- Prostate Center
- About Prostate
The prostate is an organ found in males located on the bladder outlet.
Having a usual weight of around 20 g, this tissue starts to enlarge especially after 40 years of age.
Both benign and malignant prostate diseases are common conditions.
More than half of the elderly patients may have a prostate-related disease. Prostate diseases can be classified into benign prostate hyperplasia (BPH), prostate cancer and prostatitis.
When enlarged, prostate starts to obstruct urinary track and block urinary flow. Based on the obstruction grade, male individuals experience some complaints regarding urination.
Therefore, it is important for all male patients beyond 45 years of age have their prostate checked without waiting for signs. This allows making a prediction regarding the patient's prostate status using some work-up and analyses.
In patients admitted for these complaints, early and accurate diagnosis is important. Because these complaints may also indicate prostatitis and prostate cancer. That being said, prostate cancer can also be detected in patients without any complaint, which means that complaints alone are not enough for the diagnosis of prostate-related diseases.
The most important one of these analyses is Prostate-specific antigen (PSA). Using this analysis, the association between the prostate disease and cancer can be detected, and early diagnosis becomes possible.
How to Perform PSA Test? What Is the Normal Range?
PSA (prostate-specific antigen) is an enzyme secreted by the prostate and providing the consistency of semen. This enzyme is present at very high amounts in prostate tissue.
Typically, its level is much higher in prostatic ducts and semen than that in the blood. However, in some conditions where the cellular integrity of prostate is impaired, it passes to blood at increased levels, resulting in elevated blood level. The reason for the elevation of blood PSA level in prostate cancer is that tumoral tissues sometimes impair the cellular integrity of prostate.
Early diagnosis of prostate cancer is possible by this test studied on a blood sample. With the use of this test, prostate cancer-related mortality rates started to decrease. However, as it may also elevate in conditions other than cancer, the specificity and sensitivity of this test decrease.
PSA values naturally increase by a mean of 0.05 ng/mL per year.
Reference for normal PSA values: Hans-Joachim Luboldt , Joachim F. Schindler, Herbert Rubben .Age-Specific Reference Ranges for Prostate-Specific Antigen as a Marker for Prostate Cancer.eau-ebu update series 5 (2007) 38–48.
Normal values have been recognized as shown above.
PSA may vary based on ethnicity and prostate volume. Black males have higher values compared to white males in the same age group. Other than cancer, it may also elevate in BPH, prostatitis, after sexual intercourse, after biopsy, after rectal examination, in urinary tract infection, and after urinary tract interventions (catheter placement) and operations.
Sudden PSA elevation in a male with a history of normal PSA progression is usually caused by non-cancer reasons. In such cases, the approach should be eliminating the condition underlying this elevation, and later, waiting for a period of time. Depending on the underlying cause, values elevated due to non-cancer reasons can take 3-7 days on average to return to baseline levels.
In conclusion, while every PSA elevation does not mean cancer , low levels are not adequate to rule out cancer. Note that prostate cancer is detected in one in 5 patients with values within normal range.
Therefore, for the diagnosis of prostate cancer, a digital prostate examination can be considered together with PSA value. Several additional techniques can be performed for the diagnosis of prostate cancer in suspected patients.
How to Perform Prostate Examination?
Physical examination is of high value in prostate diseases. Especially, rectal examination provides guiding findings about prostate diseases. It has a reputation as a difficult examination among patients. Therefore, some of the patients with prostate complaints are unwilling to seek medical help only because they are shy about this examination.
However, it is not as difficult examination as it is thought. A lubricating gel is applied on gloves, the index finger is placed into the rectum, and the physical examination takes a very short time. By this examination, valuable information regarding the prostate consistency, regularity of its surface and its total volume is obtained.