Best Way To Screen For Prostate Cancer

Living With Prostate Cancer

Prostate Cancer Screening and Biopsy with Urologist Dr. Scott Davidson

As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.

Nevertheless, it can affect your life. As well as the possible side effects of treatment, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.

You may find it beneficial to talk about the condition with your family, friends, a GP and other people with prostate cancer.

Financial support is also available if prostate cancer reduces your ability to work.

Psa Blood Test For Prostate Cancer

PSA levels are measured as ng/mL. According to the ACS:

Men with a PSA level between 4 and 10 have about a 25 percent chance of having prostate cancer.
Men with a PSA level higher than 10 have more than a 50 percent chance of having prostate cancer.

Not all men with high PSA levels have prostate cancer. High levels may also be caused by a urinary tract infection, prostatitis or benign prostatic hyperplasia, all of which are noncancerous conditions. Conversely, men with a low PSA level may still develop prostate cancer.

PSA tests are not an indication of how aggressive the prostate cancer may be. Many prostate cancers are slow-growing and dont require immediate treatment.

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.

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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.

Prostate Cancer Care At Medstar Georgetown Cancer Institute

If you need a second opinion on your PSA level after screening for prostate cancer, you’ll benefit from our team approach and broad experience. At the MedStar Georgetown Cancer Institute, our cancer team involves experts from a variety of disciplines, including urologists, medical oncologists, radiation oncologists, and others who work closely together to evaluate which treatment option will benefit you the most. We treat more patients for prostate cancer than most health systems in the region, so you can trust that we have the tools and the experience necessary to care for you.

Don’t let the fear of a prostate cancer diagnosis keep you from getting a prostate cancer screening. Talk to your doctor about getting your PSA checked early so that you can seek timely treatment, if necessary, and continue doing the things you love while you’re in the prime of your life.

When Should You Start Screening

First, talk to your doctor at your next checkup to go over your particular risk factors. You may have more than one risk factor at play and thus have a greater chance of developing prostate cancer than other men.

In general, discussions with your doctor about screening for prostate cancer should begin in your 40s. Here are some rough guidelines:

Do you have family history of prostate,ovarian, breast, colon, or pancreatic cancers,or do you know that gene mutations are present in your family?

Discuss screening with your doctor startingaround age 40.

Psa Screening Risks And Benefits

In recent years, PSAscreening has come under fire because of concerns that it has led to overdiagnosis and overtreatment. At Fred Hutchinson Cancer Center, we believe there are several good reasons to continue PSA screening.

A protein made by the prostate gland and found in the blood. Prostate-specific antigen blood levels may be higher than normal in men who have prostate cancer, benign prostatic hyperplasia , or infection or inflammation of the prostate gland.

PSAscreening has yielded a dramatic transformation in how prostate cancer patients present â meaning, the status of their disease when they first get the diagnosis. More men begin care with early-stage and potentially curable disease.

PSAscreening has likely saved many lives, but it also uncovers many cases of prostate cancer that may not need to be treated. The main harm in screening is not the PSA test itself but the possibility that the results may lead to overtreatment of low-risk cancers in older men.

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African American Men Are Two To Three Times More Likely To Die From Prostate Cancer Than Caucasian Men

Health disparities exist for African American men who have a much higher prostate cancer mortality rate than White men. While you may not be able to control the social or economic drivers of health inequities, you can choose to get informed on the disease and schedule a prostate cancer screening every year to increase your chance of catching it early when it’s easily treated. Pick a consistent time of year every year to schedule your screening, like football season, to help you remember.

African American men are 2-3X more likely to die from #ProstateCancer than Caucasian men. On the blog, find out if and when you may benefit from a #PSA screening test that could save your life: https://bit.ly/3h8gfcx.

What Is The Most Accurate Test For Prostate Cancer

Avoid prostate biopsies with new cancer screening

Prostate cancer is one of the most common types of cancer. More than 47,500 people are diagnosed with prostate cancer each year. In this video, Consultant Urological Surgeon, Mr Declan Cahill, explains how prostate cancer affects the prostate gland:

If you spot possible prostate cancer symptoms, such as difficulty starting to urinate or a weak flow, it is important to go to the doctor for testing. But what is the most accurate test for prostate cancer? Read on as we discuss.

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Patient Values And Preferences

Because of recent efforts to encourage screening for prostate cancer, some men may be interested in PSA screening despite the current recommendations. Evidence suggests that a patients perceived vulnerability to the disease, as a result of family history or otherwise, and physician recommendation are both associated with patient request for screening with the PSA test.50 Although high-quality evidence on the best way to facilitate informed decision-making about prostate cancer screening is lacking, such discussions should aim to elicit the knowledge, preferences and values of patients who ask about PSA screening.51,52 Many men view screening positively but are unaware of the potential harms.53 In addition to a focus on the patients values and preferences, informed decision-making requires practitioners to distinguish between the benefits and harms of screening, subsequent investigations and treatment, including an overview of diagnostic and therapeutic options in the event that the PSA test result is abnormal.

The task force recognizes that some men may place greater value on the potential benefits of screening than on the harms and risks associated with diagnosis and treatment and may choose to be screened with the PSA test. To facilitate informed decision-making about screening for prostate cancer, the task force has developed decision aids and tools that are available at www.canadiantaskforce.ca.

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.

