“If you’re a veteran and you have an elevated PSA, and this has been established through blood work, through your primary care doctor, you want to know what do next,” Dr. Rettig tells SurvivorNet of the standard screening method for prostate cancer.

“Your primary care physician should put in a referral to a urologist, the surgical subspecialist who focuses in prostatic diseases. That should happen automatically and you should not have to initiate a further effort to be seen by the urologist.”

Services Can Vary at VA Medical Centers

There are many VA medical centers across the country — and you can check accesstocare.va.gov to see which specialties are offered at locations in your area.

“In certain circumstances it may be required that you get referred to the community for the ability to see a urologist, you’ll have to go to a community urologist for the further evaluation,” Dr. Rettig says.

“However, at most VAs, including the VA I work at, all of the subspecialty care is contained within our VA medical center. So a urologist would receive the consultation, you would be seen, evaluated and a biopsy potentially done. At that point, once the diagnosis is established, then we have to talk about what the next steps are in evaluating your prostate cancer and its extent.”

Outside Community Providers

Dr. Rettig also notes “there are fewer options if you are referred to the community” as compared to “having private insurance and you’re picking out your urologist from a long list of possibilities.”

Though the VA Health Care workers are there to help assist you, doing your own legwork is encouraged if you are able.

“Of course you should do your homework when it comes to the urologist to which you are referred in the community,” Dr. Rettig adds.

“However, for the most part, the performance of a biopsy is fairly straightforward and you don’t need to have a super specialized urologist to execute a biopsy,” Dr. Rettig assures. “This is a fairly straightforward urologic procedure.”

If You’ve Been Diagnosed with Prostate Cancer

If the biopsy of your prostate comes back positive, or malignant, “the next step is the staging of your prostate cancer, determining the extent of the disease and ultimately the treatment of your disease,” Dr. Rettig says.

“Typically this can all be done within the VA through the multiple subspecialists available at your VA. In that case, you’ll be traveling to your local VA and all of the appointments that you should receive, whether it’s with a urologist, radiation oncologist or a medical oncologist should be set up on your behalf,” he continues.

“You would get your appointment, a letter and often a phone call indicating when your appointment is, which you can change, and then you would come to your appointment with the subspecialist like any other appointment such as an appointment you have with your primary care physician.”

“You’ll then have a discussion with the subspecialist who will go over the important features of your case and you can have a discussion about how you should be treated and what the options are,” Dr. Rettig adds.

What is a PSA Test?

A prostate-specific antigen (PSA) test is one of the most commonly used screening tools for prostate cancer. It is also used for tracking the disease following diagnosis and during treatment. To perform the test, your doctor will take a blood sample just like any other routine blood test.

The test checks for the level of PSA circulating in the blood. While the PSA protein is produced by normal prostate cells and usually present at low levels in the blood, it can also be made by cancerous prostate cells.  As the cancer cells grow and become more active than normal prostate cells, they can cause  PSA levels to spike. However, PSA can also be elevated for non-cancerous reasons too.

What is an Abnormal PSA Test?

Typically a PSA level of 4.0 ng/mL or higher is considered high and requires further workup. However, many men with a PSA above 4.0 do not have prostate cancer and some men with a PSA below 4.0 ng/mL can have prostate cancer. It’s crucial to review your test results with your care team to understand what they mean and if you need any follow-up.

For some men, an elevated PSA is normal. Numerous factors can cause a rise in PSA level too, including:

• Increasing age
• Enlarged prostate
• Benign prostatic hypertrophy (BPH)
• Infection of the prostate
• Recent biopsy
• Recent ejaculation

It’s worth noting that some medications can actually lower PSA levels. These include drugs used to treat hair loss or urinary problems, such as finasteride and dutasteride.

Who Should Get Prostate Cancer Screening?

The decision of when to begin screening with the PSA test varies between males — who should always consult with their doctor and discuss their personal and family history. However, the American Cancer Society recommends the men begin screening at the following ages:

• Age 50 for men with average risk of prostate cancer
• Age 45 for high-risk men, including African American men and men with a father or brother diagnosed with prostate cancer at a young age (younger than 65 years old)
• Age 40 for very high-risk men with a father or brother who died from prostate cancer at an early age

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