Prostate Cancer and PSA: What You Need to Know About Screening and Diagnosis

What Is Prostate Cancer and Why Is It Important?

Prostate cancer (PCa) is one of the most common oncological diseases among men. It is estimated that approximately one in six men in the US will be diagnosed with this type of cancer in their lifetime [7]. The prostate is a small organ of the male reproductive system, located beneath the bladder, which produces fluid that makes up part of semen.

Despite its high prevalence, the molecular mechanisms of PCa development and progression are not fully understood. However, studies show that certain factors, such as chronic inflammation and atrophy, may play a role in carcinogenesis. For example, proliferative inflammatory atrophy (PIA) and high-grade prostatic intraepithelial neoplasia (HGPIN) are considered potential precursors to prostate cancer [7]. Understanding these precursor conditions and their association with inflammation is essential for developing chemoprevention and early diagnosis strategies.

PSA: A Key Marker in Prostate Cancer Diagnosis

Prostate-specific antigen (PSA) is the primary marker used for the diagnosis and monitoring of prostate cancer [2]. PSA is a protein produced by prostate cells, and its blood levels can rise in various conditions, including both benign diseases (such as benign prostatic hyperplasia, prostatitis) and malignant ones (prostate cancer).

Biochemically, PSA is a complex molecule that exists in blood serum in the form of five isoforms and multiple molecular configurations and complexes. A deeper understanding of PSA biochemistry has significantly expanded the potential for using this marker in the diagnosis of malignant prostate neoplasms [2]. Modern commercial PSA assays are calibrated according to the World Health Organization's 1st International Standard for Prostate-Specific Antigen (90:10), which ensures greater consistency of results among different assay kits [2].

Prostate Cancer Screening with PSA: Pros and Cons

Prostate cancer screening using the PSA test is a subject of active debate in the medical community. On the one hand, early detection of prostate cancer can lead to timely treatment and an improved prognosis. On the other hand, the PSA test is not entirely specific for cancer, and elevated levels can be caused by benign conditions. This can lead to:

• Overdiagnosis: the detection of slow-growing tumors that would never have caused harm to the patient during their lifetime.
• Overtreatment: performing invasive procedures (such as biopsy, surgery, radiation therapy) with potential side effects (urinary incontinence, erectile dysfunction) that may not be necessary.

Therefore, the decision to undergo screening should be made individually, after discussing all potential risks and benefits with a doctor, taking into account the patient's age, overall health status, family history, and personal preferences.

When and How Is the PSA Test Performed?

The PSA test is a simple blood test that measures the level of prostate-specific antigen. It is usually recommended for men starting at a certain age (often 50, or earlier if risk factors are present, such as a family history of PCa). Before taking the test, it is important to inform your doctor about any recent medical procedures or conditions that may affect PSA levels, such as:

• Recent prostate biopsy.
• Urinary tract infections or prostatitis.
• Bladder catheterization.
• Intense physical exercise or cycling immediately prior to the test.

An elevated PSA level does not definitively mean cancer. The doctor may recommend additional studies, such as a digital rectal examination (DRE), a repeat PSA test after some time, determining the free-to-total PSA ratio, or a multiparametric MRI of the prostate. If suspicions persist, a prostate biopsy may be scheduled for a definitive diagnosis.

Modern Approaches to Prostate Cancer Treatment

Prostate cancer treatment depends on the stage of the disease, the tumor's aggressiveness, the patient's age, and their overall health status. Treatment options may include active surveillance, surgical removal of the prostate (radical prostatectomy), radiation therapy, hormone therapy, chemotherapy, and targeted therapy.

For patients with metastatic castration-resistant prostate cancer (mCRPC), innovative treatments such as radiopharmaceutical therapy using ¹⁷⁷Lu-PSMA-617 are available. This method is an established approach, but it requires careful monitoring of renal function before and after each treatment cycle, as the radiopharmaceutical is excreted by the kidneys and can cause measurable radiation exposure to them [1]. Understanding the dynamics of renal function, especially in patients with comorbidities such as hypertension and diabetes mellitus, is crucial for treatment planning and safety assessment [1].

Sources

1. [1] Renal Function During and After ¹⁷⁷Lu-PSMA-617 Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer. https://pubmed.ncbi.nlm.nih.gov/42481178/
2. [2] Prostate specific antigen: biology, biochemistry and available commercial assays. https://pubmed.ncbi.nlm.nih.gov/11732646/
3. [7] Human prostate cancer precursors and pathobiology. https://pubmed.ncbi.nlm.nih.gov/14607218/

The information presented in this article is for reference purposes only and does not replace professional medical advice. Always consult a qualified physician for the diagnosis and treatment of any medical conditions.