Prostate Cancer Screening: Biopsy Vs Pet Scans
While most men know about first-line prostate cancer screenings like PSA blood tests and physical exams, they are less likely to know their options when their doctors suspect a problem.
To help clear up any confusion and arm you with knowledge, the experts at the CyberKnife Center of Miami have compiled a list of options so you know your options and can ask your doctor.
What Is A Normal Psa Test Result
There is no specific normal or abnormal level of PSA in the blood. In the past, PSA levels of 4.0 ng/mL and lower were considered normal. However, some individuals with PSA levels below 4.0 ng/mL have prostate cancer and many with higher PSA levels between 4 and 10 ng/mL do not have prostate cancer .
In addition, various factors can cause someones PSA level to fluctuate. For example, the PSA level tends to increase with age, prostate gland size, and inflammation or infection. A recent prostate biopsy will also increase the PSA level, as can ejaculation or vigorous exercise in the 2 days before testing. Conversely, some drugsincluding finasteride and dutasteride, which are used to treat BPHlower the PSA level.
In general, however, the higher a mans PSA level, the more likely it is that he has prostate cancer.
Genetic Testing For Some Men With Prostate Cancer
Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.
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Does The Prostate Swell After A Biopsy
When it comes to inflammatory responses, people differ. No matter how small, any trauma will cause local inflammation, and the prostate will swell a bit. However, in some individuals, this swelling may be more than in others.
This swelling of the prostate can make urinating difficult for individuals. Generally, this swelling would not last long. Nonetheless, your healthcare provider would recommend urinating before the procedure.
For most people, the swelling would last for a few hours. However, if it lasts longer, it may cause urinary retention or a problem peeing. In such instances, doctors may need to insert a catheter.
Dealing With Bph Since 2003
Based on the experience of 2003, I will never again have a prostate biopsy. Since having my left cancerous kidney removed in April of 2015, the condition of my prostate has been monitored by more PSA tests and semi-annual prostate sonograms. My new urologist has me on the drug Avodart containing dutasteride to help shrink the prostate and another, Harnal containing tamsulosin hydrochloride, which makes it easier for me to urinate during the night.
This content is accurate and true to the best of the authorÃ¢s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
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What Is A Trus Biopsy
This is the most common type of biopsy in the UK. The doctor or nurse uses a thin needle to take small samples of tissue from the prostate.
Youll lie on your side on an examination table, with your knees brought up towards your chest. The doctor or nurse will put an ultrasound probe into your back passage , using a gel to make it more comfortable. The ultrasound probe scans the prostate and an image appears on a screen. The doctor or nurse uses this image to guide where they take the cells from. If youve had an MRI scan, the doctor or nurse may use the images to decide which areas of the prostate to take biopsy samples from.
You will have an injection of local anaesthetic to numb the area around your prostate and reduce any discomfort. The doctor or nurse then puts a needle next to the probe in your back passage and inserts it through the wall of the back passage into the prostate. They usually take 10 to 12 small pieces of tissue from different areas of the prostate. But, if the doctor is using the images from your MRI scan to guide the needle, they may take fewer samples.
The biopsy takes 5 to 10 minutes. After your biopsy, your doctor may ask you to wait until you’ve urinated before you go home. This is because the biopsy can cause the prostate to swell, so they’ll want to make sure you can urinate properly before you leave.
What Does A Prostate Biopsy Involve
If you decide to have a biopsy, youll either be given an appointment to come back to the hospital at a later date or offered the biopsy straight away.
Before the biopsy you should tell your doctor or nurse if youre taking any medicines, particularly antibiotics or medicines that thin the blood.
You may be given some antibiotics to take before your biopsy, either as tablets or an injection, to help prevent infection. You might also be given some antibiotic tablets to take at home after your biopsy. Its important to take them all so that they work properly.
A doctor, nurse or radiologist will do the biopsy. There are two main types of biopsy:
- a trans-rectal ultrasound guided biopsy, where the needle goes through the wall of the back passage
- a transperineal biopsy, where the needle goes through the skin between the testicles and the back passage .
