What If My Biopsy Results Are Negative
A negative biopsy does not definitively exclude the presence of cancer. After a negative result, you will have a PSA test every three to six months. If the PSA remains elevated, the physician will recommend a second biopsy.
The closer you follow the patients with negative biopsies, the less likely you are to miss a clinically significant cancer.Dr. Herb Ruckle
For a second biopsy, MRI imaging is typically performed. An MRI-guided prostate biopsy uses advanced, more accurate imaging to take a biopsy and detect a cancer missed in the first ultrasound-guided biopsy. If this second biopsy comes back as negative, the physician will continue to keep a close eye on your PSA levels with the variety of tests, and you may need to undergo additional biopsies. The closer you follow the patients with negative biopsies, the less likely you are to miss a clinically significant cancer, Ruckle says.
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.
What Should My Free Psa Level Be
Free PSA is the form of prostate specific antigen that is produced by benign cells of prostate gland, finding 10% of total PSA as Free is acceptable for healthy men. The lower the riskier.Benign prostate tumors normally show Free PSA percentage higher than 10%.Carcinogen cells reducing free PSA percentage to less than 10% and raise the values of total PSA due to the increasing of complexed PSA by cancer cells, from PSA blood test explainedLow PSA level, what does it mean?The normal PSA level is 0 but it can rise to up 4 with infection or other minor issues.A PSA of 0.6 is good and would not normally need further blood tests.PSA 1.0 is lower than men limit of PSA but is still not a cancer marker.If you have prostate cancer already and have had treatment, then 0.5, 1.0, or 2.0 is still nothing serious to worry about.The same is applied for PSA 2.0 or 3.0: means youre a cancer free or have your treatment course succeeded and lowered the PSA percentage.A problem with prostate production of prostate specific antigen can lead to very low PSA level.Diminished free PSA with normal PSA total is not fully understood.
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When Should I Have My Psa Levels Tested
The first thing to do is talk to your doctor about the pros and cons of prostate cancer screening before you decide whether to be tested. Donât get tested until you have that talk. Opinions differ about when you should do that.
The American Cancer Society says to get tested at age:
- 40 or 45 if youâre at high risk
- 50 if youâre at average risk
The American Urological Association suggests:
- Under 40: No screening
- 40 to 54: No screening if youâre at average risk. If youâre at a high risk, you and your doctor can decide.
- 55 to 69: Screening if your doctor suggests
- Over 70 or less than a 10-15 year life expectancy: No screening
The U.S. Preventive Services Task Force says:
- 55 to 69: Men with prostate cancer risks may need testing.
If your doctor thinks you might have prostate cancer based on either a PSA level or a rectal exam, a biopsy is the next step. This is a test where the doctor takes a small amount of tissue from your prostate and sends it to a lab for tests. Itâs the only way to be sure you have cancer.
Who Should Have Regular Screening Tests For High Psa
The PSA test was first developed to observe prostate changes in men who had a history of prostate cancer. Then it became more widely used in the general population as a way to detect and prevent prostate cancer before symptoms developed. But routine screening can find prostate cancers that grow slowly and do not need treatment. Talk to your healthcare provider to see if you should have regular PSA tests.
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During Watchful Waiting Or Active Surveillance
If you choose observation or active surveillance, your PSA level will be monitored closely to help decide if the cancer is growing and if treatment should be considered.
Your doctor will watch your PSA level and how quickly it is rising. Not all doctors agree on exactly what PSA level might require further action . Again, talk to your doctor so you understand what change in your PSA might be considered cause for concern.
What Is Prostate Cancer
Prostate cancer develops when abnormal cells in the prostate gland grow in an uncontrolled way, forming a malignant tumour.
Prostate cancer is the second most common cancer diagnosed in men in Australia and the third most common cause of cancer death. It is estimated that 18,110 new cases of prostate cancer will be diagnosed in Australia in 2021. One in 6 men will be diagnosed with prostate cancer by the age of 85. It is more common in older men, with over 63% of cases diagnosed in men over 65 years of age.
Early prostate cancer refers to cancer cells that have grown but do not appear to have spread beyond the prostate.
There are two stages of advanced prostate cancer:
- locally advanced prostate cancer where the cancer has spread outside the prostate to nearby parts of the body or glands close to the prostate
- metastatic prostate cancer where the cancer has spread to distant parts of the body.
The five year survival rate for prostate cancer is 95%.
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Psa & Prostate Cancer Screening: Some Issues
Prostate cancer screening has been a controversial issue because decisions were made about adopting PSA testing in the absence of efficacy data from randomized trials. Subsequently, the European Randomized Study of Screening for Prostate Cancer reported a small absolute survival benefit with PSA screening after 9 years of follow-up however, 1,410 men needed to be screened and 48 additional patients would need to be diagnosed with prostate cancer to prevent one prostate cancer death. Although the report did not address quality of life outcomes, considerable data show the potential harms from aggressive treatments, including erectile dysfunction, urinary incontinence, and bowel problems .
What Is Considered An Elevated Prostate
Researchers havent settled on a single normal PSA level. Previously, a level of 4.0 ng/mL or higher would lead to more testing, usually a prostate biopsy. During the biopsy, a healthcare provider removes a small sample of prostate tissue to check it for cancer.
However, healthcare providers now consider other issues together with the PSA level to decide whether to perform a biopsy. Your age, general health, family history and health history factor into the decision.
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Experts In Urology Care
If you are experiencing symptoms consistent with urinary issues, we urge you to complete our urologic cancer risk assessment form.
