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.
Us Studies On Phi In Prostate Cancer Screening
In 2011, Catalona and colleagues published the results of a large multicenter trial of PHI for prostate cancer detection in 892 men with total PSA levels from 2 to 10 ng/ml and normal digital rectal examination who were undergoing prostate biopsy . The mean PHI scores were 34 and 49 for men with negative and positive biopsies, respectively. Setting the sensitivity at 8095%, PHI had greater specificity for distinguishing prostate cancer on biopsy compared with PSA or percentage free PSA . On receiver operating characteristic analysis, PHI had an area under the curve of 0.70, compared with 0.65 for %fPSA and 0.53 for PSA. Although the PHI test has been approved by the US Food and Drug Administration only in the 4 -10 ng/ml PSA range, this study showed that PHI performed well in the 2-10 ng/ml PSA range. .
Since the aforementioned results came from a large multicenter trial, it is important to note that PHI has also been examined in a grassroots population with consistent findings. Specifically, Le and colleagues compared PHI with to its individual components in men undergoing a prostate biopsy with PSA levels from 2.5 to 10 ng/ml and negative DRE from a prospective screening population of 2034 men . On ROC analysis, PHI had the highest AUC compared with p2PSA , %fPSA and PSA for prostate cancer detection.
How To Prepare For A Prostate Ultrasound
Ultrasound imaging of prostate tissue is a relatively simple procedure. Still, men should know how they can best prepare for the entire process. This helps to make the man more comfortable while they are undergoing the procedure.
There are not too many steps that a man can take to prepare for the procedure. There are, however, a few things that a man can do to make the entire procedure less inconvenient for themselves.
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Changing Standard Of Care
Will a Prostate MRI eventually become the standard of care? Dr. Walker thinks so. Across the country and in the minds of urologists, he says the Prostate MRI is becoming essential for the management of patients at risk of prostate cancer.
Now I think a lot of docs are becoming more comfortable using the MRI ahead of time to get a little bit more accurate biopsy. And more patients actually know about the MRI technology and even ask about it. -Dr. Todd Brandt of Metro Urology
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.
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Discuss Prostate Cancer Testing With Your Doctor
Medical authorities do not recommend that all men should be tested for prostate cancer. In fact, most authorities suggest that men should make their own choice about whether or not to have a PSA test. If you decide to be tested, it is recommended that it should be done every two years from 50 to 69 years of age, and only if your health is such that you expect to live for at least another seven years.
Men at high risk of prostate cancer, such as men with a family history of prostate cancer , or men who have previously had an elevated test result, can start two-yearly testing from age 45. Your doctor can help you decide whether this is necessary.
While there is now some evidence that regular testing may prevent prostate cancer deaths, there are concerns that many men may be diagnosed and treated unnecessarily as a result of being screened, with a high cost to their health and quality of life .
However, the option of active surveillance, where a low-risk cancer is watched closely instead of being treated, helps to lower these risks. Active surveillance is now used quite commonly in Australia for men with low-risk prostate cancer.
If you are unsure whether or not to be tested after considering the benefits and uncertainties of testing and your own risk of prostate cancer, discuss it with your doctor.
In Australia, if you choose to be tested for prostate cancer the tests are covered by Medicare.
Do I Need The Psa Test
The PSA test is not recommended for men who dont have symptoms of prostate cancer, as it can lead to unnecessary investigations and treatments that have serious side effects.
If you are at higher risk of developing prostate cancer, or if you have symptoms that may indicate cancer, PSA testing may be of more benefit.
Cancer Council Australia and the Royal Australian College of General Practitioners both recommend against routine screening in men without symptoms. That is because the PSA test is not very accurate for screening men without symptoms. High PSA levels can be due to many things, and cancer is just one of them. And a man with prostate cancer can have a normal PSA level.
As there is a range of risks and potential benefits of PSA testing, talk to your doctor to help make an informed decision.
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Will The Mri Be Done With An Endorectal Coil Or An External Pelvic Coil
Some radiology practices use an endorectal coil a probe-like device covered with latex which is inserted into the rectum and helps provide high-quality images of the prostate. With a newer, high-quality MRI system, endorectal coils are not necessary and an external pelvic coil can be used instead, eliminating patient discomfort while maintaining high quality images.
How Accurate Are Prostate Cancer Tests
Prostate cancer testing is heavily reliant on measuring prostate specific antigen levels, which can give notoriously high false-positive results. But why is this and how can doctors diagnose the disease more accurately?
Reviewed byDr Sarah Jarvis MBE
24-Sep-19·6 mins read
Prostate cancer is one of the most common cancers in the UK, affecting one in eight men at some point in their lives. While survival rates are good overall , it’s really important for men to understand their risk.
The disease mostly affects men over 50, with the most common age at diagnosis being 65-69. It is twice as common in men of black ethnicity, and two and a half times as common in men with a family history of prostate cancer. Usually asymptomatic at the earliest, localised stage, it may eventually lead to urinary symptoms such as difficulty emptying your bladder, or needing to pee more than usual. If it has spread beyond the prostate, you may notice blood in the urine or semen, hip or pelvis pain, or unexplained weight loss.
It goes without saying that, if you do notice any changes of this kind, it’s essential to visit the GP. No one symptom is really a giveaway for prostate cancer – they can all be caused by other health problems, most commonly non-cancerous prostate gland enlargement – so it may be necessary to run some diagnostic tests. Typically, the GP would start by offering you a PSA test.