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Repeating The Psa Test

A mans blood PSA level can vary over time , so some doctors recommend repeating the test after a month or so if the initial PSA result is abnormal. This is most likely to be a reasonable option if the PSA level is on the lower end of the borderline range . For higher PSA levels, doctors are more likely to recommend getting other tests, or going straight to a prostate biopsy.

A Note On Suspicious Results

Pull your finger out, doc, rectal exams aren

A suspicious result indicates that the biopsy sample contained some abnormalities but no cancer was found. There are a couple of potential explanations for a suspicious prostate biopsy result, including:

Prostatic intraepithelial neoplasia refers to changes within prostate cells that are abnormal, but not indicative of cancer. This condition is low-grade or high-grade, depending on how abnormal the cells are. Low-grade PIN is very common and isnt associated with prostate cancer. High-grade PIN, however, is associated with a higher risk of prostate cancer. If you have high-grade PIN after a prostate biopsy, your doctor may recommend that biomarker tests be performed on the sample to learn more about the cells. Alternatively, another prostate biopsy may be suggested.
Atypical small acinar proliferation indicates that the biopsy sample contains some cells that appear to be cancerous, but not enough to confirm the diagnosis. In most cases, this finding suggests that another prostate biopsy is needed.
Proliferative inflammatory atrophy describes a prostate biopsy that reveals inflammation in the prostate and abnormally small prostate cells. While these cells arent cancerous, having PIA may be associated with an increased risk of developing prostate cancer.

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Prostate Cancer Screening Patient Version

Scientists are trying to better understand whichpeople are more likely to get certain types of cancer. They also study the thingswe do and the things around us to see if they cause cancer. Thisinformation helps doctors recommend who should be screened for cancer, whichscreening tests should be used, and how often the tests should be done.

It is important to remember that your doctor does not necessarilythink you have cancer if he or she suggests a screening test. Screeningtests are given when you have no cancer symptoms. Screening tests may be repeated on a regular basis.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.

When To Startand Stopscreening

The doctors and researchers who recommend screening argue that cases of prostate cancer found very early can be cured more quickly, with less chance of relapse or spread. Those who recommend against routine screening point to the slow-moving nature of prostate cancer and the side effects of surgical and medical treatment, which can be considerable.

The introduction of PSA screening in the US led to an initial increase in the number of prostate cancer cases diagnosed each year, even though many of these new cases were non-aggressive or low-risk prostate cancer. The issue was not that screening was harmful, it was that many of these low-risk cancers did not necessarily need immediate treatment. It seems strange to say that a patient might be better off leaving cancer untreated, but in some cases, it can be true. For a few years, the United States Preventative Services Task Force recommended against PSA screening. We are now seeing more cases of advanced prostate cancer diagnosed in recent years. This may be a long-tail effect of that USPSTF recommendation. It has now been changed to note that for men aged 55 to 69 years, the decision to undergo PSA screening is an individual one and should be discussed with your doctor. USPSTF continues to recommend against screening for men aged 70 and over.

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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.

Recommendations On Screening For Prostate Cancer With The Prostate

Urine Test Used To Screen For Prostate Cancer

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Prostate cancer is the most commonly diagnosed nonskin cancer in men and the third leading cause of cancer-related death among men in Canada.1 The current estimated lifetime risk of diagnosis is 14.3%, whereas the lifetime risk of death from prostate cancer is 3.6%.2 The prevalence of undiagnosed prostate cancer at autopsy is high and increases with age .3 Most cases of diagnosed prostate cancer have a good prognosis the 10-year estimated relative survival ratio is now 95%, the highest among all cancers in men.1

In Canada, the age-standardized rate of death from prostate cancer rose from 1969 to 1991, followed by a decline of 37.5% from 1992 to 2009, at an average rate of 2.6% per year . In 1990, the estimated age-standardized mortality was 30 cases per 100 000, and in 2010 it was just below 20 per 100 000.1 However, over the same period, the number of cases and the age-standardized incidence of prostate cancer both increased. Subsequent to the introduction and adoption of prostate-specific antigen testing, the incidence of prostate cancer increased rapidly from 1990 to a peak in 1993 and a second, less-pronounced peak in 2001 . Much of the excess incidence represents overdiagnosis,4,5 that is, the detection of cancers that would not progress to cause symptoms or death.6

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What Is Cancer Screening

Cancer is a disease when the cells of the body grow out of control. Cancer screening is having tests to look for signs of cancer before you have any symptoms. By the time cancer causes symptoms, it may have already spread to other parts of your body. A screening test may help find cancer early, when it may be easier to treat.

Cancer screening only tells you whether you might have cancer. It doesn’t diagnose cancer. If a screening test shows signs of cancer, you’ll need to have other tests to find out if you do have cancer and how serious it may be.

Recent Advances Can Help Men With A Worrisome Psa Result Avoid Immediate Biopsy

Prostate-specific antigen blood testing receives high marks as an effective way to monitor disease activity in men diagnosed with prostate cancer. Yet, as a screening tool for prostate cancer, PSA testing is problematic.

PSA naturally tends to increase as men get older, but levels that get too high may suggest prostate cancer. A PSA level of less than 4 nanograms per milliliter is often reassuring, unless there has been a sudden jump from a much lower number. Many doctors consider a total PSA level higher than 10 ng/mL as the threshold for getting a biopsy to check for cancer.

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