Growth Of Cancer Cells
Depending on different factors such as the health of the patient and side effects, the doctor can decide to check for the presence of cancer cells on the prostate. The prostate gland is located just close to the rectum.
The doctor will use a lubricated and gloved finger to feel the growth of the cells. The finger is driven through the rectum to the prostate for the doctor to feel if there are cells on the prostate gland. It is rather an uncomfortable but simple process.
Should I Have A Psa Test
If you have no symptoms of prostate cancer and are thinking about having a PSA test, you should ask your doctor about the risks and benefits.
While some studies suggest PSA reduces mortality on a population basis, the test picks up large numbers of cancers that would have caused no symptoms or harm in the patient. This is known as overdiagnosis. Overdiagnosis of prostate cancer can lead to unnecessary treatments that have side effects such as sexual impotence, urinary incontinence and bowel problems.
It is important to balance the potential benefit of detecting a prostate cancer early against the risk that detection and treatment may not be necessary. Treatment may affect your lifestyle but it may also save your life.
Make your own decision about whether to be tested after a discussion with your doctor. Ensure you get good quality information to make an informed decision.
Screening tests for breast, bowel and cervical cancer can save lives, but there is still confusion around PSA testing for prostate cancer. Find more information here.
Remember, if you have any concerns or questions, please contact your doctor.
What Are The Symptoms Of Prostate Cancer
Not everyone with prostate cancer has symptoms, so regular screening should be a part of your annual physical, starting at the age of 40-50. However, prostate symptoms should never be ignored and should be brought up to a physician.
Typical symptoms of prostate cancer, according to the Prostate Conditions Education Council , include:
- Frequent urination
- Weak urinary stream
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Screening For Prostate Cancer
Prostate cancer is typically treatable if caught early. More than 90 percent of prostate cancers are found when the disease is in the beginning stages, confined to the prostate and nearby organs.
Unlike screenings for breast and colon cancers, there are no universal screening guidelines for prostate cancer. The U.S. Preventive Services Task Force recommends that men age 55 to 69 weigh the benefits and risks before deciding whether they should undergo screening, which is typically performed with a blood test that measures levels of a protein called prostate-specific antigen .
However, men in high-risk groupssuch as those who are of African-American descent and/or have a first-degree relative diagnosed with prostate cancer before age 65should consider speaking with their doctor about starting screenings at an earlier age.
Men older than 70 shouldnt be routinely screened for prostate cancer, according to the USPSTF.
Regardless of age or risk factors, men should get checked if they suddenly experience issues with urination, erectile dysfunction or unexplained pain.
The USPSTF suggests that, before deciding on a screening, men should seek expert advice about the benefits and harms of screening. Risks may include:
- False positives
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Who Should Get A Psa Test
Not everyone should get a PSA test. Why? Because many in this country are treated for low-risk prostate cancer that is discovered through the PSA test, even when it is unlikely that the disease will ever cause symptoms or lead to death. And treatment is associated with significant side effects, including impotence and incontinence . You should discuss whether prostate cancer early detection is right for you with your personal primary care physician.
To avoid the risks of over-treatment, Roswell Park follows the guidelines established by the National Comprehensive Cancer Network . The NCCN brings together world-renowned experts from 30 of the nations top cancer centers to write guidelines that specify the best ways of preventing, detecting and treating cancer. The guidelines are updated at least every year, on the basis of the latest research.
Michael Kuettel, MD, PhD, MBA, Chair of Roswell Park’s Department of Radiation Medicine, serves on the NCCN Prostate Cancer Panel.
If you decide that Prostate Cancer Early Detection is right for you, the NCCN recommends PSA testing as follows:
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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.
What Happens If You Have A Likert Score Of 3 Or More
This result on its own doesnt mean that you definitely have prostate cancer. But its more likely that you do. Your doctor is likely to recommend for you to have a biopsy.
The MRI scan also helps doctors know where to take the biopsy from. You usually have tissue samples taken from the suspected area of cancer and also from the rest of the prostate. Doctors call these targeted biopsies and systematic biopsies. This is because not all cancers can be seen on an MRI scan.
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Who Should Get A Prostate Exam
Starting at age 50, all men should discuss prostate cancer screening with their doctor. The American Cancer Society advises men at higher risk to have this conversation at age 45.
Youre considered to have an increased risk if youre African-American or if a first-degree relative had prostate cancer before age 65. If more than one first-degree relative had prostate cancer before age 65, you might want to consider beginning prostate cancer screening even earlier.
The ACS estimates there will be about 26,120 men will die from it.
Prostate cancer is easier to treat before it spreads. However, some prostate cancers are so slow-growing that they dont always require treatment. A lot depends on your age and other factors.
Discuss your risk factors with your doctor, and ask if you should have a prostate exam as part of your yearly checkup.
When To Get A Prostate Cancer Screening
A prostate screening can help your doctor find prostate cancer early, but youll need to decide if the benefits of the exam outweigh the risks. Have a discussion with your doctor about prostate cancer screenings.
