Author: Dr. Bryce Hendy, DC, DNCert
Prostate cancer was decreasing in the last 10 years or so, and then in the last 5 or so years the incidence rate has risen again. Experts are hypothesizing that there has not been an actual increase in prostate cancer, but there has been an increase in the diagnosis of prostate cancer. For a long time the best and only way to check for prostate cancer was with a digital rectal examination (DRE), which involved a physician using a gloved finger (digit) and inserting rectally to palpate the prostate gland. For some men, this test was not something they readily signed up for due to the uncomfortable nature of the exam procedure, which for many years was suggested at the age of 40 to help with early detection of prostate cancer. Now it could be correlated that with less men signing up for this exam procedure, there were more cases of prostate cancer missed, which ultimately made it seem like there was a decline in the incidence rate of prostate cancer.
Fast forward and now we have the Prostate Specific Antigen (PSA) blood test. This procedure is much less invasive and has a better specificity rate in detecting prostate cancer than the DRE. The PSA test is a blood drawn test, that looks for the specific protein PSA, which is produced by the prostate gland. When there is an increase in the PSA blood level numbers this can indicate something is wrong with the prostate. PSA numbers can increase with other conditions such as enlarged prostate and prostatitis (inflammation of the prostate). Ideally the number for the PSA test that is in normal range if <4, when the number is between 4 and 10, further testing is typically indicated to figure out what exactly is wrong. A number greater than 10 on this test has a higher likelihood of being diagnosed as prostate cancer, but still requires further testing.
With the increase in use of the PSA test due to the better specificity and better early detection, there has been an increase in the incidence rate of prostate cancer diagnoses. This in large part could be due to the better accuracy and ability to detect prostate cancer with the PSA vs the DRE. This could also be correlated to more men being apt to sign up for the PSA vs the DRE and if they had not been able to have the PSA and decided to skip the DRE they may not have found out that they have prostate cancer.
This is not to say that the DRE is no longer used. The best accuracy and early detection starts with a PSA test and if that number is higher than 4, then it is usually followed up by a DRE and a biopsy to better and more accurately diagnose and propose a treatment plan. The PSA is not only a more accurate test for prostate cancer, but has bridged a gap for men who did not want to have the DRE done as the PSA only requires a blood draw. Along with this, due to the rise in health conscious individuals, more men are getting the PSA done at a younger age, which can further help with early detection, especially when there is a family history.
The PSA test has helped to bring prostate health into a new light, which has helped many men with early detection, which has ultimately lead to early and more affective treatment, which means better prognoses for prostate cancer diagnoses.
