What means precocious diagnosis?

Precocious diagnosis is the diagnosis of a cancer before it has given symptoms. A person can carry out the precocious diagnosis or stem from the called population campaigns of screening or precocious diagnosis. In these campaigns many people are summoned for the risk of developing certain cancer.


To carry out it it is necessary to have an exploration (for example, mamografía in breast cancer) or blood test-PSA (in prostate cancer) or test of secret blood in dregs (in intestine cancer), which has been demonstrated effective in the detection of initial tumors.

But, also, the test applied to the population to the risk, must serve to diminish the mortality that on the studied group produces the above mentioned cancer.

The case perhaps more well-known is that of the breast cancer, in which, by means of the called screening campaigns, the mamografías in women without apparent breast cancer, allow to detect the breast cancer in very precocious and curable stages of the illness. the used mamografía like that allows to diminish the mortality in 30 % in women in ages between 50 and 65 years (to see in www.cancermama.org).


Is there anything similar in prostate cancer?

This is a polemic topic. On one hand, the way is had for the precocious diagnosis of the cancer of prostate, which is the PSA (see further on), but, on the other hand the campaigns with determination of the PSA and precocious diagnosis of the cancer of prostate, have not demonstrated in a categorical way, up to the date, which they were serving to diminish the mortality for this cancer.

It is for it that there is no world agreement in recommending all the men at the risk of developing cancer of prostate, that realize periodically a PSA. But at individual level, FEFOCrecomienda who with age superior to 50 years practises on every man an annual PSA (or of 40 years, if it has familiar precedents of the above mentioned cancer).


Let's speak a little about the PSA

The PSA (known by the initials of his denomination in English, or prostate specific antigene, specific antigen of the prostate) has supposed an authentic revolution in the precocious diagnosis of this cancer.

The PSA is produced only by a textile of the prostate, his epithelium, for it it is so specific. But, and this is very important, the PSA is a specific of the prostate, not of the cancer of prostate. Therefore, any increase of size of this gland (be for a benign motive - for example, inflammation or prostatitis - or malignant - cancer) they can make to increase the PSA level. In short, the increase of PSA is alert towards a problem in the prostate but it does not establish a diagnosis. For it, other means are needed.


How does the PSA decide?

With a simple blood test.

What are his values?

The analysts give the results in nanograms per milliliter (ng/ml). On having increased normally the size of the prostate on having been increase the age of the person, it is considered that a normal PSA must be lower than 2,5 between 40-49 years of age; of 3,5 in 50-59; of 4,5 of 60-69; and less than 6,5 between 70 and 79 years of age. Inside every age group, a level of PSA over the alert normality towards an alteration, benign or malignant


As everyone knows, in Medicine there are always exceptions what these numbers it is necessary to take them like orientativas and sometimes it is possible to diagnose prostate cancer with numbers lower than the due ones.


Major all that is the level of the PSA, major is the risk, but, we insist, the PSA himself is never a definitive test but an important sign of alert.

Can it, this way, increase the PSA without there being prostate cancer?

Yes, in effect. For it, there is dissuaded a PSA is realized if they happen some / some of the following circumstances:

a). The ejaculation increases temporarily the PSA level, by what two days before the analysis the sexual activity must be avoided.

b) Also it can be increased by the inflammation of the prostate, his infection, the hiperplasia (increase of size) benign of the prostate and the rectal tact.

c) Some medicines, type finasteride that is used in the benign hiperplasia, also can increase it.

What is the free PSA?

It is the PSA that circulates in the blood, without being joined to proteins, as it is the case of the PSA till now described. Between 65 % and 90 % of the PSA circulates ligature to proteins while the rest constitutes the free PSA or not ligature. The percentage of free PSA is major in benign cases and lower in malignant cases.

What is the utility of the free PSA?

Especially in the doubtful cases (PSA between 4 and 10 ng/ml), a low percentage of free PSA on the whole of PSA suggests as more probable the cancer diagnosis.

On the contrary, a high free PSA, it goes more in favor of a benign process.

Therefore, it is not enough to determine the entire PSA but it is necessary to request also the free PSA.

Which are the contributions of the PSA in prostate cancer?

Since his achievement began in the 90s of the 20th century, it has changed radically the model of presentation of the cancer of prostate.

In effect, earlier, most of men were coming to the first diagnosis of this cancer with symptoms (pains) of affectation of the skeleton, confirming to him his affectation by means of radiographies. it was a question, then, of incurable cases.

This model has turned. Nowadays, most of men with prostate cancer, when they are diagnosed, the cancer are located in the prostate and are curable.

In fact, in the last years, the mortality for prostate cancer is diminishing.

Perhaps all this progress should not only the PSA to itself. But there is a very direct relation between his appearance and the decrease of mortality.

The PSA: does it have other applications?

The PSA is very useful to continue the evolution of the patients after the treatment. While the PSA is supported in the limits of the normality, the illness has not been not reproduced usually.

On the contrary, if in the periodic PSA determination, it is observed that it has increased, it is necessary to realize tests and explorations to see if the illness has been reproduced.

Therefore, a person treated by cancer of prostate must practise periodic analyses of his PSA on herself.