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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Should You Know Your Psa Level
Instead of a national screening programme, there is an informed choice programme, called prostate cancer risk management, for healthy men aged 50 or over who ask their GP about PSA testing. It aims to give men good information on the pros and cons of a PSA test.
If you’re aged 50 or over and decide to have your PSA levels tested after talking to a GP, they can arrange for it to be carried out free on the NHS.
If results show you have a raised level of PSA, the GP may suggest further tests.
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.
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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 .
The Future Of Prostate Cancer Screening
Science is constantly advancing, and tests are evolving. In the future, we expect to have more refined tests, especially for men with an increased risk of prostate cancer.
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New Approaches To Diagnosis
This diagnostic process, with all its advantages and disadvantages, is the best we have for now. However, Prostate Cancer UK is investing in a number of research projects that are exploring other routes of diagnosis.
“Recently there have been a number of studies highlighting areas to explore further,” says the spokesperson. “These include imaging using different MRI and ultrasound techniques, tests based on measuring various proteins and DNA changes through blood samples, and tests for measuring tumour cells circulating in the blood.”
One exciting possibility is a blood test, developed by MDNA Life Sciences. Called the Mitomic Prostate Test, the test analyses mitochondrial DNA to determine the presence, or otherwise, of cancer. The company says the test could reduce the number of prostate biopsies by up to 30%.
“Our test won’t be replacing biopsies any time soon – it’s more about giving the doctor information about which patients should be going forward for that biopsy,” explains Harbottle. “This test would be used on men who have slightly elevated, but not super-high, PSA scores – what we call the ‘PSA grey zone’. Three out of four of those men won’t have cancer, so do you want to send them for a biopsy or not? Our test would be used to triage those patients, to see whether they do need an MRI-guided biopsy.”
Currently, the test is only available privately, but the company’s partner, Aspire Pharma, is working to make it available on the NHS.
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 .
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Prostate Cancer Urine Test
This test detects the gene PCA3 in your urine and can also help your doctorbetter assess your prostate cancer risk.
PCA3 is a prostate-specific noncoding RNA. Its a gene thats only in yourprostate. If the gene is overexpressed , then theres a greater chance you have prostate cancer.
Like PSA and PHI tests, this isnt definitive, either. But data suggestthat when cancer is present, the PCA3 will be positive 80 percent of thetime. This test can also help your doctor determine whether a biopsy isnecessary.
Both of these new tests are more accurate than the PSA test. Your doctormay recommend one or more than one, based on the specifics of your case.
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.
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Need To Do A Prostate Screening Talk To Your Doctor About Your Options
If you have a family history of prostate cancer, talk to your MDVIP-affiliated doctor about what screening method is best for you. And if you dont have a primary care physician, consider partnering with MDVIP. MDVIP-affiliated doctors have the time to work with you to help you develop a personalized wellness plan that can focus on improving your overall health. Find a physician near you and begin your partnership in health »
Data Collection And Analysis
Selection of studies
Search hits from each database were downloaded and combined into a review database managed in Mendeley Desktop. Each search hit was screened against the inclusion/exclusion criteria by SM and a 2nd investigator independently, based on title and abstract. Full text articles were reviewed if a reviewer was unclear on the basis of title and abstract. Any discrepancies of study inclusion were adjudicated by a third reviewer .
A pre-prepared proforma for data extraction was used to collate relevant data from each included study, including two by two tables for the index and reference tests. SM extracted the data from all included studies. A second investigator extracted data from a random sample of 10% of included studies for verification of accuracy of data extraction. Any discrepancies were adjudicated by a third reviewer .
Risk of bias and applicability of all included studies was assessed by SM using the QUADAS-2 tool, with a second investigator independently assessing 10% of included studies and discussed any discrepancies with SM.
Raw data extracted from included papers on PSA result and prostate cancer diagnoses were extracted and combined into 2 × 2 tables to assess diagnostic accuracy. Measures of pooled diagnostic accuracy were intended to be determined for the following outcomes using bivariate mixed effects regression :
Any prostate cancer diagnosis
Clinically significant prostate cancer diagnosis
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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 .
Who Can Have The Psa Test
If you are over 50, you can ask your GP for a PSA test. GPs do not routinely offer PSA testing as part of a general health check, or if you do not have any symptoms.
If you ask for a PSA test, your GP will advise you to think carefully about the benefits and disadvantages.
If you have a higher risk of prostate cancer, it is important to talk to your GP about your personal risk. This is even if you do not have any symptoms. Early prostate cancer does not usually cause symptoms.
Talking to your GP can help you to make an informed decision about having a PSA test.
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Pros And Cons Of Psas Test
Critics of the PSA test, which was first approved in 1986 to monitor progression of prostate cancer and later expanded as a screening tool, say the test can result in false positives and often identifies a slow-growing cancer in older men who are far more likely to die from something else. Both instances lead to overtreatment. A European study, for example, found the test promoted a 20 percent decrease in cancer deaths but to prevent a single death, 48 men had to be treated. Treatment for the disease can result in impotence and incontinence.
Proponents of the PSA point to a lack of other screening tools to identify men who may be at risk of dying from the disease prostate cancer kills about 34,000 men a year in the U.S.
Currently, the U.S. Preventive Services Task Force recommends against testing for men over 70 and suggests the decision to use the PSA be made on an individual basis on younger patients based on family history, ethnicity and comorbid medical conditions.
Which is why a new test and study is good news. The study, published in The Journal of Urology, found that a new prostate cancer test is more accurate than the PSA. Its also less invasive than prostate biopsy, which is used to confirm prostate cancer diagnoses.
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.
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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.
The Test Is Often Not Needed
Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:
- An enlarged prostate gland.
- Recent sexual activity.
- A recent, long bike ride.
Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.
Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.
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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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New Prostate Screening Test: Myprostatescore
Researchers from University of Michigan Rogel Cancer Center developed the MyProstateScore, a test that measures prostate cancer genes in a patients urine. The test involves a high level digital rectal exam combined with a urine test and is based on previous University of Michigan research that found about 50 percent of prostate tumors have a genetic anomaly, specific only to prostate cancer. The genes — TMPRSS2 and ERG — reposition themselves on a chromosome and merge together, activating prostate cancer development.
Prostate cancer begins in the prostate gland. There are several types of prostate cancer some more aggressive than others. These cancers tend to grow slowly, which is a blessing, because its easy to miss the early signs and symptoms of these cancers, says Bernard Kaminetsky, MD, medical director, MDVIP. However, if the cancer is left untreated or doesnt respond to treatment, it can spread to bones and organs, becoming life-threatening.
Because prostate cancers often developed later in life are so slow growing, many doctors feel the best course of action is monitoring the patient, as opposed to treating them. U-Ms MyProstateScore benefits these patients, as well as patients who scored false positives on PSA tests because it can spare them unnecessary radiation, chemotherapy and/or surgery.
U-Ms MyProstateScore study included 1,525 men with elevated PSA scores. Results found:
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What Is Cancer Screening
Screening means testing people for early stages of a cancer, or for early changes that could develop into cancer if left untreated. For screening to be useful the tests:
- need to be reliable at picking up cancers that need treatment
- overall must do more good than harm to people taking part
- must be something that people are willing to do
Screening tests are not perfect and have some risks. The screening programme should also be good value for money for the NHS.