Johnson: Test for PSA early

Published 6:53 pm Tuesday, March 24, 2009

The options to treating prostate cancer in men increase greatly with PSA testing and early detection. That was the main message conveyed by Dr. Steven Johnson, chairman of the Lewis Hall Singletary Oncology Center at Archbold Medical Center in Thomasville, Ga., to the Bainbridge Rotary Club during lunch Tuesday.

Prostate-Specific Antigen (PSA) is a protein produced by a normal prostate and is also produced by cancerous tissue in the prostate. It is normal for a certain amount of PSA to be present in a healthy male, but an increased amount could indicate the presence of cancerous cells in the prostate.

“The PSA level allows us to detect cancer at a very early stage,” said Dr. Johnson. “But probably what is more important than the level of PSA is the velocity that the level is rising. We are now detecting cancer with a PSA that is in the normal range, but with a large jump from one test to another.”

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The PSA level can increase for a variety of reasons. One reason is cancer, but another reason is simply inflammation or infection. The normal course of action for an elevated PSA count is antibiotics initially. If the antibiotics do not bring the level down, a biopsy could be necessary.

Dr. Johnson also explained the use of the Gleason Score, used to grade the aggressiveness of prostate cancer, during the treatment and range from two to 10. A Gleason Score less than six is “bread and butter and highly curative,” at scores of seven and eight the cure rates decrease, and scores of nine or 10 are almost incurable.

“Someone with prostate cancer with a Gleason Score of less than six and a PSA level of less than 10, which is the majority of what we see, has a cure rate of 90 percent,” explained Dr. Johnson.

There are a variety of treatments available for prostate cancer and they are all equally curative. In fact, no study has ever demonstrated one treatment’s superiority over the other. So doctor’s decisions on treatment are often made depending on side effects.

“One of the first things I do when determining treatments with a patient is the willingness to be treated. This disease progresses over a period of years, not months like other cancers, so I wouldn’t expose a patient to the side effects unless he had at least 10 years of life left, when there is almost no chance that the patient would outlive the disease.”

The common treatments are radiation, surgery and seed implantation. Seed implantation, when radioactive seeds are implanted to destroy the cancerous cells, is the favored treatment method for patients that are otherwise healthy, have a PSA of less than 10, and a Gleason Score of less than six.

The underlying message from Dr. Johnson’s address was the importance of regular PSA testing.