PSA stands for prostate specific antigen. It is a protein produced by the prostate gland and released in the blood. Prostate is a small gland situated at the mouth of the urinary bladder essential for producing semen. PSA test involves testing the blood for levels of this protein.

PSA screening is done to assess the risk of prostate cancer. The commonest cause for its rise is due to non-cancerous reasons. The non-cancerous causes are urinary tract infection, recent instrumentation or recent sexual activity.

Bicycle riding does not cause a rise in PSA levels.

The most benefit is seen in those with the highest risk of prostate cancer. These include those with two or more first relatives with prostate cancer.  A  shared decision-making is necessary after discussing the potential risks and benefits of screening with your general practitioner.

Generally higher the PSA higher is the risk for prostate cancer. We recommend a consultation with a Urologist to discuss this further. You might need to have a prostate biopsy.

This is a day case procedure (under anaesthesia) where a small tissue sample of the prostate is taken from different zones of the prostate to rule out prostate cancer.

The various methods are –

1. TRUS biopsy – This involves placing an ultrasound probe in the rectum and taking tissue samples from the prostate.
2. Transperineal biopsy – This involves placing an ultrasound probe in the rectum and taking samples of the prostate via the perineum (between the scrotum and anus).
3. MRI biopsy – This involves performing a transrectal biopsy with the assistance of an MRI to locate the area of suspicion.

Depending on the size of the prostate gland, its feel and prior investigations (MRI prostate) the Urologist will decide the best way to biopsy the prostate.

Prostate cancer is graded according to the ISUP (International Society of Uro-pathology) classification from grades 1-5. The higher the grade the more aggressive is the cancer. Gleason grading is an older nomenclature for grading of prostate cancer and some urologists still use this classification.

Prostate cancer is a slow growing cancer and survival is better than most other cancers even in the advanced stage due to the availability of multiple new agents for treatment.

• Localised prostate cancer –

These patients can be cured of their cancer in the majority of cases.

The treatment options include –

1. Active surveillance – This approach is used for very low and low risk prostate cancers that do not require treatment straight away and can be kept under surveillance. Surveillance involves regular visits, examination, PSA test and repeat prostate biopsies. This avoids the potential risks of surgery or radiotherapy. A minority of these cancers can progress to more aggressive cancers on follow up and may require surgery or radiotherapy.
2. Surgery – Radical prostatectomy can be performed either using traditional open incision (cut) or via small incisions using the DaVinci robotic system.
3. Radiotherapy – Radiation can be administered either via seeds or rods (Brachytherapy) inserted into the prostate or via external beam for treatment of localised prostate cancer. Brachytherapy is only suited for a certain type of prostate cancer subgroups.

• Advanced prostate cancer –

These patients have progression of cancer either in organs around the prostate or at distant sites. The options for treatment include –

1. Hormonal ablation – using oral and injectable therapy to block testosterone. Testosterone (male hormone) fuels the growth of prostate cancer
2. Chemotherapy – Patients with a large cancer burden or those who progress despite of hormonal ablation require chemotherapy. This involves administration of chemotherapy under the supervision of a medical oncologist.
3. Other treatment options – include second and third line hormonal manipulation.
4. Radiation therapy – this is used for painful bony cancer deposits.