Week 11 NUS 213 Health Assessment Bridge Prostate Cancer
Please review the following sections
Identify:
3 things you did not know
2 things that are most important in educating a client
1 thing you would like to know more about
American Cancer Society Recommendations for Prostate Cancer
Early Detection
The American Cancer Society (ACS) recommends that men have a
chance to make an informed decision with their health care provider
about whether to be screened for prostate cancer. The decision
should be made after getting information about the uncertainties,
risks, and potential benefits of prostate cancer screening. Men
should not be screened unless they have received this information.
The discussion about screening should take place at:
• Age 50 for men who are at average risk of prostate cancer
and are expected to live at least 10 more years.
• Age 45 for men at high risk of developing prostate cancer.
This includes African Americans and men who have a first-degree
relative (father or brother) diagnosed with prostate cancer at an
early age (younger than age 65).
• Age 40 for men at even higher risk (those with more than one
first-degree relative who had prostate cancer at an early
age).
After this discussion, men who want to be screened should get
the prostate-specific antigen (PSA) blood test. The digital rectal
exam (DRE) may also be done as a part of screening. (See Screening
Tests for Prostate Cancer.)
If, after this discussion, a man is unable to decide if
testing is right for him, the screening decision can be made by the
health care provider, who should take into account the man’s
general health preferences and values.
If no prostate cancer is found as a result of screening, the
time between future screenings depends on the results of the PSA
blood test:
• Men who choose to be tested who have a PSA of less than 2.5
ng/mL may only need to be retested every 2 years.
• Screening should be done yearly for men whose PSA level is
2.5 ng/mL or higher.
Because prostate cancer often grows slowly, men without
symptoms of prostate cancer who do not have a 10-year life
expectancy should not be offered testing since they are not likely
to benefit. Overall health status, and not age alone, is important
when making decisions about screening.
Even after a decision about testing has been made, the
discussion about the pros and cons of testing should be repeated as
new information about the benefits and risks of testing becomes
available. Further discussions are also needed to take into account
changes in a man’s health, values, and preferences.
Signs and Symptoms of Prostate Cancer
Most prostate cancers are found early, through screening.
Early prostate cancer usually causes no symptoms. More advanced
prostate cancers can sometimes cause symptoms, such as:
• Problems urinating, including a slow or weak urinary stream
or the need to urinate more often, especially at night
• Blood in the urine or semen
• Trouble getting an erection (erectile dysfunction or
ED)
• Pain in the hips, back (spine), chest (ribs), or other areas
from cancer that has spread to bones
• Weakness or numbness in the legs or feet, or even loss of
bladder or bowel control from cancer pressing on the spinal
cord
Most of these problems are more likely to be caused by
something other than prostate cancer. For example, trouble
urinating is much more often caused by benign prostatic hyperplasia
(BPH), a non-cancerous growth of the prostate. Still, it’s
important to tell your health care provider if you have any of
these symptoms so that the cause can be found and treated, if
needed. Some men might need more tests to check for prostate
cancer.
Tests to Diagnose and Stage Prostate Cancer
Most prostate cancers are first found as a result of screening
with a prostate-specific antigen (PSA) blood test or a digital
rectal exam (DRE). (See Screening Tests for Prostate Cancer.) Early
prostate cancers usually don’t cause symptoms, but more advanced
cancers are sometimes first found because of symptoms they
cause.
If prostate cancer is suspected based on results of screening
tests or symptoms, tests will be needed to be sure. If you’re
seeing your primary care doctor, you might be referred to a
urologist, a doctor who treats cancers of the genital and urinary
tract, including the prostate.
The actual diagnosis of prostate cancer can only be made with
a prostate biopsy (discussed below).
Medical history and physical exam
If your doctor suspects you might have prostate cancer, he or
she will ask you about any symptoms you are having, such as any
urinary or sexual problems, and how long you have had them. You
might also be asked about possible risk factors, including your
family history.
Your doctor will also examine you. This might include a
digital rectal exam (DRE), during which the doctor inserts a
gloved, lubricated finger into your rectum to feel for any bumps or
hard areas on the prostate that might be cancer. If you do have
cancer, the DRE can sometimes help tell if it’s only on one side of
the prostate, if it’s on both sides, or if it’s likely to have
spread beyond the prostate to nearby tissues. Your doctor may also
examine other areas of your body.
After the exam, your doctor might then order some tests.
PSA blood test
Prostate-specific antigen (PSA) is a protein made by cells in
the prostate gland (both normal cells and cancer cells). PSA is
mostly in semen, but a small amount is also in the blood.
Use in men who might have prostate cancer
The PSA blood test is used mainly to screen for prostate
cancer in men without symptoms. It’s also one of the first tests
done in men who have symptoms that might be caused by prostate
cancer.
PSA in the blood is measured in units called nanograms per
milliliter (ng/mL). The chance of having prostate cancer goes up as
the PSA level goes up, but there is no set cutoff point that can
tell for sure if a man does or doesn’t have prostate cancer. Many
doctors use a PSA cutoff point of 4 ng/mL or higher when deciding
if a man might need further testing, while others might recommend
it starting at a lower level, such as 2.5 or 3.
• Most men without prostate cancer have PSA levels under 4
ng/mL of blood. Still, a level below 4 is not a guarantee that a
man doesn’t have cancer.
• Men with a PSA level between 4 and 10 (often called the
“borderline range”) have about a 1 in 4 chance of having prostate
cancer.
• If the PSA is more than 10, the chance of having prostate
cancer is over 50%.
If your PSA level is high, you might need further tests to
look for prostate cancer.
To learn more about how the PSA test is used to look for
cancer, including factors that can affect PSA levels, special types
of PSA tests, and what the next steps might be if you have an
abnormal PSA level, see Screening Tests for Prostate Cancer.