Diagnosis - Free PSA And DRE

Prostate Cancer Diagnosis

(Video courtesy of DrBob)

PSA advancement in the last few years have enabled doctors to differentiate 'free' PSA from 'bound' PSA, resulting in a more accurate indication of prostate cancer. Bound PSA refers to PSA that is bound to protein in the blood, as opposed to free PSA.

Low free PSA may indicate cancer, while high free PSA (above 25%) is likely to be benign prostate hyperplasia (BPH). Knowing this will eliminate the need for a biopsy for 1 in 5 person that would otherwise undergo one. Most men with prostate cancer have a free PSA below 15%.

A free PSA reading of below 7% is a strong marker for prostate cancer and a biopsy is strongly recommended. Even when the biopsy show a negative result, another biopsy is crucial to confirm the first result.

A surge in a single PSA test is not amountable to biopsy but when the elevated PSA reading is recorded consistently, known as PSA velocity, chances of prostate cancer is high and a biopsy will be neccesary. To obtain PSA velocity, PSA blood test can be done a few weeks apart.

There are now at least six different ways to look at serum PSA: total PSA, free PSA, age-adjusted PSA, ethnically adjusted PSA, PSA velocity and PSA density.

In a DRE screening, the doctor will insert a gloved and lubricated finger into the rectum to feel any irregularites in size, shape and texture. A DRE combined with a comprehensive PSA test is the most viable screening of prostate cancer available.

In the event that a biopsy is recommended, a sample of the prostate tissue will be take using a long needle for lab test. A biopsy usually do not require hospitalization in most cases, but patient may be required to spend a night in the ward to monitor for bleeding or signs of infections.