Not everyone should get a PSA test. Why? Because many men in this country are treated for low-risk prostate cancer that is discovered through the PSA test, even when it is unlikely that the disease will ever cause symptoms or lead to death. And treatment is associated with significant side effects, including impotence and incontinence . So a PSA test is recommended only for men who might be at greater risk for dying of prostate cancer for example, younger men with a family history of prostate cancer or African-American men.
To avoid the risks of over-treatment, Roswell Park follows the guidelines established by the National Comprehensive Cancer Network . The NCCN brings together world-renowned experts from 30 of the nations top cancer centers to write guidelines that specify the best ways of preventing, detecting and treating cancer. The guidelines are updated at least every year, on the basis of the latest research.
Michael Kuettel, MD, PhD, MBA, Chair of Roswell Parkâs Department of Radiation Medicine, serves on the NCCN Prostate Cancer Panel.
The NCCN recommends that only men in these categories receive a PSA test for early detection of prostate cancer:
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Does My Psa Level Determine Whether I Have Prostate Cancer
Your provider looks at two factors related to your PSA:
- Your PSA level: A higher level means a higher risk of prostate cancer.
- A continuous rise: PSA levels that continue to rise after two or more tests may mean you have cancer.
But the PSA level alone doesnt determine if you have cancer or not. Two men can even have the same PSA levels but different risks of prostate cancer. And a high PSA level may reflect prostate problems that arent cancer.
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High Psa Levels From A Urinary Tract Infection
“Any infection near the prostate gland, including a urinary tract infection, can irritate and inflame prostate cells and cause PSA to go up,” says Milner.
If youve been diagnosed with a urinary tract infection, be sure to wait until after the infection has cleared up before you get a PSA test. In men, most urinary tract infections are caused by bacteria and respond well to antibiotics.
Having BPH increases your risk for a urinary tract infection.
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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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.
Cell Cycle Inhibitor P27
The cell cycle inhibitor p27 is a putative tumor suppressor gene. Loss of p27 is associated with a poor prognosis in patients with breast, colorectal, and prostate carcinoma. In men treated with radical prostatectomy, loss of p27 expression correlates with an increased probability of cancer recurrence and lower survival rates. Decreased p27 expression also is associated with high-grade cancer cells, positive surgical margins, seminal vesicle invasion, and lymph node metastases.
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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 a mans 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 men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the use of the PSA test in conjunction with a digital rectal exam to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing to help doctors determine the nature of the problem.
In addition to prostate cancer, a number of benign conditions can cause a mans PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis and benign prostatic hyperplasia . There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
What If A Screening Test Shows An Elevated Psa Level
If a man who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to have an elevated PSA level, the doctor may recommend another PSA test to confirm the original finding. If the PSA level is still high, the doctor may recommend that the man continue with PSA tests and DREs at regular intervals to watch for any changes over time.
If a mans PSA level continues to rise or if a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. A urine test may be recommended to check for a urinary tract infection. The doctor may also recommend imaging tests, such as a transrectal ultrasound, x-rays, or cystoscopy.
If prostate cancer is suspected, the doctor will recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. Most often, the needles are inserted through the wall of the rectum . A pathologist then examines the collected tissue under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to diagnose prostate cancer.
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My Psa Is Elevated What Could It Mean
First, realize that having an elevated PSA does not necessarily mean you have cancer in your prostate. Other causes for an elevated PSA include:
- infection, instrumentation of the urinary tract, disruption, trauma, or manipulation of the prostate
- certain conditions like prostatitis or enlarged prostate
You and your doctor will work together to identify any of these possible contributing factors to your higher PSA through measures like checking for urine infection, reviewing for history of instrumentation, inflammation and discussing family health history. You and your doctor may identify such a cause, address it with treatment, and re-test PSA to see whether the level has appropriately decreased.
If you and your doctor do not rule out any other causes, you will likely need to undergo another PSA test and a digital rectal exam. During this exam, a physician inserts a lubricated, gloved finger into the rectum to reach the prostate and feel for any lumps or hard areas. Continued abnormal results from the PSA test or rectal exam call for further investigation to identify clinically significant prostate cancer.
What Is Biopsy And How Is It Done
Once we find an abnormal area in the prostate on ultrasound, we need to remove small pieces of prostate for pathological examination called prostate biopsy.
While the ultrasound probe is in the rectum, a biopsy needle is inserted through the probe and under the ultrasound guidance, biopsies are performed. Six to twelve tine pieces of tissue are taken from the prostate. These pieces of prostate tissue are then sent to a Laboratory where a pathologist who is an expert in prostate cancer examined these pieces under the microscope to determine.
- Whether cancer is present
- Evaluate microscopic features of cancer
- Whether suspicious lesions are present
- Or the biopsy is negative for cancer
- Whether inflammation is present
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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
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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Interpretation Provides Information To Assist In Interpretation Of The Test Results
When total prostate-specific antigen concentration is below 2.0 ng/mL, the probability of prostate cancer in asymptomatic men is low, further testing and free PSA may provide little additional information. When total PSA concentration is above 10.0 ng/mL, the probability of cancer is high and prostate biopsy is generally recommended.
The total PSA range of 4.0 to 10.0 ng/mL has been described as a diagnostic âgray zone,â in which the free:total PSA ratio helps to determine the relative risk of prostate cancer . Therefore, some urologists recommend using the free:total ratio to help select which men should undergo biopsy. However, even a negative result of prostate biopsy does not rule-out prostate cancer. Up to 20% of men with negative biopsy results have subsequently been found to have cancer.
Based on free:total PSA ratio: the percent probability of finding prostate cancer on a needle biopsy by age in years:
Free:total PSA ratio