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Medical History And Physical Exam
If your doctor suspects you might have prostate cancer, you will be asked about symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors, including your family history.
Your doctor will also examine you. This might include a digital rectal exam , during which the doctor inserts a gloved, lubricated finger into your rectum to feel for any bumps or hard areas on the prostate that might be cancer. If you do have cancer, the DRE can sometimes help tell if its only on one side of the prostate, if its on both sides, or if its likely to have spread beyond the prostate to nearby tissues. Your doctor may also examine other areas of your body.
After the exam, your doctor might then order some tests.
Prostate Biopsy: How It Works
The instrument used to perform most prostate biopsies today is a spring-loaded device that pokes a hollow needle through the rectal wall to collect small samples of prostate tissue, guided by an ultrasound or MRI.
The samples are quite smalljust several times the diameter of the lead in a mechanical pencil. Later, a pathologist checks the samples under a microscope for signs of cancer.
Prostate biopsy comes with certain risks. For example, when the biopsy needle passes through the rectal wall to reach the prostate, it can spread a bacterial infection to the prostate gland or bloodstream.
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Transrectal Ultrasound Scan Guided Biopsy
Your doctor takes a series of small tissue samples from the prostate to examine under a microscope. You have the biopsy through the back passage using a transrectal ultrasound scanner.
A TRUS guided biopsy can be uncomfortable. You usually have a local anaesthetic to numb the area and reduce any pain.
What Does My Prostate Do
The prostate is beneath the bladder and in front of the rectum. Itâs a walnut-shaped gland that surrounds part of the urethra. . Hereâs what it does:
- It produces fluid for semen, which includes sperm produced in the testicles.
- It prevents urine from being included during ejaculation.
If it gets too big, your prostate can block pee from passing through the urethra and out the penis.
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Evidence Synthesis And Recommendations Development
In order to develop these recommendations, the following questions related to prostate cancer screening and diagnosis were defined, a priori, to guide the specific literature searches and evidence synthesis:
What Is Prostate Cancer Screening
The diagnosis of prostate cancer usually follows a biopsy prompted by a significantly elevated initial PSA level, an increase in PSA levels over time, or an abnormal digital rectal examination.
According to JAMA, patients with a prostate cancer history benefit from extended PSA monitoring. Elevated PSA levels may help determine when to go in for a prostate MRI and hopefully avoid unnecessary or repeat prostate biopsies.
The American Journal of Mens Health reports that prostate cancer diagnosis occurs most often in men older than 50.
Other factors influencing the rate of prostate cancer are ethnicity and family history. Screening is vital because localized prostate cancer sometimes causes no symptoms or warning signs.
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What Is A Prostate Biopsy
The prostate gland is found only in males. It sits below the bladder andwraps around the urethra . Theprostate helps make semen.
A biopsy is a procedure used to remove a small piece of tissue or cellsfrom the body so it can be examined under a microscope.
In a prostate biopsy, prostate gland tissue is taken out with a biopsyneedle or during surgery. The tissue is checked to see if there are canceror other abnormal cells in the prostate gland.
A prostate biopsy may be done in several different ways:
Transrectal method. This is done through the rectum and is the most common.
Perineal method. This is done through the skin between the scrotum and the rectum.
Transurethral method. This is done through the urethra using a cystoscope .
Ultrasound is usually used to look at the prostate gland and guide thebiopsy needle.
Does A Prostate Biopsy Damage The Prostate
Many people want to know, does a prostate biopsy damage the prostate? During a prostate biopsy, doctors use needles to take a sample of tissues for examination and prostate cancer diagnosis. Though they take most precautions when taking biopsy samples, nonetheless the procedure is invasive.
Moreover, a needle is introduced through the bowel wall to the prostate. It means that the prostate is not only traumatized due to needles. In addition, there is always a risk of some pathogens entering the prostate gland.
Transrectal prostate biopsy does cause some damage to the prostate. Fortunately, this damage is relatively small.
