Pros And Cons Of The Psa Test
Pros:
- it may reassure you if the test result is normal
- it can find early signs of cancer, meaning you can get treated early
- PSA testing may reduce your risk of dying if you do have cancer
Cons:
- it can miss cancer and provide false reassurance
- it may lead to unnecessary worry and medical tests when there’s no cancer
- it cannot tell the difference between slow-growing and fast-growing cancers
- it may make you worry by finding a slow-growing cancer that may never cause any problems
What Other Test Are Available For Men At Risk For Prostate Cancer
While traditionally, the options available to men at risk for prostate cancer were limited to PSA blood test and a prostate exam , a number of exciting innovative options are now available.
PSA is still a useful test but is being supplanted by more informative tests such as 4KScore and PHI , both of which incorporate the traditional PSA test as well. Thus, the report will list both the traditional PSA test and the 4KScore or PHI score respectively.
PHI is a new test that provides an incremental improvement over the PSA test alone when it comes to predicting the risk of prostate cancer. It can be used to reduce the need for unnecessary biopsies in some men.
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What Are Normal Psa Levels
Thereâs no such thing as a normal PSA for any man at any given age, but most men with prostate cancer have a higher than normal level. In general:
If your PSA results are in the borderline range , the % free PSA can be useful in helping distinguish between prostate cancer or benign prostatic hyperplasia . The pattern is the opposite of that seen with PSA in that a high % free PSAâabove 20%âpoints to BPH, while a %- free PSA less than 10% indicates a greater likelihood of cancer.
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What Is The Controversy Surrounding Psa Screening
In recent years, there has been some controversy surrounding the PSA test. In 2012, the U.S. Preventive Services Task Force assigned the PSA test a D rating. This meant that the USPSTF concluded the harms that resulted from PSA testing, such as unnecessary biopsies and negative treatment side effects, outweighed the benefits of finding and managing the disease early. This recommendation did not include exceptions for men at increased risk of developing the disease, such as African American men, those with a family history of the disease, and those with BRCA gene mutations. The USPSTF recommendation is important as it guides primary care physicians in preventive care and can impact insurance coverage and reimbursement for screening. Prior to its D rating, the PSA test had an I rating, meaning the USPSTF concluded there was insufficient evidence to assess the pros and cons of testing.
In May 2018, the USPSTF updated their recommendation on PSA screening. In response to new research demonstrating the benefits of PSA screening , an increase in the number of men choosing active surveillance, and advocacy efforts, the USPSTF released a draft recommendation in April 2017 that assigns the PSA test a C rating for men ages 55 to 69 . This rating has now been certified official by the task force.
Biopsy During Surgery To Treat Prostate Cancer
If there is more than a very small chance that the cancer might have spread , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy .
The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.
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What Is Screening For Prostate Cancer
Some men get a PSA test to screen for prostate cancer. Talk to your doctor, learn what is involved, and decide if a PSA test is right for you.
Cancer screening means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.
If you are thinking about being screened, learn about the possible benefits and harms of screening, diagnosis, and treatment, and talk to your doctor about your personal risk factors.
There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.
Other Factors That Influence Psa Levels
The PSA blood test alone cannot diagnose prostate cancer. It is possible, although rare, to have prostate cancer without raised PSA levels in the blood. A higher-than-normal PSA level doesnt automatically indicate prostate cancer either. A high PSA level is due to cancer in around one in three cases.
PSA levels can be raised by other factors, including:
- , also known as benign prostatic enlargement .
For this reason, the PSA blood test isnt used in isolation when checking for prostate cancer.
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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:
When Should I Get A Psa Test
The guidelines below are adapted from the NCCN Clinical Practice Guidelines In Oncology for Prostate Cancer Early Detection. Please use these guidelines to have a discussion with your physician about your personal risk and make a plan for screening.
