Prostate Cancer

Prostate Cancer: A PSA about Checking Your PSA Levels

The prostate gland is small. But when it becomes cancerous, it can cause BIG problems.

And this is why keeping check on your PSA levels is so important.

Unlike many other cancers, prostate cancer often doesn’t cause any noticeable symptoms in most men. When symptoms do finally occur, it’s often a sign that the cancer has spread beyond the prostate.

So, what’s the best way to prevent and detect this disease? Through regular screenings with a PSA test — which involves a simple blood draw.

When caught early through screening, prostate cancer can typically be treated very successfully.

Prostate cancer isn’t fun to talk about. It can feel embarrassing to discuss it even with your doctor. But talking about it can lead to testing for it and testing for it can literally save your life. So, rev yourself up to have that talk with your physician.

A Pit Stop with Michael O. Koch, MD

Dr. Koch, the John P. Donohue Professor of Urology and chair of the Department of Urology at Indiana University School of Medicine, has been a member of the IU community since 1998. His clinical and academic interests are in bladder and prostate cancers, and his research efforts have focused on the treatment of those cancers. He’s leaning in on the turn toward curing both.

The prostate gland is a small gland that’s located at the bottom of the bladder and is near other vital structures in the body. Urine goes through it, and it also makes secretions that impact male fertility. These little glands can become cancerous — similar to breast cancer in women. It tends to occur in older men since it involves a degeneration of the prostate. But it can also occur in younger men.

Probably not. There’s not a clear understanding of what causes it. In some cases, it might have to do with a high fat diet. Unfortunately, Black men tend to get prostate cancer at a higher rate and their surgical and radiation outcomes aren’t as good as those experienced by white males. Also, in general, only 10% of men with prostate cancer have a family history of it. That means, 90% don’t.

The gold standard for prostate cancer screening is the PSA test. It’s an amazing test in that it detects cancer prior to when it spreads. It’s a blood test that detects protein made by the glands in the prostate, and it’s able to detect early cancers. If your count is 0 to 4, that’s considered normal. In men under age 60 it should be under 2.5. If it’s above that, your urologist will need to decide what should come next.

Surgery and radiation are the main way prostate cancer is currently treated. Surgery is done robotically, delivering a minimally invasive procedure.

In some cases, even when prostate cancer is detected, it doesn’t need to be treated. Instead, it only needs to be monitored by regular PSA testing and/or by taking a biopsy. This is referred to as active surveillance. This approach doesn’t mean doing nothing. Instead, it refers to an approach that involves active patient management — such as conducting a PSA test every six months at a minimum and/or doing biopsies when indicated.

There are risks associated with over treatment of prostate cancer. Side effects can cause urinary incontinence and/or a loss of sexual function. There was a study conducted at John Hopkins involving patients with non-aggressive prostate cancers. For those who had been diagnosed with this type of non-aggressive prostate cancer and then put into an active surveillance protocol, no one had died 10 years out from their diagnosis.

Of course, there are some cases in which prostate cancer is more aggressive. So, that factor is taken into consideration when determining the course of treatment.

At IU, we can treat just the cancer rather than involving the entire prostate whenever possible. For example, with smaller, less aggressive prostate cancers, we use high intensity focused ultrasound (HIFU) technology that creates heat and burns the cancer away. Alternatively, TULSA uses high energy ultrasound guided by MRI to heat up and destroy cancerous spots in the prostate.

Some think they’re going to get a rectal exam and want to avoid it. Only about 10% of cancers diagnosed have a normal PSA (<4), so it can be avoided if the patient finds it objectionable.  

There are also patients who just don’t want to know if they have prostate cancer, and they don’t want treatment due to the risk of sexual dysfunction. Early detection usually allows successful treatment where the urologist can try to preserve sexual function and if delayed until the tumor has grown, this may not be possible.

In some cases, men who are having trouble urinating don’t want to go to the doctor because they’re afraid it might be prostate cancer. However, it’s important to remember that there aren’t symptoms when prostate cancer is in its early stages — which is when it’s most treatable. In most cases, trouble urinating is a sign of an enlarged prostate — not prostate cancer. So, if you’re experiencing problems with urination, come see me so we can address it.

There are always modifications of the PSA test happening. But they tend to come and go. The basic PSA test is the gold standard. If we find something unusual with the results of a PSA test, there are supplementary tests that can be used to determine what might be going on.

For those men who are at a higher risk — such as Black men and men with a family history of prostate cancer — start annual screening at age 40 to 45. For others, start getting screened at 50. Screening usually ends at 70 since prostate cancer is relatively slow growing.

Prostate cancer is the second leading cause of death in men. The only way to reduce the morality rate is to screen for it. Once prostate cancer has spread, it’s treatable but not curable.

As a urologist, I checked my PSA levels annually. For 10 years in a row, they were in the 1 to 2 range — which is normal. I also didn’t have any symptoms. However, when I checked them that 11th year, the levels began to rise slightly— eventually up to 3.8. That’s when I found out that I had prostate cancer.

I went through treatment and now I’m fine. I live my life, and I don’t think about cancer. This is because, through annual PSA screenings, my prostate cancer was caught early. So, when I tell other men to get screened, I’m speaking from personal experience.

Well, my dad died from kidney cancer at a pretty young age. So, that was a significant reason I wanted to go into urologic oncology. But what interested me about urology specifically was the types of people who enter this field. They tend to be intellectually curious and very relatable. I enjoyed being around them and wanted to be part of that community.

Shaping the Future of Prostate Cancer

Researchers and clinicians at IU are actively involved in studies focusing on the diagnosis and treatment of prostate cancer at all stages. Three of these studies include:

PSMA-PET Imaging
Using prostate-specific membrane antigen positron-emission tomography (PSMA-PET), researchers are studying how this technology can make it easier for physicians to see and diagnose prostate cancer. During PET-imaging, PMSA causes cancer cells to “glow” — making them more visible.

TULSA PRO MRI-guided Transurethral Ultrasound
Drs. Koch, Clint Bahler and Thomas Gardner are investigators in a clinical trial that’s studying the new TULSA -PRO procedure for treating prostate cancer. According to an Indiana University School of Medicine post, “the precision imaged-guided focused ablation of the prostate with the TULSA procedure may result in better preservation of nerves surrounding the prostate, as well as better quality of life for patients.”

Targeted Chemotherapy
A new targeted chemotherapy trial is being led by Nabil Adra, MD, and Jennifer King, MD. It’s testing a treatment that specifically seeks out and attaches to prostate cancer cells in a patient’s body.

Racing Highlights

  • The first robotic prostatectomy in Indiana was performed by urologists at IU School of Medicine in 2002. To date, more than 5,000 of these procedures have been performed by IU urologists.
  • The first HIFU research protocol was developed at IU School of Medicine with Dr. Koch and his colleague, Thomas Gardner, MD. In 2007, Dr. Koch and others published the results of their study, showing that “the treatment had few side effects and had the potential to be an effective treatment for early-stage prostate cancer.”
  • Each year, there are almost 300,000 new prostate cancer diagnoses in the United States.
  • Every American man has a 12.9% chance of developing prostate cancer during his lifetime.
  • The average age of men at initial diagnosis is 67.
  • The five-year relative survival rate for patients whose prostate cancer was diagnosed while still localized is 100%.


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