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 :
What Is Advanced Prostate Cancer
When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.
Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.
- Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
- Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
- Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.
There are several types of advanced prostate cancer, including:
Biochemical Recurrence
With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.
Castration-Resistant Prostate Cancer
Non-Metastatic Castration-Resistant Prostate Cancer
Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.
Metastatic Prostate Cancer
- Lymph nodes outside the pelvis
- Other organs, such as liver or lungs
Metastatic Hormone-Sensitive Prostate Cancer
Favorite Online Support Networks And Advocacy
PHEN is an organization geared toward African-American men a group that has the nations highest prostate cancer incidence and mortality rates. It offers support groups, survivor networks, and a monthly newsletter that features new treatments and clinical trials. Their annual Fathers Day Rally event takes place at churches nationwide.
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When To Get Tested
You’ll have your first follow-up PSA test 1 to 3 months after your surgery. You need to wait because some PSA stays in your blood after your prostate is removed. If you wait until it has cleared, that will make an accurate result more likely.
Then you’ll have repeat PSA tests once every 6 to 12 months for about 5 years. If your doctor says chances are high that your cancer will come back, you may need them once every 3 months. If your PSA levels stay normal, you can switch to once-a-year PSA tests. Ask your doctor how often you’ll need a test.
Where Does Prostate Cancer Spread
The most common place for prostate cancer to spread to is the bones. It can also spread to the:
A large tumour in the prostate gland can spread into or press on areas around the prostate, such as the back passage or urethra. The urethra is the tube which carries urine from the bladder to the outside of the body.
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How You Might Feel
When prostate cancer is advanced, it can no longer be cured. But treatment can control it for some time and help to relieve symptoms.
Finding out that your cancer cant be cured is distressing and can be a shock. Its common to feel uncertain and anxious. It’s normal not to be able to think about anything else.
Lots of information and support are available to you, your family and your friends. It can help to find out more about your cancer and the treatments you might have. Many people find that knowing more about their situation can make it easier to cope.
Talk to your doctor or nurse to understand:
- what your diagnosis means
Other Reasons For An Elevated Psa Test
In addition to urinary tract infection and prostatitis, there are other reasons that can cause a high PSA level. These include:
- Benign prostatic hyperplasia Benign prostatic hyperplasia, also known as BPH, is enlargement of the prostate caused by aging. An enlarged prostate can produce higher levels of PSA. There are treatments available for BPH.
- Medical procedures A prostate exam or digital rectal exam can result in inflammation of the prostate and increased PSA levels. A urinary catheter or urethral scope can also cause higher PSA levels. For accurate results, wait a few weeks after having a medical procedure done before having a PSA test.
- Age It is normal for PSA levels to gradually trend up with age. If the rise in your PSA level is slow, and consistent with your age, there is likely no concern.
- Cancer An elevated PSA level does not mean you have cancer but most men with prostate cancer do have an elevated PSA level. If you have an elevated PSA level your doctor may perform a digital rectal exam to check for lumps on the prostate. They will also likely order another PSA test to see if your level continues to rise. They may order imaging tests to check for cancer on the prostate. If you are receiving treatment for prostate cancer, your doctor will likely monitor your PSA level to help determine how effective treatment is. If PSA decreases, it can indicate that treatment is effective.
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Are Psa Tests Regularly Done
The UK government has not introduced a prostate cancer screening programme and therefore, no men are currently called in to have their PSA levels measured. Patients with new urinary symptoms like decreased urinary flow, for example, may be advised to have a PSA test once the implications of the test have been discussed. Unfortunately, the PSA test is not always accurate and can lead to further investigations in some men who do not actually have prostate cancer .
Some men, who have no urinary symptoms, may want to undergo a PSA test. This can be because they have become anxious about the possibility that they have prostate cancer and want to get checked out. A PSA test can be performed provided that the patient has had a proper discussion about the pros and cons of the test. NHS England has produced a guidance leaflet for men aged over 50 who are considering a test and have no urinary symptoms.
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Prostate Cancer Surgery Wont Boost Survival In Men With Early
Men with early-stage prostate cancer often face a difficult choice as to treatment: Do they opt for radiation, surgery or watchful waiting to see if the cancer gets worse.
A new study in the New England Journal of Medicine finds men who opt to surgically remove their prostate gland a procedure called a radical prostatectomy are no less likely to die than men who choose wait and monitor their symptoms to see if the cancer progresses.
The study adds to the ongoing debate surrounding prostate-specific antigen testing and whether the tests pick up cancers that may be too slow-growing to ever cause a problem.
