Getting The Results Of The Biopsy
Your biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. Getting the results usually takes at least 1 to 3 days, but it can sometimes take longer. The results might be reported as:
- Positive for cancer: Cancer cells were seen in the biopsy samples.
- Negative for cancer: No cancer cells were seen in the biopsy samples.
- Suspicious: Something abnormal was seen, but it might not be cancer.
If the biopsy is negative
If the prostate biopsy results are negative , and the chance that you have prostate cancer isnt very high based on your PSA level and other tests, you might not need any more tests, other than repeat PSA tests sometime later.
But even if many samples are taken, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer , your doctor might suggest:
- Getting other lab tests to help get a better idea of whether or not you might have prostate cancer. Examples of such tests include the Prostate Health Index , 4Kscore test, PCA3 tests , and ConfirmMDx. These tests are discussed in Whats New in Prostate Cancer Research?
- Getting a repeat prostate biopsy. This might include getting additional samples of parts of the prostate not biopsied the first time, or using imaging tests such as MRI to look more closely for abnormal areas to target.
Prostate cancer grade
Gleason score
Whats The Bottom Line
My first prostate exam happened during a routine physical. Noting I was in my late forties and had not yet had a prostate exam, we agreed it was in my best interest to have the procedure. It was no big deal. Dont ignore or avoid a routine prostate exam out of anxiety. If I can handle it, so can you.
What To Expect During Your Prostate Exam
If youve been avoiding a prostate exam, you could be putting your health at risk. Knowing the facts about the procedure will help put any fears, concerns, or squeamishness to rest.
If youre a man older than 40 and have not yet had a prostate exam, its a good time to talk to your doctor. If youre also African American or have a family history of prostate cancer, its a really good time. One of six men eventually gets a prostate cancer diagnosis. And even though most men have a slow-growing type, prostate cancer is still the leading cause of cancer deaths in men older than 75. So if youre afraid of a prostate exam, its time get over it and protect your prostate health.
Start talking about your prostate care plan at age 40, and if you and your doctor think the time is right, get a digital rectal exam and a PSA blood test during your annual physical, suggests Dan Zenka, senior vice president of the Prostate Cancer Foundation and a prostate cancer survivor who was diagnosed at age 51 in 2010.
What to Expect During a Primary Care Prostate Health Exam
Your doctor will probably start by asking you if you have any prostate health symptoms like a weak urine stream, dribbling, straining to urinate, or blood in your sperm or urine. Your doctor may also ask if you have a father or a brother with prostate cancer and if the doctor doesnt ask, volunteer the information.
Here are the two tests that will be done:
What to Expect if You Need a Prostate Cancer Exam
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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 :
Genetic Testing For Some Men With Prostate Cancer
Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.
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Are Prostate Cancer Screenings Recommended
Absolutely. Screening for prostate cancer is very important and recommended by the American Urology Association for men over 55 years old–age 40 if they are at higher risk. Prostate cancer is very treatable and early detection of prostate cancer is key to treatment and recovery.
Men should have a conversation with their primary care physician about their personal health to determine the best time for prostate cancer screening.
What To Expect At A Prostate Exam
Many men avoid getting a prostate exam. Its in a very private area, and its normal to have anxiety about the procedure. But problems with the prostate are common, so its an area that should not be ignored.
The prostate is prone to enlargement, which can cause health problems. This can lead to frequent, urgent urination, especially at night. The enlargement may or may not be related to prostate cancer.
I had my prostate examined for the first time at age 48 by my primary care provider. It was not painful and took seconds to complete. I suffered no serious side effects. Heres what you need to know.
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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.
When Should I Have A Prostate Exam
That depends. There are many factors that could increase the risk of prostate cancer. Not everyone agrees on when you should have your prostate examined for the first time. Talk to your doctor about risk factors you may have. Prostate cancer is rare for men under 40, and risk starts to increase around age 50. African-American men, for unknown reasons, are more prone to prostate cancer and more aggressive types of prostate cancers. If you have a family history of prostate cancer, especially a brother or father, that is a risk factor to consider. If breast cancer runs in your family, especially a sister or mother, that may also put you at risk as there is a genetic link.
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What Will I Know Afterwards
A rectal exam can’t definitively diagnose prostate cancer. Only a biopsy can do that and you wont be offered one if you don’t need it. Rectal exams are part of a suite of diagnostic tests, including PSA blood tests and MRI scans, that help to either build or break the case for further investigation.
Cant I Just Get A Blood Test
If you have concerns about prostate cancer you certainly should have a Prostate Specific Antigen blood test. Knowing your PSA level can help to establish whats normal for you so that a spike is more easily identified. But a blood test alone is not enough. The test has been known to deliver false-positive results in some cases leading men into have invasive biopsies for no reason. Up to 20% of men with prostate cancer show no increase in PSA levels*. So its best used to check against the result of a rectal exam but cant be relied upon in isolation.
