Prostate Cancer in Older Men

Dorothy A. Calabrese, MSN, RN, CURN, CNP

Disclosures

Urol Nurs. 2004;24(4) 

In This Article

Pathology and Diagnosis

More than 95% of Ca P are adenocarcinoma (Presti, 2004). Other types of Ca P include transitional cell carcinoma, small-cell carcinoma, or sarcoma.

Prostate cancer is diagnosed by examination of tissue retrieved during a prostate biopsy. Most biopsies are completed because the patient has a rising prostate-specific antigen (PSA) level in the blood. PSA is a glycoprotein that is produced by the prostate gland, and it is elevated with certain prostate conditions such as Ca P, benign prostatic hyperplasia (BPH), prostatitis, and instrumentation of the genitourinary tract (for example, the insertion of a Foley catheter for urinary retention).

The PSA blood test is a valuable tool in detecting Ca P. Normal PSA levels are less than 2.6 ng/ml (Gretzer & Partin, 2003). When the PSA level is 2.6 to 10 ng/ml, the likelihood of Ca P is judged as moderate, but values greater than 10 ng/ml indicate a high level of suspicion (Gretzer & Partin, 2003). The American Urologic Association (AUA, 2000) established variations of PSA levels based on ethnicity and age (see Table 1 ).

A variety of factors should be considered when evaluating PSA results. Several techniques have been developed to increase the PSA test's ability to predict the presence of prostate cancer. Following the increase in PSA values over time (PSA velocity), age-specific PSA (a younger man should have a lower PSA), and assessing bound versus unbound portions of PSA (free vs. total PSA) are all methods of helping to identify a patient that needs a prostate biopsy to prove or disprove a cancer diagnosis (AUA, 2000). A fractionated PSA measures free versus protein-bound PSA in the blood. Men with Ca P have a higher proportion of their PSA bound to protein, whereas the proportion of free PSA is higher in men with BPH (Gretzer & Partin, 2003). Measurements of PSA density (PSAD) are useful in men whose original values fall in the moderate suspicion range. PSAD combines the serum PSA value and prostate volume assessed via transrectal prostatic ultrasound. Scores are calculated by dividing the PSA by the prostate volume; men with a score above 0.15 are more likely to have cancer than men with lower values (Gretzer & Partin, 2003).

The result of a digital rectal examination (DRE) also provides data for the health care practitioner. The DRE may identify abnormalities of the prostate, such as nodules, firmness, or subtle variations in the gland that need further evaluation. PSA detects more prostate cancers earlier than a DRE, but the combination of the DRE and PSA is more sensitive than either PSA or the DRE individually.

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