomarker test.

Keep reading below for answers to the most asked questions about prostate cancer detection.

What is PSA?

As mentioned above, when diagnosed early, prostate cancer responds well to treatment, and one common way to screen for the disease is to measure a person’s PSA levels. PSA is a protein produced within the prostate gland and is mostly found in semen, but small amounts can also be found in the blood of healthy men. PSA levels naturally increase as men age because the prostate tends to enlarge over time and PSA levels fluctuate for a variety of reasons, but research has shown that higher levels could indicate the presence of prostate cancer or other benign (non-cancerous) prostate conditions. That’s why measuring PSA levels is usually the first step in any prostate cancer diagnosis but it’s also important to note that PSA levels alone cannot indicate if cancer is present.

Who Should Get Tested for PSA?

A doctor is the best person to speak to about the risk of developing prostate cancer, and whether a PSA test should be performed. They may recommend a PSA test if a patient falls into any of the following categories:

  • almost 50 years old
  • has a family history of prostate cancer
  • is of African ancestry
  • has symptoms of prostate cancer
  • has already been diagnosed with prostate cancer and is being monitored

What are the Different Types of PSA Tests?

PSA Test:
A PSA test is a simple blood test that measures the amount of PSA protein in the blood. For the reasons listed in the ‘What is PSA?’ section, measuring PSA levels can be a useful tool in screening for prostate cancer as well as monitoring the progression of the disease in someone who has already been diagnosed with prostate cancer. Discussing the risks and benefits of prostate cancer screening with a doctor, having a baseline PSA taken, and considering a baseline DRE are all important steps in early detection.

Free PSA Test:
To help manage patients with a borderline or moderately elevated PSA level, a doctor may follow up with another test called a free PSA test. When circulating in the bloodstream, PSA is either attached to other proteins (called bound PSA) or it is not attached (called free PSA). By measuring free PSA in addition to total PSA (which includes the amount of both free and bound PSA in the blood) a free-to-total PSA ratio can be calculated. When combined with a complete clinical assessment, it can help determine whether follow-up procedures, like a prostate biopsy, are necessary.

What are the Limitations of PSA Testing?

Results of PSA testing should never be used in isolation because, as mentioned, high or abnormal PSA levels on their own do not always indicate the presence of prostate cancer. In fact, most high PSA levels only require active monitoring as opposed to aggressive forms of treatment or advanced diagnostic investigations.

As such, to further evaluate whether a patient’s high PSA level is of concern, a doctor may follow up with the methods below:

Digital Rectal Exam:
A digital rectal exam (DRE) is an exam that involves a doctor inserting a finger into the rectum to check for abnormalities in the lower abdomen or pelvis. This test can help identify a variety of health problems, including prostate cancer. Following a DRE, the doctor may recommend more tests as DRE results are most informative when evaluated in conjunction with other clinical and demographic information.

SelectMDx®:
SelectMDx® is a urine test that is completed following a DRE. It measures two prostate cancer-related genetic biomarkers, HOXC6 and DLX1. Combined with other clinical factors, such as total PSA and age, the test produces a high or low risk result of discovering clinically significant disease. This provides the doctor with another important piece of information to consider when determining whether a biopsy is required and potentially avoiding unnecessary procedures.

Interested in learning more about SelectMDx®? Download the brochure here.

Talking to a Doctor

Early detection of prostate cancer saves lives without question. Please download the PSA test brochure here to learn more and speak to a doctor if you, or your loved ones, are at risk.

Having a conversation about men’s health, and more specifically prostate cancer, with a doctor is key to arriving at the most appropriate recommendation based on a patient’s unique healthcare journey. 

For further information about PSA testing, please visit: /test/prostate-specific-antigen-psa-test

Sources

  1. Prostate Cancer. Canadian Cancer Society. https://cancer.ca/en/about-us/prostate-cancer Accessed Sep 13, 2021
  2. Screening for prostate cancer. UpToDate. https://www.uptodate.com/contents/screening-for-prostate-cancer?csi=0cc78af6-eb08-44ab-81a8-8a5865ceee79&source=contentShare. Accessed Sep 13, 2021 
  3. Hayes, J. H., & Barry, M. J. (2014). Screening for prostate cancer with the prostate-specific antigen test: a review of current evidence. Jama, 311(11), 1143-1149. 
  4. Izawa, J. I., Klotz, L., Siemens, D. R., Kassouf, W., So, A., Jordan, J., … & Iansavichene, A. E. (2011). Prostate cancer screening: Canadian guidelines 2011. Canadian Urological Association Journal, 5(4), 235. 
  5. Catalona, W. J., Partin, A. W., Slawin, K. M., Brawer, M. K., Flanigan, R. C., Patel, A., … & Southwick, P. C. (1998). Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. Jama, 279(19), 1542-1547. 
  6. Prostate-specific antigen (PSA) test. Canadian Cancer Societyhttps://cancer.ca/en/treatments/tests-and-procedures/prostate-specific-antigen-psa-test , Accessed Sep 13 2021