Improving The Accuracy Of Psa
The need for an accurate marker is driven by the fear of unnecessary biopsies on the one hand, and the more danger risk of missing a treatable cancer on the other. Given the scepticism about the utility of aggressive screening programmes, we would certainly appreciate something more accurate than what we have.
There is no consensus on using any of the PSA modifications, and none of them has been shown to reduce the number of unnecessary biopsies or improve clinical outcomes. The total PSA cut-off of 4.0 ng/mL has been the most accepted standard because it balances the trade-off between missing important cancers at a curable stage and avoiding detection of clinically insignificant disease and subjecting men to unnecessary prostate biopsies . Ongoing efforts are targeted at identifying new serum markers that will have greater diagnostic accuracy for prostate cancer, particularly those that can predict aggressive tumours whose treatment will save lives .
Factors Affecting Normal Psa Levels
A number of factors affect the normal PSA levels and should be known before making a decision on what is elevated.
Age-Specific Reference Ranges
In men without prostate cancer, serum PSA reflects the amount of glandular epithelium, which in turn reflects prostate size. Thus as prostate size increases with increasing age, the PSA concentration also rises it increases at a faster rate in elderly men . As a result, different normal reference ranges may be appropriate based upon a mans age. The following ranges have been suggested:
| 40 to 49 years |
Age-specific reference ranges have been proposed as a means of improving specificity and positive predictive value of the serum PSA in screening for prostate cancer. However, it should be recognized that the use of a higher upper range of normal for older men reduces the sensitivity of serum PSA testing for the detection of early prostate cancer, while increasing specificity.
Race-Specific Normal Ranges
Men without cancer from different ethnic and racial groups have different average PSA concentrations. In particular, black men without prostate cancer tend to have higher PSA values than white men without prostate cancer. It has been proposed that the definition of a normal PSA should vary by race using race-specific reference ranges.
Other Effects on Normal Range
Medications
Several classes of medication may affect serum PSA levels:
Random Variation
What Causes An Elevated Psa Level
Prostate cancer is the main cause of an elevated PSA level. But PSA levels increase with age and can reflect different prostate conditions. Other factors that may raise a persons PSA level include:
- Prostate enlargement and inflammation .
- Urinary tract infection.
- Urinary catheter placement.
Your healthcare provider will also consider whether your medications affect PSA levels. For example, 5-alpha reductase blockers treat enlarged prostates and will lower PSA levels.
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How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:
Improving Upon The Psa Test
The limited reliability of the PSA test, and its lack of specificity for prostate cancer, has led to sharp disagreement over the use of the PSA test as a routine health screening measure for men of a certain age. What everyone does agree upon is the need for better markers of prostate cancer. To date there are no perfect biomarkers that identify only high-risk prostate cancer. But each year progress is made toward such a goal. Today, the University of Michigans Department of Pathology MLabs will begin offering the MiPS urine test that is ultra specific for prostate cancer. The MiPS test scans urine samples for two molecular markers that are distinct to prostate cancer. One marker is a snippet of RNA made from a gene that is overactive in 95 percent of all prostate cancers. The second marker is RNA that is made only when two genes abnormally fuse. The presence of this fusion RNA in a mans urine is ultra specific for prostate cancer.
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Is The Psa Test Recommended For Prostate Cancer Screening
Until about 2008, some doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50. Some organizations recommended that men who are at higher risk of prostate cancer, including African-American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45. However, as more was learned about both the benefits and harms of prostate cancer screening, a number of organizations began to caution against routine population screening. Most organizations recommend that men who are considering PSA screening first discuss the risks and benefits with their doctors.
Currently, Medicare provides coverage for an annual PSA test for all Medicare-eligible men age 50 and older. Many private insurers cover PSA screening as well.
Should I Have A Psa Test
If you have no symptoms of prostate cancer and are thinking about having a PSA test, you should ask your doctor about the risks and benefits.
While some studies suggest PSA reduces mortality on a population basis, the test picks up large numbers of cancers that would have caused no symptoms or harm in the patient. This is known as overdiagnosis. Overdiagnosis of prostate cancer can lead to unnecessary treatments that have side effects such as sexual impotence, urinary incontinence and bowel problems.
