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Questions and answers about prostate cancer diagnosis and presentation

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Q. Oh, by the way Doc, what’s a PSA?

A. The PSA or Prostatic Specific Antigen, as it is called, is the blood test that we presently use to tell us about the condition of the prostate. A normal PSA is considered less than or equal to four, but a PSA of 10 may be considered normal if a man just had surgery on his prostate, just had prostate sampling or has a bad prostate infection, while a PSA of two may be abnormal in a young man of 43 or an older man who has had curative surgery or radiation 1 year ago.{{more}}

Q. Doc, I hear that it is mainly gay men who get prostate problems.

A. The myth is that gay men have anal intercourse and since the prostate is in the rectum then are more likely to get prostate problems. The reality is straight men tend to have more prostate problems than gay men, because there are more straight men than gay. The fact is more sexually promiscuous men get more prostate problems than less sexually promiscuous ones. So, a straight promiscuous man gets a lot more prostate infections than a gay faithful man. Finally, the fact is the prostate is not in the rectum. It is in the urine passage, but it can be felt via the rectum because that part of the urine passage is deep inside the body and cannot be felt outside the body like the part of the urine passage in the penis.

Q. Doc, I hear only gay men like the rectal examination; is that true?

A. I do not know, and just to set the record straight, you cannot become gay by getting a rectal examination. If you become gay after you got a rectal examination, then you were gay before and are using the examination as an excuse. The fact of the matter is that I cannot tell if a man is straight or gay by how he reacts to the rectal examination. As you would expect, both gay and straight men have the same exam, but I suspect that gay men might have less discomfort than straight men, because they are less apprehensive. That does not mean they like the exam. In the same way, we cannot assume that prostitutes or promiscuous women like speculum examinations for PAP smears. I’m almost sure that the gynecologists will agree with me.

Q. Doc, I heard once you get the blood test, you do not need the finger test.

A. This is not true. In reality, the blood test is most accurate over serial readings done over years, but at some time a finger test will become necessary, because of a rising but “normal” blood test or symptoms or an initially high blood test. The finger test is also done to check for the prostate size, to rule out cancer in suspicious cases, to detect infections and prostatic abscesses and sometimes to obtain secretions after the examination.

Q. Doc, I heard that the normal PSA result is four or less and so I need not worry about any result below four. Besides, if I monitor the test by myself, I do not need a doctor.

A. This is both true and false. If you are over 60 years, then a PSA of around four is considered normal, but if your rectal examination is not normal, then that trumps the PSA of four. In other words, the PSA has to be combined with a rectal examination, especially when the PSA is around or above four. In fact there is no real “normal” PSA, as every value has to be interpreted in light of the clinical situation. For example, a PSA of 0.5 can be abnormal (e.g. after so called curative treatment), while a PSA of 10ng/ml may be considered “normal” during an active prostate infection. This is why there is someone called a urologist. Checking your PSA should be only a part of your annual check. The main part should be a thorough examination and history. Blood tests only become abnormal when things are bad. You want to catch anything before it is too late.

Next week, I will look at the issue of treatment of prostate cancer.

For comments or question contact:
Dr Rohan Deshong
Tel: (784) 456-2785
email: deshong@vincysurf.com

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