Generally, there would be healing in a week after the procedure. It is rare to cause long-term issues.
What Is Multiparametric
An MpMRI or multi-parametric magnetic resonance imaging uses innovative technology to create a more detailed 3D image of your prostate than a standard 2D MRI scan. AI software combines different kinds of images to help with detecting prostate cancer.
- T2-weighted images reveal prostate zones and suspected tumors and can be used to rule out insignificant cancers.
- Diffusion-weighted images show areas where there is a build-up of fluid because of restricted flow.
- Dynamic contrast-enhanced MRI scans reveal a jumble of new blood vessels that feed cancer growth.
Traditionally, insurance companies require a biopsy before an MRI, even though a biopsy has more risks. However, at ezra, you can schedule an MRI of the prostate and 12 other organs any time.
What Is The Psa Test
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in the blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.
The blood level of PSA is often elevated in people with prostate cancer, and the PSA test was originally approved by the FDA in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the PSA test to be used in conjunction with a digital rectal exam to aid in the detection of prostate cancer in men 50 years and older. Until about 2008, many doctors and professional organizations had encouraged yearly PSA screening for prostate cancer beginning at age 50.
PSA testing is also often used by health care providers for individuals who report prostate symptoms to help determine the nature of the problem.
In addition to prostate cancer, several benign conditions can cause a persons PSA level to rise, particularly prostatitis and benign prostatic hyperplasia . There is no evidence that either condition leads to prostate cancer, but someone can have one or both of these conditions and develop prostate cancer as well.
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What To Expect During The Exam
You can get a prostate exam easily and quickly at your doctors office. Generally, for cancer screenings, your doctor will take a simple blood test.
Your doctor might also choose to perform a DRE. Before performing this exam, your doctor will ask you to change into a gown, removing your clothing from the waist down.
During a DRE, your doctor will ask you to bend over at the waist or lie on the exam table in a fetal position, with your knees to your chest. They will then insert a gloved, lubricated finger into your rectum.
Your doctor will feel for anything abnormal, such as bumps or hard or soft areas that might indicate a problem. Your doctor may also be able to feel if your prostate is enlarged.
A digital rectal exam can be uncomfortable, especially if you have hemorrhoids, but isnt overly painful. It will last only a couple of minutes.
A DRE is one of your doctors tools that can help them detect several prostate and rectal problems, including:
- prostate cancer
Your doctor will be able to tell immediately if there are any areas of concern that may warrant further testing.
The results of a DRE exam are either normal or abnormal, but doctors typically rely on several different tests to help them make a prostate cancer diagnosis.
If your doctor feels something abnormal during the DRE, they will probably recommend getting a PSA blood test, if you havent done so already.
- transrectal ultrasound
Use In Men Already Diagnosed With Prostate Cancer
The PSA test can also be useful if you have already been diagnosed with prostate cancer.
- In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
- The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
- PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .
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Interpretation Of The Evidence
A major difference in interpretation of the evidence is whether or not the ERSPC and PLCO should be considered equally relevant with respect to the benefits of screening. The trials tested two different hypotheses as noted above screening versus no or little screening in the ERSPC and organized versus opportunistic screening in the PLCO. The latter interpretation of the PLCO trial is in line with statements in the PLCO publications.19,21 A modest effect of PSA screening versus none implies that a substantially larger study than PLCO is needed to meaningfully test more versus less frequent screening. Thus the PLCO was underpowered to address the question of organized versus opportunistic screening. The Panel interprets the randomized evidence to indicate that the ERSPC trial reflects the effect of PSA screening in a situation with low background screening.
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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What Have Randomized Trials Of Prostate Cancer Screening Found
Several large, randomized trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and digital rectal exam were evaluated for their ability to decrease a mans chances of dying from prostate cancer.
The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but had about the same rate of deaths from the disease . Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment.
A second large trial, the European Randomized Study of Screening for Prostate Cancer , compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer .
The United States Preventive Services Task Force has estimated that, for every 1,000 men ages 55 to 69 years who are screened for 13 years :