Psa

>  Blood test

Ultrasound: Hypoechoic zone

The prostate specific antigen (PSA) is a substance secreted by the prostate. The increase in rate can detect prostate cancer. It is a tumor marker. If it is specific to the prostate, it is not only linked to cancer. Indeed, the rate can be increased in benign pathology, especially adenoma (BPH). The maximum acceptable rate is generally 4ng / ml. The more we move away from that figure, the greater the risk of developing cancer. Nevertheless, there are cancers with normal PSA and moderate elevations of PSA without any associated cancer. Similarly, an infection of the prostate (acute prostatitis) can increase the value of PSA to 'sky levels'. Therefore, the current recommendations urge the realisation of a digital rectal examination associated with the determination of PSA for every man overthe age of 50 (45 years old in case of family history). When rectal examination and PSA are considered in the standards, the risk of cancer is very low and only a regular surveillance (Annual) is recommended. An abnormality of one or the other will push your doctor to recommend biopsies of the prostate (see this chapter) under ultrasound guiding. Limit values (close to the standards), or so-called normal values but rising over time require in the first instance a more accurate measure of PSA. This is the Free PSA and the ratio on Free/ Total. Your Urologist should explain the significance of these results that are sometimes complex to understand. The PSA can also measure the effectiveness of treatment and therefore allow to follow its evolution and efficacy.

>  Recommendations
Zoom Ultrasound guided biopsies	The current recommendations are in favor of screening from the age of 50 years and even 45 when there is a family history of prostate cancer (father, grandfather, uncle ...). It consists of making an annual determination of PSA and a digital rectal exam by a Urologist.