Despite regular DREs from his midfifties onwards, doctors failed to detect a tumour because it was on the gland's deep side. Luckily, McGivern also underwent a complementary form of screening. In general, the higher the PSA, the greater the cancer risk. A reading above 4 nanograms per millilitre is often used to trigger further evaluation. Often more telling are changes revealed by a series of PSA tests.
Further evaluation is needed to determine if the cause is benign enlargement, cancer or infection.
Patients should ask themselves if they'd rather have the information or not. In McGivern's case, a first-off PSA reading of 26 warranted quick investigation. A biopsy showed cancer. Currently at St Vincent's Clinic in Sydney, Golovsky is coordinating an Australasian trial of a second generation PSA test that can distinguish between the antigen from benign prostate tissue and one generated by malignant cells. And at South Australia's Flinders Cancer Centre, Professor Villis Marshall and Dr Wayne Tilley are developing a test for another protein that may also help distinguish between benign prostate problems and cancer.