What Does The Psa Test Involve
The PSA test involves taking a blood sample and sending it to a laboratory for analysis. The results indicate:
- Normal levels: Most healthy adult males have PSA levels below 4 nanograms per milliliter .
- Borderline levels: PSA levels of 410 ng/ml are borderline. There is a 25% chance that cancer is present, and the person will usually need additional tests.
- High levels: If PSA levels are over 10 ng/ml, there is a 50% chance that the person has prostate cancer. The specialist will likely recommend more testing, including a prostate biopsy.
It is important to note that PSA levels can naturally vary from person to person. A person with high levels may not have prostate cancer. On the other hand, about 15% of people who test positive for prostate cancer after a biopsy have PSA levels below 4 ng/ml.
Prostate cancer is not the only cause of high PSA levels. Find out more about the other causes here.
What Happens During A Dre
The DRE will take place in a private exam room at your doctors office. The test only takes a few minutes. You will need to take off any clothes below your waist. You will be given a gown to wear or a cloth to wrap around your body.
For men. The doctor will ask you to stand and bend forward at the waist or they will ask you to lie on your side on an exam table with knees pulled up to your chest. As they start the DRE, the doctor may ask you to relax and take a deep breath. Then they will gently insert a lubricated, gloved finger into your rectum. The doctor will feel the size of your prostate gland. They will also feel for bumps, soft or hard spots, or other abnormal areas. The doctor will also examine the wall of your lower colon and rectum.
For women. The doctor will usually ask you to lie on your back on an exam table. Your feet will be in raised stirrups. The doctor may ask you to relax and take a deep breath as they start the DRE. Then they will gently insert a lubricated, gloved finger into your rectum. The goal is to feel your reproductive organs and the bowel. The doctor may also feel for problems in your internal organs. They do this by pressing on your lower abdomen or pelvic area with their other hand.
A DRE usually does not hurt, but you may be uncomfortable. You may also feel the need to urinate. If a mans prostate is enlarged, there may be some discomfort or mild pain during the exam.
Further Testing For Advanced Cancer
If there’s a significant chance the cancer has spread from your prostate to other parts of the body, further tests may be recommended.
These include:
- an MRI scan, CT scan or PET scan these scans build a detailed picture of the inside of your body
- an isotope bone scan, which can tell if the cancer has spread to your bones a small amount of radiation dye is injected into the vein and then collects in parts of the bone where there are any abnormalities
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What Happens After A Prostate Exam
After the exam, the doctor can tell you straight away whether everything felt normal with your prostate. However, sometimes the prostate can feel fine even though there might be a problem. It can also have abnormalities caused by something other than cancer, such as inflammation or benign prostate enlargement.
This is why your prostate exam is often combined with a blood test called a PSA test. It looks for levels of a certain enzyme, which, if higher than normal, can be a sign of cancer.
It usually takes between 1-2 weeks to get the results back. Your prostate exam and PSA will determine whether any further tests are needed and help the doctor decide how regularly you need to be checked in the future.
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.
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Repeating The Psa Test
A mans blood PSA level can vary over time , so some doctors recommend repeating the test after a month or so if the initial PSA result is abnormal. This is most likely to be a reasonable option if the PSA level is on the lower end of the borderline range . For higher PSA levels, doctors are more likely to recommend getting other tests, or going straight to a prostate biopsy.
Weighing Your Options For Treatment
If you test positive for prostate cancer, you have some options as to what youd like to do about it. Until recently, nearly everyone opted for surgery or radiation, while some patients choose not to undergo treatment, instead opting for active surveillance, during which the cancers are left alone but regularly monitored to be certain that theyre not growing.
Certainly, screening can lead to earlier prostate cancer detection, and with earlier detection, youre eligible for multiple different treatments or active surveillance, said Sia Daneshmand, MD, director of urologic oncology at USC Urology of Keck Medicine of USC and associate professor of urology at Keck School of Medicine of USC. So we encourage patients who are candidates for screening to discuss it with their urologist and/or primary care physician so that we can determine whats the best course of treatment for them.
There also is a new option for those seeking prostate cancer treatment. Its called High-Intensity Focused Ultrasound , which uses ultrasound beams to non-surgically destroy prostate tumors.
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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 :
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.
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Imaging Tests For Prostate Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. One or more imaging tests might be used:
- To look for cancer in the prostate
- To help the doctor see the prostate during certain procedures
- To look for spread of prostate cancer to other parts of the body
Which tests you might need will depend on the situation. For example, a prostate biopsy is typically done with transrectal ultrasound and/or MRI to help guide the biopsy. If you are found to have prostate cancer, you might need imaging tests of other parts of your body to look for possible cancer spread.
The imaging tests used most often to look for prostate cancer spread include:
What Do You Want Men To Know About Prostate Cancer
The important thing to know is that, if you live long enough, you will probably get prostate cancer. If you live into your 80s, about 80 percent of men have some sort of prostate cancer. That doesnt mean theyre going to die from prostate cancer because, as a percentage, very few men die from prostate cancer. It means its important to be aware of it and consider screening early, so if its a high-grade type, we can identify it and treat it.
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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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Why Do I Need A Psa Test
It’s your choice whether to have a PSA test to screen for cancer. You and your prover may consider your risk for developing a serious cancer that could spread if you don’t catch it early. Your risk for serious prostate cancer may be higher depending on 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.
You may also have a PSA test if:
- You have symptoms of a prostate condition, such as:
- Painful or frequent urination
- Pelvic and/or back pain
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What Would You Say To Men Who Dont Want To Get A Prostate Check
A rectal exam is recommended but optional. We recommend both, but if theyll just let you do a blood test, thats better than not doing anything at all.
If concern about the rectal exam is the only reason youre not getting screened, talk to your doctor about it. We can discuss the risks and benefits. None of the evaluation tests are mandatory, but the reason we do that is that it improves our ability to detect cancer. So, if thats why youre not being evaluated, we can talk and decide if we can do other tests.
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Medical History And Physical Exam
If your doctor suspects you might have prostate cancer, you will be asked about 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.
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Tests To Diagnose And Stage Prostate Cancer
Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.
If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.
The actual diagnosis of prostate cancer can only be made with a prostate biopsy .
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Understanding Your Gleason Score
Your Gleason score is the sum of various grades the pathologist has given samples taken from the prostate gland. The more aggressive the cancer looks, the higher the grade. The lowest Gleason score you can receive for prostate cancer is a 6. These cancers are considered low-grade and unlikely to be aggressive. A Gleason score of 8 to 10 is more aggressive and more likely to grow and spread quickly. A cancer with a Gleason score of 9 to 10 is likely to be even more aggressive.
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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 Parkâs 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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Checking For Psa At Home
Itâs best to look for prostate symptoms and then screen using a Prostate Specific Antigen blood test. While there is no physical way for you to check for prostate cancer at home, there are at-home screening options for PSA. imaware⢠at-home test for PSA can help screen you for prostate issues.
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Biopsy During Surgery To Treat Prostate Cancer
If there is more than a very small chance that the cancer might have spread , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy .
The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.
Both Tests Are Better Than One
Using these tests together is better than using either test alone. PSA testing together with a DRE may help find a dangerous cancer early when it is easier to treat.
Follow-up tests
If a problem is found, more tests will be done to find out whether you have prostate cancer or another health problem. Further tests can include:
- a follow-up PSA test
- a transrectal ultrasound a test that uses sound waves to make a picture of the rectum and nearby organs, including the prostate
- a biopsy of the prostate tissue samples of the prostate are looked at under a microscope
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