Prostate cancer is one of the most common cancer types in men. It is said that out of 100 American men, up to 13 will be diagnosed with prostate cancer during their lifetime.
What we know about cancer so far is that prevention, early detection, and early treatment are critical. Speaking of early detection, we need to talk about PSA screening.
More importantly, we need to discuss the different factors that influence the PSA screening rates, with stress, anxiety, and depression being the main psychological factors.
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What is a PSA test?
PSA stands for prostate-specific antigen. It is, in fact, a protein that is produced by the prostate gland in men. The prostate gland is a small endocrine gland located between the bladder and the penis.
This small gland has an important function regarding the reproductive process. It is its job to produce part of the seminal fluid, which then mixes with the sperm the testicles make.
The prostate-specific antigen circulates through the body at all times. The PSA test measures the levels of the prostate-specific antigen in the blood. In healthy men, their PSA levels are usually low. The PSA levels are reported as ng/mL or nanograms of PSA per milliliter of blood.
Some experts consider PSA levels of 4.0 ng/mL as normal. However, not everyone agrees on this. These levels vary greatly throughout life. Certain conditions such as prostatitis, urinary tract infection, benign prostatic hyperplasia, and prostate cancer, among other factors, can all cause a rise in PSA levels. Any sexual activity and vigorous exercise in the last 48 hours prior to the PSA test can affect your PSA levels too. Certain medications, such as the 5-alpha-inhibitors used to treat benign prostatic hyperplasia, can impact the results as well.
Doctors use PSA screening as a part of prostate cancer screening. Prostate cancer is a severe and potentially life-threatening disease that unfortunately affects millions of men worldwide. This disease is diagnosed in every 1 in 8 men during their lifetime. Prostate cancer affects men aged 65, and older while vary rarely affects men above the age of 40.
The symptoms of prostate cancer develop slowly. The slow growth process of prostate cancer itself can explain this. In the majority of cases, we are speaking of metastatic prostate cancer. As cancer grows, it starts spreading to other body organs and no longer limits to the prostate gland. This will lead to the occurrence of additional symptoms over time.
Prostate cancer patients usually report experiencing the following signs and symptoms:
- Frequent urination, especially during the night;
- Weak urine flow;
- A burning sensation during urination;
- Painful urination;
- Presence of blood in the urine;
- Erectile dysfunction;
- Unintentional weight loss;
- Present swelling in the legs/feet, etc.
Since it can take a couple of years, decades even, before the prostate cancer is even diagnosed, doing the occasional PSA testing can come in handy. This is especially important for those who are considered a part of the so-called high-risk groups for prostate cancer. As we mentioned before, prostate cancer risk is higher among older men past the age of 65. African-American men also face a high risk of prostate cancer and those with family history and/or medical history of this disease. Obesity, too, seems to be a great risk factor for prostate cancer as well.
As explained earlier, prostate cancer causes PSA levels to increase. If your doctor notices a rise in your PSA levels, he/she can order a prostate biopsy and a digital rectal exam to further investigate your condition.
During a prostate biopsy, small samples of the prostate gland tissue are taken and later analyzed in the laboratory to determine prostate cancer cells’ potential presence. A digital rectal exam allows the doctor to feel any abnormal changes regarding the prostate gland.
Other than a prostate biopsy and the digital rectal exam, you may require additional tests as well, including:
- Free PSA test, which measures the levels of free, or unbound, prostate-specific antigen. When a patient has a higher than 10% free PSA, he is considered to have a greater risk of prostate cancer. In case the free PSA is 25% or higher, healthcare providers treat his case as highly concerning;
- PSA velocity, which measures the rate of rising over time. A greater rise in the PSA levels may indicate a greater risk of prostate cancer;
- PSA-based markers, including the Prostate Health Index and the 4K score, among others;
- PSA-density, which measures the patient’s PSA level per volume of the prostate. In this case, a higher density links to a higher risk of this disease, etc.
Having higher than normal PSA levels do not equal prostate cancer. That is why these extra tests are done in order to confirm the doctor’s suspicions about your health. The PSA screening is vital for early prostate cancer detection. Early detection equals early treatment, which will only increase your chances of winning the fight against prostate cancer.
Speaking of treatment, it is good to know that you have many options. The three most commonly used treatment methods are, of course, radiation therapy, hormonal therapy, and radical prostatectomy. Active surveillance is important, too, allowing your doctor a clear insight into the disease activity and your general health.