- If you are between ages 45 and 75:
- Discuss the risks and benefits of prostate cancer screening with your doctor, have a baseline PSA, and consider a baseline DRE
- If your PSA is below 1 ng/mL and your DRE is normal, repeat testing every 2-4 years
- If your PSA is between 1 and 3 ng/mL and your DRE is normal, repeat testing every 1-2 years
- If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
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What Is The First Test For Detecting Prostate Problems
The first test for detecting prostate problems is a blood test to measure prostate-specific antigen , a protein made only by the prostate gland. This test is often included in routine physical exams for men older than age 50. Because African American men have higher rates of getting, and dying from, prostate cancer than men of other racial or ethnic groups in the United States, medical organizations recommend a PSA blood test be given starting at age 40 for African American men. Medical organizations also recommend a PSA blood test be given starting at age 40 for men with a family history of prostate cancer. Some medical organizations even recommend a PSA blood test be given to all men starting at age 40.
If urination problems are present or if a PSA blood test indicates a problem, additional tests may be ordered. These tests may require a patient to change his diet or fluid intake or to stop taking medications. If the tests involve inserting instruments into the urethra or rectum, antibiotics may be given before and after the test to prevent infection.
Is The Psa Test Recommended For Prostate Cancer Screening
Beginning around 2008, as more was learned about both the benefits and harms of prostate cancer screening, a number of professional medical organizations began to caution against routine population screening with the PSA test. Most organizations recommend that individuals who are considering PSA screening first discuss the risks and benefits with their doctors.
Some organizations do recommend that men who are at higher risk of prostate cancer begin PSA screening at age 40 or 45. These include Black men, men with germline variants in BRCA2 , and men whose father or brother had prostate cancer.
In 2018, the United States Preventive Serves Task Force updated its recommendation statement for prostate cancer screening from a D to a C in men ages 55 to 69. The updated recommendation, which applies to the general population as well as those at increased risk due to race/ethnicity or family history, is as follows:
- For individuals ages 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one. Before making the decision, a person should discuss the potential benefits and harms of screening with their clinician and consider these in the context of their own values and preferences.
- PSA-based screening for prostate cancer is not recommended for individuals 70 years and older.
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Psa Test For Prostate Cancer
The prostate gland makes a protein called prostate specific antigen . This protein helps to nourish sperm. Normally, only tiny amounts of it enter the bloodstream.
Cancer cells in the prostate interfere with proper functioning and can cause large amounts of PSA to enter the bloodstream. Therefore, when high levels of PSA are detected in the bloodstream, this may indicate cancer.
Early prostate cancer often has no symptoms. However, high PSA levels can occur five to 10 years before the onset of prostate cancer symptoms. In such circumstances, the PSA test can help to indicate the presence of cancer at an early stage.
Other tests are needed to confirm a diagnosis because an abnormal PSA test can be due to non-cancerous causes. Equally, it is possible for a man to have a normal PSA level when cancer is present.
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.
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Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11, 18F-DCFPyl , and Ga 68 gozetotide , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body. PSMA PET scans can also be used to help determine if the cancer can be treated with a radiopharmaceutical that targets PSMA.
Doctors are still learning about the best ways to use these newer types of PET scans, and some of them might not be available yet in all imaging centers.
Problems With The Psa Test
There are reasons doctors donât agree on whether you need this test:
- Finding prostate cancer early doesnât always protect you. The PSA test often finds small, slow-growing tumors that arenât life-threatening. Treating them anyway, whether itâs with surgery or radiation, can expose you to harmful side effects and complications. Also, finding cancer early may not help if you have an aggressive tumor or if it spread to distant body parts before you found it.
- The results arenât always accurate. If you have a high level but you donât have cancer, the test results can create a lot of worry and lead to medical procedures you donât need. A negative result if you really do have cancer can prevent you from getting treatment you do need.
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When You Should Screen For Psa Levels
Colloquially, prostate cancer screening is thought to be routinely undertaken by men over the age of 40. The American Urological Association recommends the following:
- Men under 40: No screening there is no evidence to suggest a benefit of screening under 40
- Men aged between 40 to 54: No screening if youre at average risk. If youre at a high risk , the decision should be made by yourself and your doctor.
