By: RS Abdi Waluyo
An elevated PSA result can be worrying. However, that number alone is not enough to diagnose prostate cancer. Your doctor needs to consider the result alongside your medical history, risk factors, and other findings before deciding what to do next.
Prostate cancer is the uncontrolled growth of cells in the prostate, a small gland below the bladder that produces some of the fluid in semen. Because early prostate cancer often causes no symptoms, testing can help identify problems before symptoms appear. Even so, not every man needs the same set of tests.
PSA provides an initial clue
PSA, short for prostate-specific antigen, is a protein produced by prostate cells and measured with a blood test. Levels can rise because of prostate cancer, but also because of benign prostate enlargement, inflammation, or infection. A low PSA result does not completely rule out cancer either.
This means the result needs to be interpreted in the context of your health. Your doctor may consider your age, family history, physical examination, and previous PSA results. In some situations, the PSA test is repeated before further investigations are recommended. A single elevated result does not automatically mean you need a biopsy. [1]
MRI helps identify suspicious areas
If the initial assessment raises concern, your doctor may recommend a prostate MRI. This scan uses magnetic fields and radio waves to produce detailed images of prostate tissue. It helps identify areas that may need further investigation.
An MRI report may include a PI-RADS score. This system assesses how suspicious an area is for clinically significant prostate cancer, meaning cancer that is more likely to need treatment. Scores range from 1 to 5, with higher scores indicating greater suspicion. The score is not a cancer stage or a confirmed diagnosis.
MRI also has limitations. Benign conditions may look suspicious, and some cancers may not be visible. An MRI with no suspicious findings therefore does not always remove the need for a biopsy, particularly when risk factors or other test results remain concerning. [2]
A biopsy examines tissue to confirm the diagnosis
A prostate biopsy involves taking small tissue samples with a needle. The samples are examined in a laboratory to check for cancer cells. Examining tissue is the main way to confirm a diagnosis of prostate cancer.
Your doctor may take samples systematically from different parts of the prostate or target suspicious areas seen on MRI. Both approaches may be used together when appropriate. If cancer is found, the appearance of the cells under a microscope also helps assess how aggressive it is. [2, 3]
Like other medical procedures, a biopsy carries risks, including bleeding, infection, and difficulty urinating. Your doctor will explain how to prepare, what the procedure involves, and its benefits and risks before it takes place. [1]
Why testing is tailored to each person
The aim is to identify cancers that need care while reducing unnecessary procedures. Some prostate cancers grow so slowly that they may never cause symptoms during a person’s lifetime.
Finding such a cancer is called overdiagnosis. If it leads to treatment that was not needed, this is called overtreatment. Both are important reasons to discuss the benefits and risks of testing with your doctor. [1]
To decide on the next step, your doctor considers your overall situation, including age, general health, family history, PSA, physical examination, and MRI when needed. Monitoring and repeat testing may be appropriate for some people. Others may need a biopsy to clarify the diagnosis. [2]
What happens after testing
If cancer is found, care depends on its stage and characteristics, your overall health, and your preferences. A prostate cancer diagnosis does not always mean immediate surgery. For selected patients with low-risk cancer, active surveillance with scheduled follow-up may be an option. [3]
You can consult a doctor at RS Abdi Waluyo to discuss your test results and the next steps. If prostate cancer is diagnosed, how does your doctor decide whether monitoring or treatment is appropriate? Explore the options in our next article: Prostate Cancer Does Not Always Require Surgery: Understanding Your Treatment Options.
Referensi