It is important to balance the potential benefit of detecting a prostate cancer early against the risk that detection and treatment may not be necessary. Treatment may affect your lifestyle but it may also save your life.
Make your own decision about whether to be tested after a discussion with your doctor. Ensure you get good quality information to make an informed decision.
Screening tests for breast, bowel and cervical cancer can save lives, but there is still confusion around PSA testing for prostate cancer. Find more information here.
Remember, if you have any concerns or questions, please contact your doctor.
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A Note On Suspicious Results
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 isn’t 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.
I Have High Psa Levels: How Do I Find Out If I Have Prostate Cancer
Prostate cancer is the most common form of cancer in men. The first test most doctors use to screen for prostate cancer is the PSA test. A high PSA level can indicate the presence of cancer. But other factors besides cancer can cause an elevated PSA level. If your PSA level is rising, learn more about your options for finding out if you have prostate cancer.
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Effectiveness Of Prostate Cancer Screening
In real terms, the efficacy of a screening programme need not necessarily mean it is effective. While efficacy will improve diagnosis, the programme can be considered effective only if it results in improved survival. The thrust, however, continues to be towards improving efficacy, in the hope perhaps that this will 1 day also be effective.
Effect of Lowering PSA Cut-Offs
Some investigators have suggested using a lower PSA cut-off because some men with PSA levels below 4 ng/mL and normal digital rectal examinations were found to have prostate cancer .
In a subset analysis from the placebo arm of the Prostate Cancer Prevention Trial, 449 of 2,950 men ages 62 to 91 years who had consistently normal PSA levels and digital rectal examinations during the 7 years of annual screening had prostate cancer on an end-of-study biopsy 67 had high-grade prostate cancer with a Gleason score of 7 or higher . Among men with a PSA concentration between 2.1 and 4.0 ng/mL, 24.7% had prostate cancer, and 5.2% had prostate cancer with a Gleason score of 7 or higher.
A 2010 meta-analysis summarized results from six randomized trials , with a total of 387,286 participants . Screening with PSA with or without DRE compared to no screening did not reduce death from prostate cancer . However, screening significantly increased the probability of cancer diagnosis . Similar results were echoed in findings of the SEER group .
Psa Test: The Current Prostate Screening Standard
Before recommending when you should be screened for prostate cancer, yourdoctor will consider many factors, such as:
- Age
- Family history, particularly whether any of your family members have had prostate cancer
- Race, as African-American men have a higher risk of developing prostate cancer
If your doctor determines you should undergo screening, he or she will mostlikely recommend the PSA test. For more than 30 years, the PSA test hasbeen the gold standard in prostate cancer screening. This simple blood testmeasures how much prostate-specific antigen is in your blood.
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Both Tests Are Better Than One
Using these tests together is better than using either test alone. PSA testing together with a DRE may help find a dangerous cancer early when it is easier to treat.
Follow-up tests
If a problem is found, more tests will be done to find out whether you have prostate cancer or another health problem. Further tests can include:
- a follow-up PSA test
- a transrectal ultrasound a test that uses sound waves to make a picture of the rectum and nearby organs, including the prostate
- a biopsy of the prostate tissue samples of the prostate are looked at under a microscope
Simple Blood Test Can Diagnose Lung Other Cancers
- Date:
- American Society of Anesthesiologists
- Summary:
- Early-stage lung and prostate cancers, as well as their recurrence, can be detected with a simple blood test, according to a study. Serum-free fatty acids and their metabolites may be used as screening biomarkers to help diagnose early stages of cancer, as well as identify the probability of recovery and recurrence after tumor removal, researchers found.
Early-stage lung and prostate cancers as well as their recurrence can be detected with a simple blood test, according to a study presented at the ANESTHESIOLOGY 2013 annual meeting. Serum-free fatty acids and their metabolites may be used as screening biomarkers to help diagnose early stages of cancer, as well as identify the probability of recovery and recurrence after tumor removal, researchers found.
“While cancer is the second-leading cause of death worldwide, diagnosis at the early stages of cancer remains challenging,” said Jinbo Liu, M.D., M.S., researcher at Cleveland Clinic, and lead study author. “In this study, we identified compounds that appear to be new screening biomarkers in cancer diagnosis and prognosis.”
