Prostate-Specific Antigen Testing: Overview, Physiologic Characteristics of PSA, Other Prostate Cancer Markers

colon and prostate cancer symptoms :: Article Creator

More Young People Than Ever Will Get Colorectal Cancer This Year

Marisa Peters had been experiencing symptoms for years: blood on her toilet paper after going to the bathroom, changes in her stool and difficulty controlling the urge to poop. But she was in her 30s, healthy and physically active. She did not have any abdominal pain, and doctors dismissed the symptoms as hemorrhoids, or normal postpartum changes after the birth of her first son. When Ms. Peters finally visited a gastroenterologist in 2021, after having her third child and experiencing worsening bleeding from her rectum along with changes in her stool consistency, an urgent colonoscopy confirmed that she had colorectal cancer.

It had been four or five years since her symptoms had first emerged. Yet "I did not expect that cancer was going to be what they found," Ms. Peters said.

A report published by the American Cancer Society in January suggests that rates of colorectal cancer are rising rapidly among people in their 20s, 30s and 40s — even as incidence is declining in people over the age of 65.

"It's unfortunately becoming a bigger problem every year," said Dr. Michael Cecchini, a co-director of the colorectal program in the Center for Gastrointestinal Cancers and a medical oncologist at Yale Cancer Center. He added that early-onset colorectal cancers have been increasing by about 2 percent per year since the mid-1990s. This increase has moved colorectal cancer up to being the top cause of cancer deaths in men under the age of 50 and the second-leading cause of cancer deaths in women under 50 in the United States.

In fact, experts are noticing a rise in early-onset colorectal cancers around the world — a trend that they are racing to explain.

Colon and rectal cancers share many similarities and are typically lumped into one category, called colorectal cancer. Studies, however, show that the increase in diagnoses is mainly driven by a rise in rectal cancers and cancers found in the left, or distal, side of the colon, near the rectum. "That maybe provides an important clue for understanding what might be going on," said Caitlin Murphy, an associate professor and cancer researcher at UTHealth Houston.

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Diagnosing Prostate Cancer Too Early Might Cause More Harm Than Good

Prostate cancer is the third most common cancer among the male population in Malaysia after colorectal and lung cancer.

However, despite these staggering numbers, prostate cancer screening, compared to breast cancer, appears to be a very controversial topic in medicine.

To date, most health professionals and the public at large are still lost and uncertain as to how to go about preventing and treating prostate cancer.

Sometimes, early prostate cancers are localised and contained within the prostate.

The cancer grows very slowly and may not cause problems for years, or may not even become advanced cancer.

In cases like these, patients do not need to be treated.

The United States Preventive Services Taskforce (USPSTF) gave a Grade C recommendation on screening for prostate cancer.

This means that individuals do not necessarily need to screen for prostate cancer unless they have concerns, which should be discussed with their physicians.

This recommendation came about to reduce the overdiagnosis and overtreatment of prostate cancers.

However, it has resulted in an increasing trend of prostate cancer mortality (death) and morbidity (illness), causing much suffering and compromising the quality of life for patients.

The challenge today is to come up with a strategy to screen the right population to find lethal prostate cancers.

Equally important, we will also need new treatments that are less invasive and cause less disability in individuals.

Improved accuracy

For more than 30 years, the medical profession did not make headway with regard to the diagnosis and management of prostate cancer, other than developing robotic techniques and better radiotherapy to remove the tumours.

Diagnosis using systematic non-targeted transrectal ultrasound scan (TRUS) guided biopsy is highly inaccurate as it has a high false negative rate.

This is dangerous as it misses at least half of prostate cancers.

The transformative advancement in the diagnosis and treatment of prostate cancer was the development of multiparametric magnetic resonance imaging (mpMRI) of the prostate.

Using mpMRI as a form of triage can spare a significant number of men from undergoing unnecessary prostatic biopsies, and avoiding both physical and psychological trauma and morbidity, especially if TRUS biopsies are performed.

Many studies have confirmed that mpMRI is highly reliable in identifying more than 90% of men with clinically significant and lethal prostate cancer.

This method was reported to be much more sensitive (93%) in detecting prostate cancers, compared to TRUS biopsies (48%).

mpMRI also detects much fewer clinically unimportant prostate cancer (54% fewer), compared to using the traditional TRUS biopsy.

