Prostate Cancer: Advancements In Screenings
You may know thatprostate canceris one of the most common cancer types in men. The good news is that thereare many treatment and management options, even if the cancer is caught ata later stage.
What you may not know: There are several options when it comes toprostate cancer screening. After considering multiple factors, your doctor may recommend theprostate-specific antigen test, and/or one of the newer screeningtests that are now available.
Johns Hopkins urologistChristian Pavlovich, M.D., explains what you should know.
Screening Tests For Prostate Cancer
Screening is testing to find cancer in people before they have symptoms. Its not clear, however, if the benefits of prostate cancer screening outweigh the risks for most men. Still, after discussing the pros and cons of screening with their doctors, some men might reasonably choose to be screened.
The screening tests discussed here are used to look for possible signs of prostate cancer. But these tests cant tell for sure if you have cancer. If the result of one of these tests is abnormal, you will probably need a prostate biopsy to know for sure if you have cancer.
What Is Done If A Screening Test Shows An Elevated Psa Level
If someone 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 person continue with PSA tests and digital rectal exams at regular intervals to watch for any changes over time .
If the PSA level continues to rise or a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. These may include imaging tests, such as magnetic resonance imaging or high-resolution micro-ultrasound.
Alternatively, the doctor may 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. The biopsy needle may be inserted through the wall of the rectum or through the perineum . A pathologist then examines the collected tissue under a microscope. Although both biopsy techniques are guided by ultrasound imaging so the doctor can view the prostate during the biopsy procedure, ultrasound cannot be used alone to diagnose prostate cancer. An MRI-guided biopsy may be performed for patients with suspicious areas seen on MRI.
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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. Having a small tumor found and treated may not, however, reduce the chance of dying from prostate cancer. That is because many tumors found through PSA testing grow so slowly that they are unlikely to be life threatening. Detecting such tumors is called overdiagnosis, and treating them is called overtreatment.
Overtreatment exposes a person unnecessarily to the potential complications associated with prostate surgery and radiation therapy. These include urinary , gastrointestinal , and sexual side effects .
In addition, finding cancer early may not help someone who has a fast-growing or aggressive prostate tumor that may have spread to other parts of the body before being detected.
The PSA test may give false-positive results. A false-positive test result occurs when the PSA level is elevated but no cancer is actually present. A false-positive test result may create anxiety and lead to additional medical procedures, such as a prostate biopsy, that can be harmful. Possible side effects of biopsies include serious infections, pain, and bleeding.
False-positive test results are common with PSA screening only about 25% of people who have a prostate biopsy due to an elevated PSA level are found to have prostate cancer when a biopsy is done .
Psa Test: The Current Prostate Screening Standard
Before recommending when you should be screened for prostate cancer, yourdoctor will consider many factors, such as:
- 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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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 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.
Simple New Blood Test For Prostate Cancer Determines Presence And Stage Of Cancer With 99% Accuracy
A new blood test for prostate cancer is producing a 99% accuracy ratingprecision that has never before been achieved for a blood test of this particular kind of cancer.
Furthermore, the test can determine the exact stage and progression of the cancer, which also reduces the need for invasive biopsies and scans.
The team behind the breakthrough, involving researchers from Nottingham Trent University and University Hospitals Leicester NHS Trust, determined that changes in the patients immune system could be examined through blood markersspecifically white blood cells.
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Our approach not only identifies presence of the disease, but alsocruciallyits clinical significance. We can also do this with higher accuracy than current approaches, said Professor Graham Pockley, Director of Nottingham Trent Universitys John van Geest Cancer Research Center
This will spare men from having unnecessary invasive procedures and help clinicians to decide whether to watch or actively manage patients, even when they are asymptomatic.
With an estimated 1.8 million new cases in 2018 alone, prostate cancer is the fourth most common cancer in the world and the second most common form among men in the United Statesa country that sees almost 200,000 diagnoses every year. It is the most common form of cancer for men in the UK with roughly 47,000 diagnoses annually.
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There Are Risks To Getting Prostate Cancer Tests And Treatments
If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.
Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.
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When Should I Get Tested
Visit Am I at Risk? to learn more. All men are at risk of prostate cancer, so it is important to talk with your doctor to make an informed decision. Check out our recommended age and testing guidelines, which are based on the NCCN provided recommendations.
Detecting prostate cancer early gives you the best chance of living longer. In fact, more than 99 percent of men survive prostate cancer when it is caught early.
Watch prostate cancer experts, Dr. Lowentritt and Dr. Siegel in this video discuss detection and diagnosis:
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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. And other potential biomarkers of prostate cancer are being investigated. None of these tests has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include
Selected References
Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. New England Journal of Medicine 2004 350:22392246.
Research Into Prostate Cancer Screening
Research is ongoing to find other prostate cancer screening tests and ways to improve the current test. This includes:
- new blood and urine tests
- a combination of a blood test and other information such as age and family history
- MRI and other types of scans
More research is needed to find out whether these tests are reliable enough to detect prostate cancer.