The study looked at blood samples from 55 patients with lung cancer and 40 patients with prostate cancer and compared them to blood samples of people without cancer. In a second phase of the study, blood was examined preoperatively from 24 patients scheduled for curative lung cancer surgery and again at six and 24 hours after the surgery.
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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.
Using The Psa Blood Test After Prostate Cancer Diagnosis
Although the PSA test is used mainly to check for prostate cancer, it can also help your doctor:
- Choose a treatment. Along with an exam and tumor stage, the PSA test can help determine how advanced a prostate cancer is. This may affect treatment options.
- Check treatment success. After surgery or radiation, the doctor can watch your PSA level to see if the treatment worked. PSA levels normally fall if all of the cancer cells were removed or destroyed. A rising PSA level can mean that prostate cancer cells are present and your cancer has returned.
If you choose a watchful waiting approach to treatment, your PSA level can tell your doctor if the disease is progressing. If so, youâll need to think about active treatment.
During hormone therapy, the PSA level can show how well the treatment is working and when itâs time to try another treatment.
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What Is A Psa Test
The PSA test is the leading method of screening for prostate cancer. PSA screening can help catch the disease at an early stage when treatment may be more effective and potentially have fewer side effects. The PSA test may be done along with a digital rectal exam , in which a physician inserts a gloved finger into the rectum to examine the prostate for irregularities.
What Happens If My Psa Level Is Elevated
If you have a high PSA level, you will need ongoing PSA tests and DREs so your provider can look for any changes. If the PSA level continues to increase or if your healthcare provider finds a lump during a DRE, you may need other tests, including:
- Transrectal ultrasound and prostate biopsies.
- Prostate MRI.
- Iso PSA or 4Kscore® .
A biopsy can tell you definitively if you have prostate cancer. The biopsy results also affect your treatment. For example, if the biopsy shows a lot of cancer cells, you might need more aggressive treatment.
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What Are The Prostate Cancer Symptoms I Need To Look Out For
In its early stages, prostate cancer may not show any symptoms. Symptoms of early prostate cancer can include:
- difficulty passing urine
- a slow, interrupted flow of urine
- frequent passing of urine, including at night
- incontinence.
Symptoms associated with advanced prostate cancer include:
- blood in urine
- pain during urination
- lower back or pelvic pain.
These symptoms are also found in men who may have benign prostatic hyperplasia , a common, non-cancerous enlargement of the prostate gland.
If you experience these symptoms, visit your doctor.
When Is A Psa Test Needed
If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.
Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.
- You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
- Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
- If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
04/2014
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Frequency Of Psa Testing
The optimal frequency of PSA testing is unclear. Some authors suggest measuring PSA every 6 months for the first 2 years after treatment, and then annually . Others recommend modifying the surveillance schedule according to pathologic grade and stage of disease, with decreasing frequency for low-risk disease and increasing elapsed interval following original treatment , although the majority do not adhere to this principle .
Information Is A Powerful Weapon Against Uncertainty And Fear And You Can Use This To Your Advantage
A diagnosis of lung cancer naturally causes some overwhelming emotions, but you don’t have to let those emotions get the best of you. Although the percentage of cases in men is much lower than in women, male breast cancer accounts for a por. Prostate cancer is one of the most common types of cancer diagnosed in men. Information is a powerful weapon against uncertainty and fear, and you can use this to your advantage. However, as with other types of cancer,. One in seven men in the united states will receive a prostate cancer diagnosis during his lifetime. Breast cancer is the second most common cancer found in women after skin cancer but that doesn’t mean men aren’t at risk as well. The earlier the detection of prostate cancer, the better the patient’s chance of survival is. If breast cancer is diagnosed at an early enough stage, it’s treatable. A cancer diagnosis can leave you unable to comprehend anything else your doctor says, but it’s important to pay attention to what stage of cancer you have. If you have been diagnosed with adenocarcinoma cancer, you have a cancer that developed in one of the glands that lines the inside of your organs. There are a number of different treatments doctors recommend. Being armed with information is vital to begin the fight.
Although the percentage of cases in men is much lower than in women, male breast cancer accounts for a por.
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