- Men aged between 55 to 69: Screening with doctor approval. This is the age group is identified as having the greatest benefit of screening
- Men aged over 70 or less than a 10-15 year life expectancy: Routine screening not recommended unless you are in excellent health where they may be benefit
Complete Blood Profile: Cbc :
Standard values:
WBC 3.4-9.6 billion cells/L
RBC Female normal range: 3.92-5.13 trillion cells/LMale normal range: 4.35-5.65 trillion cells/L
Hemoglobin Female normal range: 11.6-15 g/dLMale normal range: 13.2-16.6 g/dL
Hematocrit
7.0-20.0 mg/dL
Why this test?
Arenal panel is used to help monitor and diagnose conditions affecting kidney function, notably kidney failure, which could aggravate cancer. Levels of urea increase in cases of kidney failure . High levels of urea are not unique to kidney failure and can also occur in the case of high protein diets, dehydration or infection.
Standard values:
0.6-1.2 mg/dL
Why this test?
Creatinine levels reflect kidney function. Creatinine is a product of skeletal muscle breakdown. It is mainly eliminated by the kidneys . Kidney function can be estimated from the renal clearance of creatinine or from its concentration in the blood using formulas for estimating the glomerular filtration rate .
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Study: New Prostate Cancer Test Could Avoid Unnecessary Biopsies
Urine test found to be extremely accurate at detecting aggressive prostate cancer with few false negatives.
A urine test based on University of Michigan Rogel Cancer Center research could have avoided one third of unnecessary prostate cancer biopsies while failing to detect only a small number of cancers, according to a validation study that included more than 1,500 patients. The findings appear in the March issue of the Journal of Urology.
The MyProstateScore test, which is being commercialized by LynxDX, a U-M startup company, measures levels of cancer-specific genes in a patients urine. It is based on U-M research that discovered that half of all prostate tumors harbor a certain genetic anomaly in which the genes TMPRSS2 and ERG relocate on a chromosome and fuse together creating an on-switch for prostate cancer development.
Currently, one of doctors best methods for detecting prostate cancer is a blood test for prostate-specific antigen, commonly known as the PSA test. Elevated PSA levels may indicate cancer, but the majority of men with an elevated PSA do not actually have prostate cancer.
Our ultimate goal was to determine whether the MyProstateScore test could be a practical, reliable test that could rule out the need for more costly or invasive testing in men referred for a prostate biopsy, says study lead author Jeffrey Tosoian, M.D., M.P.H., a clinical lecturer in urology at Michigan Medicine.
What Does A High Psa Level Mean
High PSA levels could be a sign of prostate cancer or a different condition like prostatitis or an enlarged prostate.
Other things can affect your PSA level:
- Age. Your PSA will normally go up slowly as you get older, even if you have no prostate problems.
- Medications. Some drugs may affect blood PSA levels. Tell your doctor if youâre taking dutasteride or finasteride . These drugs may falsely lower PSA levels by half of what they should be.
If your PSA level is high, your doctor may suggest that you get a prostate biopsy to test for cancer.
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Prostate Specific Antigen Blood Test
Prostate specific antigen is a protein made by both normal prostate cells and cancerous prostate cells. PSA is found in the blood and can be measured with a blood test. The test results will show the level of PSA in your blood as nanograms of PSA per millilitre of blood.
There is not one normal PSA level for everyone. If your PSA level is above 3 ng/mL , this may be a sign of prostate cancer. Younger people or people with a family history of prostate cancer may have a lower threshold. PSA levels can vary from day to day. If your PSA is higher than expected, your GP will usually repeat the test to help work out your risk of prostate cancer.
Your PSA level can be raised even when you dont have cancer. Other common causes of raised PSA levels include benign prostate hyperplasia, recent sexual activity, an infection in the prostate, or a recent digital rectal examination. Some people with prostate cancer have normal PSA levels for their age range.