No Two Men Are The Same
Prostate cancer is the most common type of cancer found in men today. It mainly affects men over age 50. As men reach their 50th birthday, many become concerned about how to protect themselves against prostate cancer.
You may be wondering if you should be tested to identify whether you have prostate cancer, even if you show no symptoms. You may have heard about the PSA test for prostate cancer and wonder whether you should have it. Perhaps family members, friends, or co-workers are urging you to be tested.
The information below will help you to better understand prostate cancer and the PSA test.
Special Types Of Psa Tests
The PSA level from a screening test is sometimes referred to as total PSA, because it includes the different forms of PSA . If you decide to get a PSA screening test and the result isnt normal, some doctors might consider using different types of PSA tests to help decide if you need a prostate biopsy, although not all doctors agree on how to use these tests. If your PSA test result isnt normal, ask your doctor to discuss your cancer risk and your need for further tests.
Percent-free PSA: PSA occurs in 2 major forms in the blood. One form is attached to blood proteins, while the other circulates free . The percent-free PSA is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not.
If your PSA test result is in the borderline range , the percent-free PSA might be used to help decide if you should have a prostate biopsy. A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy.
Many doctors recommend a prostate biopsy for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. Using these cutoffs detects most cancers and helps some men avoid unnecessary biopsies. This test is widely used, but not all doctors agree that 25% is the best cutoff point to decide on a biopsy, and the cutoff may change depending on the overall PSA level.
Response To Public Comment
A draft version of this recommendation statement was posted for public comment on the USPSTF website from April 11 to May 8, 2017. A number of comments suggested that because men are now living longer, they should be screened beyond 70 years of age. However, the USPSTF considered other evidence in addition to data on life expectancy when recommending against screening in men older than 70 years, including results from large screening trials that did not report a mortality benefit for men older than 70 years and evidence on the increased likelihood of harm from screening, diagnostic evaluation, treatment, overdiagnosis, and overtreatment. Several comments requested a recommendation for younger men and for baseline PSA-based screening in men 40 years and older or 50 years and older. The USPSTF found inadequate evidence that screening younger men or performing baseline PSA-based screening provides benefit.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Authors followed the policy regarding conflicts of interest described at . All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.
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What Are Some Of The Limitations And Potential Harms Of The Psa Test For Prostate Cancer Screening
Detecting prostate cancer early may not reduce the chance of dying from prostate cancer. When used in screening, the PSA test can help detect small tumors that do not cause symptoms. Finding a small tumor, however, may not necessarily reduce a mans chance of dying from prostate cancer. Many tumors found through PSA testing grow so slowly that they are unlikely to threaten a mans life. Detecting tumors that are not life-threatening
that requires treatment.
Limitations Of Psa Testing
PSA screening is not a standardized test that can be used in all circumstances to reliably indicate the presence of an aggressive prostate cancer .15,16 Often, other risk factors are considered when a physician discusses prostatic biopsy with a patient to make a shared decision.17,18
Notably, PSA screening has several other limitations. It does not distinguish between high- and low-grade prostate cancer.12 It is not prostate cancerspecific in fact, it offers low sensitivity and specificity for prostate cancer.15,19,20 Additionally, PSA levels can be elevated by noncancerous conditions, such as benign prostatic hyperplasia , prostatic inflammation, and lower urinary tract infection and instrumentation.7,8,21
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Prostate Specific Antigen Test
A blood test called a prostate specific antigen test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.
As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.
PSA levels also can be affected by
- Certain medical procedures.
Imaging Tests For Prostate Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. One or more imaging tests might be used:
- To look for cancer in the prostate
- To help the doctor see the prostate during certain procedures
- To look for spread of prostate cancer to other parts of the body
Which tests you might need will depend on the situation. For example, a prostate biopsy is typically done with transrectal ultrasound and/or MRI to help guide the biopsy. If you are found to have prostate cancer, you might need imaging tests of other parts of your body to look for possible cancer spread.
