Myth 1: Every person with raised PSA level has prostate cancer
Fact: PSA (Prostate-specific antigen) is a protein that is normally produced from the prostate gland in small quantities. It helps in the liquefaction of semen to improve sperm motility. Not every person with raised PSA beyond the normal range (more than 4 ng/ml) has prostate cancer. PSA is a prostate-specific antigen and not Prostate cancer-specific antigen. Raised PSA can give a clue about the possible presence of prostate cancer, but it would need a consultation with Urologist, clinical examination and some investigations. Urinary tract infection, acute prostatitis, urinary retention, Benign Prostatic enlargement are all known to raise the PSA levels. On the contrary, not every person with Prostate cancer has raised PSA. Some rarer forms of Prostate cancer can present without a raised PSA.
Bottom line: Consultation with Urologist is a must for interpretation of PSA values in the clinical context.
Myth 2: Prostate cancer affects only people who are old
Fact: Although over 70% of the patients diagnosed with prostate cancer are over 65 years, there are a considerable number of patients diagnosed in their 40s and 50s. People who have a strong family history of prostate cancer especially in first degree relatives are at a higher risk for developing prostate cancer at a younger age.
Myth 3: Prostate cancer will always present with urinary symptoms
Fact: While it is true that some patients are diagnosed with prostate cancer during the evaluation of urinary symptoms, it is not necessary that all patients have urinary symptoms. A raised PSA, abdominal pain, swelling in the feet, bony pains can all indicate prostate cancer depending on the extent of disease in the body.
Myth 4: Prostate cancer is always a slowly growing cancer
Fact: While the low-grade disease can take a long time to spread and gives enough time to even wait until it progresses (active surveillance), not all prostate cancers afford this option. High-grade disease and some variants of prostate cancer can be very aggressive and hence expert involvement by a Urologist is necessary to separate the more dangerous ones from the friendly ones.
Myth 5: Prostate cancer does not run in my family, hence I won’t suffer from it
Fact: While a small percentage of prostate cancer patients have a family history of it, most don’t. So don’t use that as an excuse to neglect your symptoms or ignore your PSA report.
Myth 6: Prostate cancer always requires surgery or radiotherapy:
Fact: While it is true that majority of the organ-confined prostate cancers need treatment either by surgery or radiotherapy, there are many low-grade cancers which can be observed for a while before they require treatment (active surveillance). The other situation wherein treatment can be avoided or deferred is in the case of Watchful waiting wherein people with a life expectancy of fewer than 10 years (due to age or other health conditions) are newly diagnosed with low-grade organ-confined prostate cancer. One more situation wherein treatment can be offered only with medications is when cancer has spread to other sites in the body like bones, lungs, brain, liver and lymph nodes outside of the pelvis. These medications will only control the disease but not cure it.
Myth 7: Sexual activity increases the risk of Prostate Cancer
Fact: This is not true. There are studies which show that the risk of prostate cancer decreases in people with a higher number of ejaculations per month
Myth 8: Benign Prostatic enlargement is a risk factor for Prostate cancer
Fact: Majority of men will have benign prostatic enlargement (BPE) with age and resultant urinary symptoms due to it. The good news is that this BPE does not increase the risk of prostate cancer. One thing that may happen is that the detection of prostate cancer may be more frequent in men who present to the Urologist with symptoms due to BPE. Prostate cancer and BPE may co-exist and this scenario is seen frequently.
Myth 9: PSA screening in asymptomatic individuals has been given up
Fact: Screening of otherwise healthy men in their late 50s and 60s, using PSA test is now recommended, but after a thorough discussion with the patient about the implications of the results, need for further investigations if PSA is found to be high and what the treatment entails if found to have prostate cancer. This means that the patient has to be given an opportunity to make an informed decision.
The writer, Dr. Ashwin Mallya, is a Consultant Urology and Kidney Transplant at, Narayana Superspeciality Hospital in Gurugram