The prostate antigen (PSA prostate specific antigen) is a substance, a protein specifically produced by the prostate. It is not pathological, instead produced by all patrons and is designed to liquidate the semen to enable the sperm to “run” and to fertilize the egg. So all men produce PSA, which is normally low but increases with age. So otherwise evaluate the PSA a man 30 or 40 and otherwise a man 60. For example a value of 4.5ng/ml can not be our concern in the second but we are concerned in the first case.

What then is the securest PSA?

The answer is not simple. Very roughly say that and start worrying when the value exceeds 3 or 4ng/ml. This does not mean that a man with a PSA greater than this value has cancer. There are other factors that elevate the PSA and overall this is the sharp increase in prostate size and prostate inflammation, known as prostatitides. Simply, the increase of PSA over those limits has been shown statistically that increases the chances of actually hiding a cancer. Pay attention to the words: increases the chances. This means that someone with perfectly PSA 10ng/ml may not have cancer and one with 3 or less, to have. Simply, the first was more likely but eventually was lucky and the second had the misfortune to belong to a small group of patients who have cancer with low PSA. So you rise to reasonable questions that evaluate the PSA. The urologist will request an ultrasound and examine the patient to assess the size of the prostate and to find signs of inflammation or signs put suspected cancer. In general, a patron who is not our common concern, one that hurts to the touch hidden inflammation and cancer, a tough hide. And unfortunately there are always exceptions, which means that a common and may mask prostate cancer and a final hard not to have anything. So many factors into account together with the findings by palpation as the patients’ age, the PSA, history etc. Also particular importance is the rate of change of PSA. Someone who has a high PSA but unchanged in recent years may be safer than someone with low PSA but which begins growing rapidly. Furthermore, if the findings of palpation are suspicious we will ignore the PSA. There are patients who have cancer but do not produce PSA and that either because they have the usual type of cancer (adenocarcinoma), but other any that do not produce PSA, or because the cancer is very “bad” and totally destroyed more cells which produce any than normal, substances and certainly not PSA. These patients are usually poor prognosis.

Ultimately, however, that put the diagnosis?

This is done by biopsy of the prostate. It’s a relatively simple test which usually gives the diagnosis. The problem is that in PSA values below 10ng/ml, many patients will not have cancer and eventually submitted to an unnecessary biopsy.

• To try to identify these patients and save unnecessary biopsies using free PSA (Free PSA). This is a fraction of PSA chatting so far and which in fact is the total PSA. We have found statistics that studies where the ratio of free to total PSA is low there is an increased risk of cancer and it is important to biopsy and soon is high the chances are small and we can avoid it, at least for now. Monitoring of PSA (total and free) must be made at least once a year with ultrasound and palpation of the prostate in all men older than 50 or 40 if a positive history.
• The PSA is the best indicator we have for early detection of prostate cancer but rather to monitor the disease. It is however quite weak points and we are not fully satisfying. Efforts are made for something better, new indicators have been found but we are not yet convinced that it is better to replace PSA. Either way a man will need to monitor the prostate for a simple reason: if the diagnosis is made very soon, the treatment can be extremely effective single cent with a complete recovery to more than 90%. This one says it all.