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Prostate cancer Q&As

Published by Bupa's health information team, November 2008.

Answers to questions about prostate cancer

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

What is a high PSA level? What might cause it other than prostate cancer?

A blood test to measure your prostate-specific antigen (PSA) level can be used to detect prostate cancer. However, having a high PSA level doesn't automatically mean you have prostate cancer - it can be raised for several other reasons.

Explanation

Your PSA level is checked by doing a blood test. PSA is a protein that is produced by both normal and cancerous cells in your prostate.

Before carrying out the blood test, your GP may ask you about your general health and recent activities. It's important to be frank with your GP as the test can't be performed if you have:

  • a urinary tract infection
  • ejaculated within the past 48 hours
  • exercised vigorously within the past 48 hours (for example riding a bike)
  • had a prostate biopsy within the past six weeks or a digital rectal examination (DRE) within the past week

PSA levels vary among individuals and increase with age - there is no set normal level. Your GP will use the following levels as a guide to decide if you need further tests:

  • 3.0 ng/ml or below is considered normal in a man aged 50 to 59
  • 4.0 ng/ml or below is normal in a man aged 60 to 69
  • 5.0 ng/ml or below is normal in a man aged over 70

If your PSA level is considered high, you may be referred to an urologist for further tests and treatment. An urologist is a doctor who specialises in identifying and treating conditions of the urinary tract.

A high PSA level doesn't necessarily mean that you have prostate cancer. It can be raised for several other reasons, such as:

  • benign prostatic obstruction (BPO) - enlarged prostate
  • prostatitis - inflammation of the prostate
  • a urinary tract infection
  • old age
  • acute urinary retention - a condition which means you are unable to pass urine
  • recent prostate examinations - this can include recently having had a prostate biopsy, a rectal examination or a urinary catheter

Generally, the higher your PSA level is, the more likely you are to have prostate cancer. Occasionally, you can be diagnosed with prostate cancer and have a normal PSA level, although this is quite rare.

PSA blood tests are not only used for diagnosing prostate cancer, they are also used to monitor progress and treatment. A PSA level that remains steady usually means that your tumour is stable and isn't growing. A PSA level that decreases shows that your tumour is shrinking and responding to treatment.

If you have any questions or concerns about prostate cancer or PSA levels, talk to your doctor.

Further information

Sources

  • Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2007:305
  • Prostate cancer tests. Cancer Research UK. www.cancerhelp.org.uk, accessed 2 September 2008
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What is the Gleason score? How does it grade prostate cancer?

The Gleason score is a grading system that allows doctors to predict how quickly a cancerous tumour in your prostate may grow and spread. This information is often used to plan treatment.

Explanation

The Gleason system is the most commonly used grading system for prostate cancer. It's a system that looks at cells from your prostate to predict how your tumour will behave. Usually, a biopsy (a small sample of tissue) is taken from your prostate which is then sent to a laboratory for testing and grading.

Grading is done by looking at the patterns of cells within each sample taken in the biopsy and how abnormal they look. There are five different types of pattern, which are graded from one to five. One is the least aggressive type of cancer and five is the most aggressive. All the biopsy samples taken are graded, then the two most frequently occurring patterns or the two areas with the highest grade are added together to get a Gleason score of between two and 10.

The lower the score, the more slow-growing your cancer is and the less likely it is to spread. A low score is usually six or less. Tumours that score high are more likely to grow quickly and spread to other parts of your body. A high score is between eight and 10.

The Gleason score acts as a guide for your doctor to help him or her plan the best course of treatment for you. It's not a fail-safe approach - most tumours do grow as expected, although not all of them do.

If you have any questions or concerns about prostate cancer or the Gleason system, talk to your doctor.

Further information

Sources

  • Cassidy J, Bissett D, Spence RAJ. Oxford handbook of oncology. Oxford: Oxford University Press, 2002:402-405
  • Grading and staging of prostate cancer. Macmillan Cancer Support. www.cancerbackup.org.uk, accessed 1 September 2008
  • Factors in deciding treatment for prostate cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 1 September 2008
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Will treatment for prostate cancer affect my sex life?

Treatments for prostate cancer can affect your sex life. How it's affected will depend on the type of treatment you have.

Explanation

Treatments for prostate cancer can affect your sex life in different ways. However, it's important to remember that not everybody will be affected to the same degree.