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Getting A Prostate Biopsy
For some men, getting a prostate biopsy might be the best option, especially if the initial PSA level is high. A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. This test is the only way to know for sure if a man has prostate cancer. If prostate cancer is found on a biopsy, this test can also help tell how likely it is that the cancer will grow and spread quickly.
For more details on the prostate biopsy and how it is done, see Tests to Diagnose and Stage Prostate Cancer.
For more information about the possible results of a prostate biopsy, see the Prostate Pathology section of our website.
Prostate Massage Therapy And Why It May Be Helpful
Prostate massage therapy , in which the prostate is stimulated through the rectum, was once a popular treatment for prostatitis.
The procedure is similar to a digital rectal exam, except rather than briefly looking for abnormalities on the prostate, the person performing the prostatic message rubs the prostate with light to moderate pressure until it secretes fluid through the urethra .
It was once thought that people could relieve symptoms related to prostatic congestion by expelling inflammatory cells and fluid from the obstructed glands. But this therapy largely fell out of favor in the 1960s, once antibiotics became available.
A study published in the journal Neurology tested whether prostate massage could be used as an adjunct treatment for people with chronic prostatitis, but the researchers found that the treatment did not significantly help patients.
In some cases, doctors have used prostate massage therapy to obtain sperm from men with spinal cord injuries, leading to successful pregnancies. But electroejaculation stimulating the prostate using an electric current delivered through a probe inserted into the rectum typically yields more sperm, noted an article published in the journal Nature Reviews Urology.
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How Often Do I Need A Prostate Exam
There are different factors that will determine how often you need to have a prostate exam and prostate cancer screening.
While PSA levels are one factor, they vary by age. Other factors like your family history, overall health, diet, and lifestyle, also play into how often you should have your prostate checked.
Your provider will take all of these factors into account when they are recommending the timing and frequency of your future prostate cancer screenings.
If you’re not due for a prostate cancer exam yet but notice changes in your health or are having symptoms that you think might be related to your prostate, don’t wait. You can always ask your provider for a checkup sooner.
Should I Be Screened For Prostate Cancer
Since there are benefits and risks to prostate screening, you should talk with your provider to decide if screening is right for you. You and your provider should consider:
- Your age. The risk of prostate cancer increases after age 50.
- Your family health history. If members of your family have had prostate cancer, your risk may be higher.
- Your race. Prostate cancer is more common in African Americans. They also have a higher risk of developing prostate cancer at a younger age and having more serious disease.
- Your general health. Are you well enough to have treatment for prostate cancer if it’s found?
- What you prefer. How do you feel about the possible benefits and harms of screening, diagnosis, and treatment?
NIH: National Cancer Institute
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Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11, 18F-DCFPyl , and Ga 68 gozetotide , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body. PSMA PET scans can also be used to help determine if the cancer can be treated with a radiopharmaceutical that targets PSMA.
Doctors are still learning about the best ways to use these newer types of PET scans, and some of them might not be available yet in all imaging centers.
How Do I Screen For Prostate Cancer
There are two main early stage screening methods a digital rectal exam , and a blood test measuring PSA levels. PSA screening is regarded as the best method to screen for prostate cancer in men over 40 or those of a certain risk factor.
While men might be intimidated by a DRE, itâs a quick and safe screening technique used by a physician, and should cause no significant pain.
A Digital Rectal Exam is a simple, painless and quick procedure. A physician inserts a gloved and lubricated finger into the rectum and feels the prostate to identify if the prostate is enlarged, has lumps or is an abnormal texture compared to a healthy example.
Although this procedure is a very clear indicator of prostate health, the entire prostate canât be examined during a DRE. This is why physicians will also take into account PSA blood work, health history, and other risk factors. Overall, itâs often difficult to detect prostate cancer early, itâs mostly found through PSA testing so PSA screenings should be done regularly, starting at the age of 40-50.
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How Do Men Feel About The Rectal Exam
I think most men are willing to do it, but some men are exceptionally opposed to it. They might be happy to hear that there are studies ongoing in the United Kingdom looking at using magnetic resonance imaging as a screening tool to be able to avoid doing a digital rectal exam in the future. There is a large African immigrant population in London with a higher incidence of prostate cancerthey didnt want to have the prostate exam because they had a lot of opposition to it. They were uncomfortable with it.
Are You Seeing Prostate Cancer Becoming More Prevalent In Younger Patients
Its pretty rare. Its less common that men in their 40s have prostate cancer, but, we also are very rarely screening them. The young men who come in to be screened tend to have one of those high-risk features. They most likely had a father who had prostate cancer, so theyre nervous about it. Or theyre African-American, and theyve been flagged by their health care providers.
If youre young, your quality of life is even more important to you right now. We know that, if diagnosed with low-grade prostate cancer, a person will need treatment at some time in life. If we can delay treatmentwhich could negatively impact urinary or sexual functionby several years, then we should do that and obviously discuss that there is a low but possible chance of metastasis developing during that time.
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