Ampath Diagnostic Guide | Pathology solutions are in our DNA
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🧬 What is Prostate Cancer?
Prostate cancer is the most common cancer among males in South Africa. It occurs more frequently in men older than 50.
Key facts:
- Most prostate cancers grow slowly and are non-aggressive
- Many men won’t die from prostate cancer
- According to the SA National Cancer Registry (2013), the average lifetime risk is:
- 1 in 18 for all males
- 1 in 9 for white males
- 1 in 15 for coloured males
- 1 in 27 for Asian males
- 1 in 29 for black males
⚠️ Symptoms
Early prostate cancer often has no symptoms – making screening essential.
When present, symptoms may include:
- Frequent urination (especially at night)
- Difficulty urinating (dribbling, weak stream, hesitancy)
- Erectile dysfunction
- Blood in urine or semen
These symptoms may also occur due to non-cancerous conditions, like prostatitis or benign prostatic hyperplasia (BPH).
🧪 Screening
Who Should Be Screened?
- All men 50+ years
- Start at 45 if a first-degree relative was diagnosed before age 65
- Start at 40 if a close relative had early-onset prostate cancer
What Screening Involves:
- Digital rectal examination (DRE) – physical exam via rectum
- Prostate-specific antigen (PSA) blood test
🔍 Understanding PSA (Prostate-Specific Antigen)
- PSA is a protein made by prostate cells
- Some PSA passes into the bloodstream
- PSA is prostate-specific, but not cancer-specific
A normal PSA level doesn’t rule out cancer. Elevated PSA may also be caused by:
- BPH (benign enlargement)
- Prostatitis (inflammation)
PSA Testing Guidelines
Avoid blood collection for PSA testing:
- 2 days after cycling, heavy exercise, or sex
- 1 week after DRE or rectal sonar
- 6–8 weeks after prostatitis, bladder infection, biopsy, or surgery
PSA is not diagnostic – it helps identify high-risk patients who may need a biopsy.
📊 PSA Interpretation
PSA levels increase with age and prostate size. Suggested age-specific reference ranges:
- 40–49 years: 0–2.5 ng/mL
- 50–59 years: 0–3.5 ng/mL
- 60–69 years: 0–4.5 ng/mL
- 70+ years: 0–6.5 ng/mL
Cancer Probability Based on PSA:
- < 2.5 ng/mL: Low risk (< 2%)
- > 10 ng/mL: High risk (≈ 67%), though 33% may still be negative on biopsy
- 2.5–10 ng/mL: Intermediate → test free PSA
🧪 Free PSA & PHI
- Free PSA is PSA not bound to protein
- A lower % free PSA = higher risk of cancer
Risk by % free PSA:
- <10%: >80% chance of cancer
- >25%: <10% chance
PHI (Prostate Health Index):
- Combines total PSA, free PSA, and proPSA
- Helps assess grey zone (2–10 ng/mL) cases
- Improves specificity and reduces unnecessary biopsies
🧫 Diagnosis
Diagnosis is confirmed by prostate biopsy under transrectal ultrasound (TRUS) guidance.
What to Expect:
- A spring-loaded needle collects tissue samples
- Guided by a TRUS probe inserted via rectum
- Samples are analysed by a histopathologist
Most common prostate cancer:
- Acinar adenocarcinoma – usually low-risk, slow-growing
📈 Cancer Grading
Grading Systems:
- Gleason Score:
- 6 or less: Low-grade
- 7: Intermediate-risk
- 8–10: High-grade
- Grade Group System:
- Group 1: Most favourable
- Group 5: Least favourable
Reports also include:
- Number of positive cores
- Volume of cancer per core
💊 Treatment
Treatment depends on:
- Patient’s age
- Tumour aggressiveness
Options include:
- Active surveillance
- Surgery
- Radiation therapy
- Hormonal therapy
- Chemotherapy
Prognosis is excellent if diagnosed early and treated appropriately.
📌 Additional support and information at: www.cansa.org.za