Click here to read more Quest articles. print | Print this page

Recommendations for CaP Testing and Then Treatment

by William J. Catalona, MD

 

My research and the research of my colleagues show the most effective and acceptable treatment for prostate cancer is to eradicate the tumor at a very early stage before it has a chance to spread.

The risk of unnecessary treatment is low when good clinical judgment is exercised.

Also, it’s important to know that prostate cancer is not like many other cancers in that we talk about a “tumor,” but early prostate cancer is more like clusters of cells forming microscopic “tumorlets” that can be in many different places in the prostate. It is almost never one single “tumor.”

Since advanced prostate cancer has no known cure and there are no means to prevent prostate cancer, the only hope is to detect it early and treat it effectively.

Because prostate cancer usually produces no symptoms until it is too late, it is necessary to screen for and detect it when it is curable.

Recent studies show that radical prostatectomy reduces the chances for metastasis (spreading of the cancer to other parts of the body) and death from prostate cancer as compared with watchful waiting.

I recommend an annual PSA and digital rectal examination beginning at age 40, or earlier in men with a family history of early age-at-onset prostate cancer.

A PSA level of 0.6 to 0.7 or less in men 40 to 50 years old is evidence of a healthy prostate gland.

I recommend monitoring PSA velocity, the rate at which a PSA rises - if and when it does begin to rise.

A 12-core biopsy of the prostate with a local anesthetic should take place if the digital rectal exam is suspicious, if the PSA is higher than 2.5, or if a PSA velocity is higher than 0.35 ng/ml/year.

If the PSA seems to be rising, then the patient should try antibiotics to see whether the rise might be due to prostatitis.

In addition, I recommend using PSA velocity, PSA density, percent free PSA, , and measurement of androgen levels to determine the need for repeat biopsies.

All the tests and measurements listed above are explained on my website (www.drcatalona.com) in language for the general reader.

Close this window