The U.S. Preventive Services Task Force now recommends that men ages 55 to 69 decide for themselves whether to undergo a prostate-specific antigen screening test, after talking it over with their doctor.
They recommend against screening for men at or above the age of 70.
The American Cancer Society strongly recommends that no one be screened without discussion of the uncertainties, risks, and potential benefits of prostate cancer screening.
They give these specific recommendations for the date at which these discussions with a healthcare provider should take place:
- Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative diagnosed with prostate cancer at an early age .
- Age 40 for men at even higher risk .
You should also speak with your doctor about a prostate exam if youre experiencing symptoms of a prostate problem, such as frequent or painful urination or blood in your urine.
After this discussion, if you decide to get a prostate cancer screening, the ACS and the American Urologic Association recommend getting a prostate-specific antigen blood test.
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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.
Screening Information For Prostate Cancer
Screening for prostate cancer is done to find evidence of cancer in otherwise healthy adults. Two tests are commonly used to screen for prostate cancer:
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Digital rectal examination . A DRE is a test in which the doctor inserts a gloved, lubricated finger into the rectum and feels the surface of the prostate through the bowel wall for any irregularities.
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PSA blood test. There is controversy about using the PSA test to look for prostate cancer in people with no symptoms of the disease. On the one hand, the PSA test is useful for detecting early-stage prostate cancer, especially in those with many risk factors, which helps some get the treatment they need before the cancer grows and spreads. On the other hand, PSA screening may find very-slow-growing prostate cancers that would never threaten someones life. As a result, screening for prostate cancer using PSA may lead to treatments that are not needed, which can cause side effects and seriously affect a persons quality of life.
ASCO recommends that people with no symptoms of prostate cancer and who are expected to live less than 10 years do not receive PSA screening. For those expected to live longer than 10 years, ASCO recommends that they talk with their doctor to find out if the test is appropriate for them.
Other organizations have different recommendations for screening:
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Psa Test For Prostate Cancer
The prostate gland makes a protein called prostate specific antigen . This protein helps to nourish sperm. Normally, only tiny amounts of it enter the bloodstream.
Cancer cells in the prostate interfere with proper functioning and can cause large amounts of PSA to enter the bloodstream. Therefore, when high levels of PSA are detected in the bloodstream, this may indicate cancer.
Early prostate cancer often has no symptoms. However, high PSA levels can occur five to 10 years before the onset of prostate cancer symptoms. In such circumstances, the PSA test can help to indicate the presence of cancer at an early stage.
Other tests are needed to confirm a diagnosis because an abnormal PSA test can be due to non-cancerous causes. Equally, it is possible for a man to have a normal PSA level when cancer is present.
Living With Prostate Cancer
As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.
Nevertheless, it can affect your life. As well as the possible side effects of treatment, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.
You may find it beneficial to talk about the condition with your family, friends, a GP and other people with prostate cancer.
Financial support is also available if prostate cancer reduces your ability to work.
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Is Going To The Bathroom Frequently A Sign Of Prostate Cancer
Thats one of the challenging things having urinary symptoms is very rarelyalmost nevera sign of prostate cancer. Having urinary symptoms means you should probably be evaluated for an enlarged prostate, also known as benign prostatic hyperplasia . We can treat your urinary symptoms and help you pee better.
If urinary symptoms bring men to the doctor, we can discuss screening for prostate cancer. Thats important because not all men will go to a doctor until theres something wrong with them. And prostate cancer screening really is the only way to detect prostate cancer, because its almost always asymptomatic.
Lymph Node Biopsy As A Separate Procedure
A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.
Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.
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Symptoms Of Prostate Cancer
When this happens, you may notice things like:
- an increased need to pee
- straining while you pee
- a feeling that your bladder has not fully emptied
These symptoms should not be ignored, but they do not mean you have prostate cancer.
Its more likely theyre caused by something else, such as prostate enlargement.
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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 Is The Chance Of A Diagnosis Of Prostate Cancer
Around 17,000 new cases of prostate cancer are diagnosed each year in Australia. It affects mostly men in older age groups and is rare in men under 50 years of age.
The chance of developing prostate cancer is significantly higher in men who have a close relative with prostate cancer the risks are higher if the relative was diagnosed before the age of 60.
If you have a family history of prostate cancer, talk to your doctor.
Use In Men Who Might Have Prostate Cancer
The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.
PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.
- Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
- Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
- If the PSA is more than 10, the chance of having prostate cancer is over 50%.
If your PSA level is high, you might need further tests to look for prostate cancer.
To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.
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If They Dont Think You Need Any Tests Or A Referral
- Can you explain why I dont need to have tests or see a specialist?
- Is there anything I can do to help myself?
- Do I need to see you again?
- Who do I contact if my symptoms continue or get worse, especially during the night or at weekends?
- Ive been reading about prostate cancer and wish to have a PSA test can you explain why I dont need one?
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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.
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