A common side-effect of treatments for prostate cancer is impotence (erectile dysfunction). This is when you can't achieve or sustain an erection for sexual activity to take place. Impotence can be caused by:

  • radiotherapy to your prostate
  • prostate surgery, such as a radical prostatectomy
  • orchidectomy (an operation to remove your testicles)
  • hormone therapy

Erection problems are often temporary, but they can be permanent, especially if you have had a radical prostatectomy. Sometimes impotence improves once you have finished your treatment, for example with hormone therapy. With other treatments, such as radiotherapy, erectile problems may not occur until several years after treatment.

There are medicines that you can take to treat impotence, such as sildenafil (eg Viagra). Or you could try using a vacuum pump or penile implants. Talk to your doctor to find out what options are available to you.

Some men find that they have a lower sex-drive after treatment. This is usually caused by an orchidectomy or hormone therapy, which lead to a lower level of testosterone in your blood. Sometimes changing to a different type of hormone therapy can help. Talk to your doctor about the options available to you.

Other sexual problems can affect the type of orgasm you have. After a radical prostectomy you will always have a dry orgasm. This means that you will have the same sensations when you ejaculate, but no semen will come out. Some men find that prostate treatments also affect the strength of their orgasm and their ability to have an orgasm.

Cancer treatments may also affect your fertility. Radiotherapy to your prostate and an orchidectomy will make you infertile. Other treatments, such as a radical prostatectomy, will also have an impact on your fertility, but if you do still wish to have a family, sperm can usually be collected directly from your testicles and used in insemination or in vitro fertilisation (IVF) treatments.

If you are about to or are having treatment for prostate cancer and you are worried about your sex life being affected, it's important to talk to your doctor. There are treatment options available that can help.

Further information

Sources

  • Bostwick DG, Crawford ED, Higano CS, et al. American Cancer Society's complete guide to prostate cancer. Atlanta: American Cancer Society, 2005:300
  • Sex and prostate cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 2 September 2008
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Why isn't there a national screening programme for prostate cancer?

In the UK there isn't currently a screening programme for prostate cancer. This is because of concerns about the prostate-specific antigen (PSA) test and our understanding of prostate cancer and its treatments. However, if you are concerned about prostate cancer, you can ask your GP for a PSA test.

Explanation

The most commonly used test to check for prostate cancer is called a PSA test. It involves doing a blood test. PSA is a protein that is produced by both normal and cancerous cells in your prostate.

In recent years, there has been much debate over whether the PSA test should be used in a nationwide screening programme. It has now been decided that such a screening programme may actually cause more harm than good. This is because doctors still have concerns over the PSA test and their understanding of prostate cancer and its treatments.

The PSA test is not a particularly sensitive or precise test. There can be many reasons why you may have a high PSA level, and these aren't always related to you having prostate cancer. A PSA level can be raised due to:

  • benign prostatic obstruction (BPO) - enlarged prostate
  • prostatitis - inflammation of the prostate
  • a urinary tract infection
  • old age
  • acute urinary retention - a condition which means you are unable to pass urine
  • recent medical examinations - this can include recently having had a prostate biopsy, a rectal examination or a urinary catheter
  • recent vigorous exercise

Also, you can have a normal PSA level even if you do have prostate cancer, although this is rare. The imprecise nature of the PSA test could lead to many men being put under unnecessary stress and worry when they don't have prostate cancer.

It's not currently clear what effect earlier detection and treatment for prostate cancer has on how long you live. In many cases prostate tumours are so slow growing that they will have no impact on a man's life. If you had a tumour and it was found through screening and treated, it may cause a lot of unnecessary physical and mental suffering. Another reason is that most prostate cancers are found in much older men, usually aged 75 to 79. At this late stage in life, the potential for prolonging life through early detection is very small.

If you are particularly concerned about prostate cancer, you can ask your GP for a PSA test. Before doing the test, he or she will discuss the pros and cons of having the test to help you decide whether or not to have it. If you are in a higher risk group it might be worth considering. Your risk of prostate cancer is increased by:

  • getting older
  • having close relatives who have had prostate cancer
  • being from African-Caribbean or African-American descent

If you have any questions or concerns about prostate cancer, talk to your GP.

Further information

Sources

  • Aim of prostate cancer risk management. NHS Cancer Screening Programmes. www.cancerscreening.nhs.uk, accessed 2 September 2008
  • Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2007:305
  • Advantages and disadvantages of having the PSA test. Macmillan Cancer Support. www.cancerbackup.org.uk, accessed 9 September 2008
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Related topics

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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: November 2008

 

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