In May, the U.S. Preventive Services Task Force, a panel of advisors on government medical guidelines, reviewed existing research and reported in its final recommendation that healthy men of all ages should not take a PSA test because the potential harms from a positive test outweigh the benefits from catching the cancer early.
The study tracked 731 men with early-stage prostate cancer found through PSA testing, average age of 67, who agreed to be randomized to either receive radical prostatectomy or just observation from a doctor between November 1994 through January 2002. The men were followed-up with by January 2010 to see how they fared.
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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
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
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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 screeningexternal icon 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.
Reasons You May Have A Low Psa Level
On the other side of the spectrum, there are also reasons that you may have a low PSA level. Some of those factors include:
-
Certain medications: 5-alpha reduced inhibitors are a type of medication used to treat BPH or urinary symptoms. Long-term use of other medications such as aspirin or statins could also yield lower PSA levels. If you take this type of medication, make sure that your doctor knows before completing a PSA test.
-
Herbal mixtures: Certain supplements may also lower your PSA level. Let your doctor know about any dietary supplements that you take regularly.
You may be wondering why its a bad thing to lower your PSA level through one of the means above. The truth is, a lower PSA level could mean a lower risk of prostate cancer. However, it could also mask a cancer diagnosis. The most accurate PSA level is one that is not influenced by outside factors. This is why your doctor will ask for a thorough list of your medications and any other health information that may influence your result.
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Isopsa More Accurate In Detecting Prostate Cancer Than Psa
Prostate cancer.Creativecommons.org/licenses/by/4.0/ Wikimedia Commons
A study in the April 2017 online European Urology says that IsoPSA may reduce the need for biopsies by up to 50 percent.
However, this was a smalls study and more investigation is needed. But its certainly something to be hopeful about, being that PSA alone results in unnecessary biopsies.
If youre worried about a very high PSA, you should know the symptoms of prostate cancer. In fact, all men should familiarize themselves with these symptoms.
Screening For Prostate Cancer
There are no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer. However, early detection and treatment can significantly improve prostate cancer survival.
The test most commonly used to aid early detection of prostate cancer is the prostate specific antigen blood test. This is not a diagnostic test as it can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.
There are no proven measures to prevent prostate cancer.
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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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The Meaning Of Very Highly Elevated Psa
PSA 1000, is it possible, does it mean the mans death?First you have to confirm the lab result when it is above the normal limits.PSA levels 100+. Often show when Patients have advanced or metastatic prostate cancer.Very high PSA level usually mean strong indicator of multinodular prostate cancer and removal after biopsy.What is the PSA level to remove prostate?Prostate cancer removal depends on the pathological report of a biopsy taken from your prostate gland to decide the extension, shape, volume, and properties of the suspected cancerous cells, PSA are only used to monitor the progress of suspicious cells, then decide a biopsy procedure. However, highly elevated PSA total with low free PSA levels is a strong prostate cancer marker and a result required fast medical decision.Elevated High PSA after prostatectomy?A careful handling of PSA values after prostate removal is must,after prostatectomy you must wait for about six weeks to take a blood PSA test, because PSA levels are commonly show elevated after surgery, but its a false PSA result, however repeating the test after some weeks can declare if its just false or it may a cause of incomplete surgery or dangerous remnants of cancer cell.Now I think you understanding what does a high PSA test mean?Dont miss, What should my PSA level be in my previous interpretation about Normal PSA Levels
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Does Prostate Cancer Have Any Symptoms
Most men with early prostate cancer dont have any signs or symptoms.
One reason for this is the way the cancer grows. Youll usually only get early symptoms if the cancer grows near the tube you urinate through and presses against it, changing the way you urinate . But because prostate cancer usually starts to grow in a different part of the prostate, early prostate cancer doesnt often press on the urethra and cause symptoms.
If you do notice changes in the way you urinate, this is more likely to be a sign of a very common non-cancerous problem called an enlarged prostate, or another health problem. But its still a good idea to get it checked out. Possible changes include:
- difficulty starting to urinate or emptying your bladder
- a weak flow when you urinate
- a feeling that your bladder hasnt emptied properly
- dribbling urine after you finish urinating
- needing to urinate more often than usual, especially at night
- a sudden need to urinate you may sometimes leak urine before you get to the toilet.
If prostate cancer breaks out of the prostate or spreads to other parts of the body , it can cause other symptoms, including:
- back pain, hip pain or pelvis pain
- problems getting or keeping an erection
- unexplained weight loss.
These symptoms can all be caused by other health problems. But its still a good idea to tell your GP about any symptoms so they can find out whats causing them and make sure you get the right treatment, if you need it.