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What Other Screening Tests Are Used To Detect Prostate Cancer
Because a biopsy is an invasive procedure, your doctor may first use one or more of the following methods to screen for prostate cancer:
Medical history
When your doctor takes a detailed medical history, they may ask you about your symptoms, underlying health conditions and whether you consume alcohol or tobacco in any form. Your doctor may also ask you whether any of your close family members such as a father, uncle or brother were diagnosed with prostate cancer at a young age . You may also be asked other questions such as whether you have experienced weight loss or a change in sex drive.
Digital rectal examination
A thorough physical examination will also allow your doctor to assess your general health by looking for any signs of disease.
Your doctor may order a digital rectal examination . During a DRE, your doctor will insert a gloved, lubricated finger into your rectum and try to feel for any lumps, irregularities or hard areas on the prostate that could suggest cancer. This examination will also provide clues as to whether the cancer is in one or both sides of the prostate and whether it has spread to the nearby structures.
Prostate-specific antigen blood test
Your doctor may order blood tests to look for blood counts or inflammatory markers . One blood test may measure the levels of a type of protein called PSA, which is made by both normal and cancerous cells in the prostate.
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.
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If You Are Transgender
If you are a trans man you do not have a prostate and do not need a PSA test.
Trans women and non-binary people assigned male at birth still have a prostate gland, whether they have had genital gender-affirming surgery or not. This means they may still get prostate cancer, although there is not enough evidence to know how common this is.
If you are a trans woman or non-binary person assigned male at birth and would like to have the PSA test, talk to your GP.
You may worry about talking to your doctor or practice nurse about this, but they are used to talking about many different needs. If you find it difficult to start the conversation, you could try showing them this information. You should talk about any worrying symptoms or concerns with your GP or nurse.
Prostate cancer UK have detailed information about trans women and prostate cancer.
The LGBT Foundation can also give you confidential advice and support. You can also talk to one of our cancer support specialists.
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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Medical History And Physical Exam
If your doctor suspects you might have prostate cancer, he or she will ask you about any 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.
The Best Prostate Cancer Screening And Detection Tool Is The 3t Mri
To date, the newer versions of the 3T MRI are the most reliable devices for screening and detecting the 15% or so of potentially deadly high-grade prostate cancers. Unlike the current standard screening and detection methods, the 3T MRI evaluates the WHOLE of the prostate, can ignore the bogus G6 cancer and, based upon imaging details in a properly conducted study, able to identify reliably with PIRADS 4 and 5 features, almost all high-grade cancer anywhere within the prostate. Any high-grade areas identified can then be targeted for needle biopsy under real-time 3T MRI for confirmation of disease as only these particular prostate cancers demand detection and treatment. However, because imaging studies are highly insensitive and, high-grade cells can reside in the bone marrow for many years undetected, treatment of some apparently localized high-grade prostate cancers can lead to a semblance of cure, especially when only followed for a few years.Joe Busch MD, prostate MRI specialist, Chattanooga, Tennessee www.drcradiology.com/
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How Do I Prepare For A Prostate Ultrasound
Some possible instructions that your doctor might give you before the test include:
- Dont eat for a few hours before the test.
- Take a laxative or enema to help clear out your intestines a few hours before the test.
- Stop taking any medications that can thin your blood, such as nonsteroidal anti-inflammatory drugs or aspirin, about a week before the procedure. This is usually recommended if your doctor plans to take a biopsy of your prostate.
- Dont wear any jewelry or tight clothes to the clinic on the day of the procedure.
- Take any medications recommended to help you relax during the procedure. Your doctor may recommend a sedative, such as lorazepam .
- Make sure someones available to take you home in case your doctor gives you a sedative.
What Are The Limitations Of Prostate Ultrasound Imaging
Men who have had the tail end of their bowel removed during prior surgery are not good candidates for ultrasound of the prostate gland because this type of ultrasound typically requires placing a probe into the rectum. However, the radiologist may attempt to examine the prostate gland by placing a regular ultrasound imaging probe on the perineal skin of the patient, between the legs and behind the scrotum of the patient. Sometimes the gland can be examined by ultrasound this way, but the images may not be as detailed as with the transrectal probe. An MRI of the pelvis may be obtained as an alternative imaging test, because it may be obtained with an external receiver coil.
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Study: New Prostate Cancer Test Could Avoid Unnecessary Biopsies
Urine test found to be extremely accurate at detecting aggressive prostate cancer with few false negatives.
A urine test based on University of Michigan Rogel Cancer Center research could have avoided one third of unnecessary prostate cancer biopsies while failing to detect only a small number of cancers, according to a validation study that included more than 1,500 patients. The findings appear in the March issue of the Journal of Urology.
The MyProstateScore test, which is being commercialized by LynxDX, a U-M startup company, measures levels of cancer-specific genes in a patients urine. It is based on U-M research that discovered that half of all prostate tumors harbor a certain genetic anomaly in which the genes TMPRSS2 and ERG relocate on a chromosome and fuse together creating an on-switch for prostate cancer development.
Currently, one of doctors best methods for detecting prostate cancer is a blood test for prostate-specific antigen, commonly known as the PSA test. Elevated PSA levels may indicate cancer, but the majority of men with an elevated PSA do not actually have prostate cancer.
Our ultimate goal was to determine whether the MyProstateScore test could be a practical, reliable test that could rule out the need for more costly or invasive testing in men referred for a prostate biopsy, says study lead author Jeffrey Tosoian, M.D., M.P.H., a clinical lecturer in urology at Michigan Medicine.