The imaging tests used most often to look for prostate cancer spread include:
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Transrectal Ultrasound With Prostate Biopsy
Transrectal ultrasound is most often used to examine the prostate. In a transrectal ultrasound, the health care provider inserts a transducer slightly larger than a pen into the mans rectum next to the prostate. The ultrasound image shows the size of the prostate and any abnormal-looking areas, such as tumors. Transrectal ultrasound cannot definitively identify prostate cancer.
To determine whether a tumor is cancerous, the health care provider uses the transducer and ultrasound images to guide a needle to the tumor. The needle is then used to remove a few pieces of prostate tissue for examination with a microscope. This process, called biopsy, can reveal whether prostate cancer is present. A transrectal ultrasound with prostate biopsy is usually performed by a doctor in a health care providers office, outpatient center, or hospital with light sedation and local anesthesia. The biopsied prostate tissue is examined in a laboratory by a pathologista doctor who specializes in diagnosing diseases.
Comparison Study Puts Psa Ultrasound And Mri To The Test
Now, another research team led by Eldred-Evans has published their results with the IP1-PROSTAGRAM Study, designed to compare the performance of PSA testing, MRI, and ultrasonography as screening tests for prostate cancer. 408 men representing the general population participated in all three screening tests . If any test was positive, the participant underwent a conventional 12-core TRUS biopsy. If either bpMRI or ultrasound was positive for prostate cancer suspicion based on a 5-point scale, an additional fusion-guided targeted biopsy was performed.
Based on an analysis of the screening tests and biopsies, the authors concluded:
MRI using a score of 4 or 5 to define a positive test result compared with PSA alone at 3 ng/mL or higher was associated with more men diagnosed with clinically significant cancer, without an increase in the number of men advised to undergo biopsy or overdiagnosed with clinically insignificant cancer. There was no evidence that ultrasonography would have better performance compared with PSA testing alone.
In other words, MRI was a more effective and selective screening tool of the general population than PSA with a cutoff threshold at 3 ng/mL or higher. Ultrasound offered no evidence of better detection of clinically significant prostate cancer than the blood test alone.
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Screening For Prostate Cancer
Prostate cancer is fairly common. Early detection of aggressive prostate cancer may allow timely treatment and can prevent the metastatic spread of cancer cells and death. Many men, especially those at high risk, choose to get screening for prostate cancer. It is important to discuss the risks and benefits of screening for prostate cancer with a urologist to make sure that screening is the right decision for you.
If you decide to get screening for prostate cancer, it is important to decide whether you should have a traditional PSA test or improved modern tests for prostate cancer such as 4Kscore test or PHI .
New York Urology Specialists, under the leadership of Dr. Alex Shteynshyuger, is the first practice in New York City and one of the first in the world to offer 4KScore and PHI test to their patients beginning in 2014.
If youre interested in testing for prostate cancer or prostate cancer screening, please contact New York Urology Specialists for an appointment.
If you have any questions, to schedule a consultation or if you need a second opinion, pleasecontact us or call:
We see patients from all parts of New York City , Long Island, Westchester and New Jersey as well as other parts of the USA. We also see from Canada, Japan, South America, Russia, Asia, Europe, Middle East, Africa, the Caribbean and other parts of the world.
What Clinical Trials Are Open
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Steven A. Kaplan, M.D., Weill Cornell Medical College Michel A. Pontari, M.D., Temple University School of Medicine
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Lymph Node Biopsy As A Separate Procedure
A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.
Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.
What Is A Grade Group
In 2014, the International Society of Urological Pathology released supplementary guidance and a revised prostate cancer grading system, called the Grade Groups.
The Grade Group system is simpler, with just five grades, 1 through 5.
*Risk Groups are defined by the Grade Group of the cancer and other measures, including PSA, clinical tumor stage , PSA density, and number of positive biopsy cores.
Many hospitals report both the Gleason score and the Grade Group, but there may be hospitals that still report only the old Gleason system.
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What Tests Do I Need After A Biopsy
If you have a biopsy that shows that you have cancer cells in your prostate, then you’ll have more tests to work out where and how big the cancer is .
The tests you might have include a CT scan and a bone scan.