In other words, mpMRI reduces overdiagnosis of clinically unimportant prostate cancer and improves the detection of clinically significant and deadly prostate cancer.

To screen or not to screen

Many screening studies have shown that the survival outcome for men diagnosed with prostate cancers, whether they are treated or not, is generally over 10 years or so.

This shows that the majority of men with prostate cancer detected by screening do not benefit from treatment.

Instead, they suffer the consequences of treatment, like losing potency and experiencing urinary or rectal symptoms with occasional incontinence.

However, long-term studies show the benefits of screening after consistent follow-ups for 12 years or more.

The Goteborg Randomised Population-Based Prostate Cancer Screening Trial, done in Sweden, revealed that there was a two-thirds decrease in advanced prostate cancer in men who had undergone over 14 years of follow-up and prostate-specific antigen (PSA) screening, compared to those in the non-screening group.

Therefore, one can conclude that men who have serial PSA screening and then treated if prostate cancer is detected, have a two-thirds less chance of developing advanced prostate cancer, which often results in very painful bone metastases.

There was also a 56% lower mortality rate in the screened population.

Extrapolating from this result, in the Swedish population, PSA screening can save 5,700 out of one million screened men from dying of prostate cancer.

A clearer future

In summary, prostate cancer is still a significant life-threatening disease.

Early detection and early prediction of the disease are crucial, whereas screening in men with long life expectancies is beneficial.

Overdiagnosis and overtreatment issues can be addressed with targeted screening and biopsy only for at-risk patients.

This aims for early detection and diagnosis of localised lethal prostate cancer, which is fully curable.

If diagnosed with non-lethal prostate cancer (especially low-grade cancer), individuals only require good active surveillance with a follow-up mpMRI.

They should also repeat a biopsy of the prostate if necessary.

It is crucial for those with intermediate-grade prostate cancer (ISUP 2) or large volume low-grade prostate cancer (over 6mm core cancer tissue) to receive careful active surveillance, paired with good clinical judgement and a follow-up mpMRI.

Men with localised lethal prostate cancer will need ablative treatment with surgery, radiotherapy, or occasionally brachytherapy.

Counselling for adverse events like erectile dysfunction and occasional urinary incontinence following ablative treatments should also be given.

mpMRI has greatly improved the diagnosis of clinically important prostate cancer, and better genomics will help predict the prognosis of the disease.

Transperineal mpMRI–ultrasound fusion prostatic biopsy is the way forward.

Focal therapy like high-intensity focused ultrasound (HIFU), irreversible electrophoresis or targeted ablation will probably play an increasing role, especially for patients with favourable intermediate-risk or low-grade large-volume prostate cancer.

The future is definitely clearer as both the medical community and the public can be more confident in this era of advanced diagnostics and treatment of prostate cancer, which covers the whole spectrum of the disease.

Datuk Dr Tan Hui Meng is a consultant urologist. For more information, email starhealth@thestar.Com.My. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

How To Avoid One Of The Deadliest Forms Of Skin Cancer

When spring turns to summer and warm weather lures more people outside, skin cancer may be at most a distant concern. But experts said it's important to take the risk seriously.

The ultraviolet rays in sunlight are a leading risk factor for skin cancer, which will affect one in five Americans over their lifetime. That includes melanoma, among the deadliest types. About 100,000 people are diagnosed with melanoma each year in the United States, and about 8,000 die from it annually, according to the American Cancer Society.

Fortunately, there are simple ways to reduce your risk, and to detect possible cases early while they are most curable. Therapies approved over the past 15 years have also transformed the treatment of melanoma, extending and improving the lives of patients even with late-stage cases.

Here's what to know about melanoma, its treatments and how to protect yourself.

Melanoma is a cancer that typically starts in skin cells known as melanocytes that make the skin's pigment. Compared with more common skin cancers that begin in squamous or basal cells, melanoma is more likely to spread to other parts of the body.

"It truly has a very aggressive behavior and biology behind it," said Dr. Michael Davies, chairman of the melanoma medical oncology department at the University of Texas MD Anderson Cancer Center.

Most melanomas appear as flat or slightly elevated blotches of dark color on skin that has been frequently exposed to ultraviolet light, such as the scalp and face, arms, back and legs (though they can occur on areas that have never been exposed to the sun, too). In a smaller share of cases, the growth may appear as a dark- or red-colored bump and grow down into the skin, which can make it more difficult to detect.