Unfortunately, prostate cancer recurrence rates are high. Research suggests that about 20 to 30 percent of prostate cancer patients will experience a relapse in their condition. Despite the high recurrence rates, this disease is not listed as a common cause of death.
While prostate cancer does not result in death that often, it commonly links with quite a few comorbidities. According to experts, high blood pressure is frequent comorbidity among these patients. The list also includes stomach ulcers, obesity, liver disease, sexual dysfunction, and many other common health issues.
Prostate cancer may also be a cause for your rheumatoid arthritis, psoriatic arthritis, and psoriasis flare-ups. Knowing this, the PSA screening can help confirm prostate cancer as a potential cause for the existing comorbidity.
Preparing for a PSA test
If you need a PSA test, this can cause quite a lot of anxiety. You have to remember everything that we discussed before and remind yourself that having higher than normal PSA levels does not necessarily have to mean that you have prostate cancer. Even if that happens to be the case, it is always better to get the occasional PSA test rather than avoiding it.
A PSA test is much like any other blood test. This test does not require any fasting nor any special preparation. A general practitioner or a practice nurse will draw some blood using a sterile needle. You should expect to feel some pain at the injection site as well as some possible bruising.
The blood sample is then sent to the laboratory where it will be properly analyzed. You should receive your PSA results in one week or sooner. As soon as you receive your test results, schedule a visit to your doctor to discuss the following events.
Nowadays, we also have the option of using a rapid PSA test. Prostate cancer patients usually use the rapid PSA test.
These patients need to monitor their PSA levels over time. The rapid PSA test usually comes in the form of a home kit, providing results in less than 3 minutes
Anxiety and PSA
As much as helpful the PSA screening can be, many believe that it is, in fact, controversial. Experts express their concerns regarding the rates of both under- and over PSA screening. While certain groups are over-screened, others are under-screened. The reasons for such behaviors remain unknown.
That encouraged researchers from the University of Chicago to investigate these events. The researchers published their findings in the Medical Care journal. The study took place in 2013, investigating the potential influence of stress, anxiety, and depression upon the PSA screening rates among different population groups. This systematic review gave a lot of insight into this topic.
The researchers looked at the gathered-up data from analyzing a total of 1,169 patients from the National Social Life, Health and Aging Process. All patients were male and within 57-85 years of age. The results showed that there was a clear link between the increased levels of perceived stress and the lower rates of PSA screening.
On the other hand, those men with low levels of perceived stress had higher rates of PSA screening. The explanation behind these links happens to be simple. Those with higher levels of perceived stress often do not appreciate their long-term health goals, meaning that they are very likely to avoid any prostate cancer screening, including PSA tests. On the other hand, those with lower levels of perceived stress take better care of their health, including testing.
There are similar links between anxiety disorder and PSA screening rates. However, in this case, the patient’s doctor visits were taken into consideration as well. The researchers found out that the PSA screening rates were significantly lower among patients with high anxiety levels and fewer doctor visits. In return, the PSA screening rates were higher among those with high anxiety levels but frequent doctor visits.
What the research says
In community studies, anxiety regarding the screening process itself links with less screening and avoidance. On the other hand, in hospital-based studies, the anxiety symptoms caused by the screening process led to higher screening rates. These patients would use the screening process to give themselves some peace of mind regarding their health condition. In conclusion, PSA anxiety is a real problem which doctors need to recognize and treat accordingly.
And last but not least important is depression and its influence on the PSA screening rates. It is no surprise to learn that depression causes a significant drop in the PSA screening rates in men. Depression is also a cause for less frequent mammograms and colorectal cancer screenings in women.
The purpose of this study was to, once and for all, determine the psychological factors and their influence upon the PSA screening rates. Now, it is up to the doctors to recognize the signs of high perceived stress, anxiety, and depression and treat these issues accordingly. By doing so, they can influence the PSA screening rates and take part in the early prostate cancer detection among their patients.
Nowadays, thankfully we have a range of treatment methods that can help those with depressive symptoms, anxiety, and stress. Knowing that both doctors and patients should do whatever they can to use these methods and protect one’s health.
If you are a man above 65 years of age, the chances are that your doctor will recommend getting a PSA test.
A PSA test can potentially detect prostate cancer while still in its early stages. But it can also detect other problems.
Knowing that each man after the age of 65 should consult his doctor about getting a PSA test.
In case of stress, anxiety, and/or depression is preventing you from doing that, do talk to your doctor about getting proper help and preserving your good health.