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The National Institute for Health and Care Excellence , 2019
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The use of PI-RADSvs2 in pre-biopsy multi-parametric MRIThe Royal College of Radiologists, 2018
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PI-RADS Prostate Imaging Reporting and Data System version 2American College of Radiology, 2015
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The 2014 International Society of Urological Pathology Consensus Conference on Gleason Grading of Prostatic Carcinoma – Definition of Grading Patterns and Proposal for a New Grading SystemJ Epstein and others American Journal of Surgical Pathology, 2016. Vol 40, Issue 2, Pages 244-252
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National implementation of multi-parametric magnetic resonance imaging for prostate cancer detection recommendations from a UK consensus meetingM Appayya and others
Psa Level Risk Analysis
- 15% of men with a PSA level less than 4 ng/ml go on to develop prostate cancer.
- 31% of men with PSA levels between 4 10 ng/ml have shown to develop prostate cancer.
- 50% 65% of men with psa scores over 10 ng/ml develop prostate cancer.
An important part of the your results is finding both the
1. Total amount of PSA in your blood.
2. Ratio of free vs bound PSA.
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What Is The Best Test For Prostate Cancer
In the past, digital rectal exam in combination with PSA was the recommended tests for prostate cancer.
In 2016, while PSA can still be used as a test for prostate cancer, newer tests that provide better information became available. As of 2016, Dr. Alex Shteynshlyuger recommends that men with symptoms suggestive of prostate cancer consider more specific tests that include the 4KScore test that includes genetic profile and PHI test.
Factors That Might Affect Psa Levels
One reason its hard to use a set cutoff point with the PSA test when looking for prostate cancer is that a number of factors other than cancer can also affect PSA levels.
Factors that might raise PSA levels include:
- An enlarged prostate: Conditions such as benign prostatic hyperplasia, a non-cancerous enlargement of the prostate that affects many men as they grow older, can raise PSA levels.
- Older age: PSA levels normally go up slowly as you get older, even if you have no prostate abnormality.
- Prostatitis: This is an infection or inflammation of the prostate gland, which can raise PSA levels.
- Ejaculation: Thiscan make the PSA go up for a short time. This is why some doctors suggest that men abstain from ejaculation for a day or two before testing.
- Riding a bicycle: Some studies have suggested that cycling may raise PSA levels for a short time , although not all studies have found this.
- Certain urologic procedures: Some procedures done in a doctors office that affect the prostate, such as a prostate biopsy or cystoscopy, can raise PSA levels for a short time. Some studies have suggested that a digital rectal exam might raise PSA levels slightly, although other studies have not found this. Still, if both a PSA test and a DRE are being done during a doctor visit, some doctors advise having the blood drawn for the PSA before having the DRE, just in case.
- Certain medicines: Taking male hormones like testosterone may cause a rise in PSA.
Some things might lower PSA levels :
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Who Should Have The Test
Having a PCA3 test done in addition to a PSA test and digital rectal exam can more accurately assess your need for a biopsy of your prostate gland. The decision to have the PCA3 test is up to you and your doctor.
Generally, the test is given if you have elevated PSA levels but a biopsy found no cancer. Its also given if you and your doctor have decided that watchful waiting is the best strategy, but you want another method of monitoring your status.
How Is A Digital Rectal Exam Performed
A DRE is a physical exam of the prostate. The health care provider will ask the patient to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies next to it. The DRE may be slightly uncomfortable, but it is brief. This exam reveals whether the prostate has any abnormalities that require more testing. If an infection is suspected, the health care provider might massage the prostate during the DRE to obtain fluid to examine with a microscope. This exam is usually done first. Many health care providers perform a DRE as part of a routine physical exam for men age 50 or older, some even at age 40, whether or not the man has urinary problems.
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Prostate cancer has few symptoms, meaning for many men they wont realise there is an issue until the cancer begins to spread. In order to avoid this, heres how to assess your risk for prostate cancer, and when to speak to your doctor.
What Is The Prostate
The prostate is a walnut-shaped gland that is part of the male reproductive system. It has two or more lobes, or sections, enclosed by an outer layer of tissue. The prostate is located in front of the rectum and just below the bladder, where urine is stored. It surrounds the urethra at the neck of the bladder and supplies fluid that goes into semen.
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