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What’s A Raised Psa Level
The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood .
If you’re aged 50 to 69, raised PSA is 3ng/ml or higher.
A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of another condition that’s not cancer, such as:
What This Means For You
The Prostate Cancer UK spokesperson sounds a note of caution for now, pointing out that until these studies have been conducted, we don’t have enough information about its benefits.
“This innovative testing method is an interesting new approach, but there simply hasn’t been enough detailed research into its effectiveness for us to be able to recommend for its use at this stage,” he says. “Until then, we would not recommend that anyone use this test as a substitute for current standard methods.”
Of course, research in the field will be continuing apace.
“In order to save more lives from prostate cancer it is crucial that we create a diagnostic process that is robust enough to routinely diagnose men early and accurately,” says the spokesperson.
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The Future Of Prostate Cancer Testing
An initial 2020 study with 72 participants found that a new blood test can diagnose prostate cancer, and identify its stage, with 99 percent accuracy.
This new test detects changes in the immune system which are identified in the blood of the patient. Alterations in the white blood cells are the primary signal for prostate cancer. Computer analysis of the blood sample can detect small changes which can indicate cancer.
Further research is needed into this method, before it becomes a recommended test. The next step is a larger study with more participants. If larger clinical studies verify the initial findings we may see this test come into use in the future.
What Are Additional Tests For Detecting Prostate Problems
If the DRE or the PSA blood test indicates a problem may exist, the health care provider may order additional tests, including urinalysis, urodynamic tests, cystoscopy, abdominal ultrasound, transrectal ultrasound with prostate biopsy, and imaging studies such as magnetic resonance imaging or computerized tomography scan.
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Why Is A Prostate
A PSA blood test is performed to detect or rule out prostate cancer. The amount of PSA in the blood is often higher in men who have prostate cancer. However, an elevated PSA level does not necessarily indicate prostate cancer. The U.S. Food and Drug Administration has approved the PSA blood test for use in conjunction with a DRE to help detect prostate cancer in men age 50 or older and for monitoring men with prostate cancer after treatment. However, much remains unknown about how to interpret a PSA blood test, its ability to discriminate between cancer and problems such as BPH and prostatitis, and the best course of action if the PSA level is high.
When done in addition to a DRE, a PSA blood test enhances detection of prostate cancer. However, the test is known to have relatively high false-positive rates. A PSA blood test also may identify a greater number of medically insignificant lumps or growths, called tumors, in the prostate. Health care providers and patients should weigh the benefits of PSA blood testing against the risks of follow-up diagnostic tests. The procedures used to diagnose prostate cancer may cause significant side effects, including bleeding and infection.
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 screening 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.
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The Pros And Cons Of The Psa Test
Youll be entitled to this test if youre aged over 50 . However, the GP will ask you to weigh up its pros and cons. While the PSA test has saved lives it can help pick up cancer even before you have symptoms its accuracy is far from perfect.
One in seven men with a normal PSA level may actually have prostate cancer, and in 2% of men that cancer is aggressive. The reverse is true too: three in four men with a raised PSA level dont have cancer, but will be put through significant worry and sometimes invasive testing as a result.
PSA is produced by both normal and cancerous prostate cells, and your level can rise with other diseases, explains Dr Andrew Harbottle, chief science officer at MDNA Life Sciences. You can have a high reading with things like benign prostatic enlargement,inflammation of the prostate, or even physical exercise, especially cycling. The PSA reading is an indication that theres something up with the prostate but its not necessarily prostate cancer specific.
The Prostate Cancer UK spokesperson adds that this can cause a lot of anxiety and even unnecessary procedures. For one thing, if your PSA level is raised you may need a biopsy, which can have side effects. For another thing, you might be diagnosed with a slow-growing and low-risk prostate cancer, and end up having treatment you dont need.
How accurate are prostate cancer tests?
Prostate Specific Antigen Test
A blood test called a prostate specific antigen test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.
As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.
PSA levels also can be affected by
- Certain medical procedures.
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Special Types Of Psa Tests
The PSA level from a screening test is sometimes referred to as total PSA, because it includes the different forms of PSA . If you decide to get a PSA screening test and the result isnt normal, some doctors might consider using different types of PSA tests to help decide if you need a prostate biopsy, although not all doctors agree on how to use these tests. If your PSA test result isnt normal, ask your doctor to discuss your cancer risk and your need for further tests.
Percent-free PSA: PSA occurs in 2 major forms in the blood. One form is attached to blood proteins, while the other circulates free . The percent-free PSA is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not.
If your PSA test result is in the borderline range , the percent-free PSA might be used to help decide if you should have a prostate biopsy. A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy.
Many doctors recommend a prostate biopsy for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. Using these cutoffs detects most cancers and helps some men avoid unnecessary biopsies. This test is widely used, but not all doctors agree that 25% is the best cutoff point to decide on a biopsy, and the cutoff may change depending on the overall PSA level.