Prostate Cancer Surgery Wont Boost Survival In Men With Early
Men with early-stage prostate cancer often face a difficult choice as to treatment: Do they opt for radiation, surgery or watchful waiting to see if the cancer gets worse.
A new study in the New England Journal of Medicine finds men who opt to surgically remove their prostate gland a procedure called a radical prostatectomy are no less likely to die than men who choose wait and monitor their symptoms to see if the cancer progresses.
The study adds to the ongoing debate surrounding prostate-specific antigen testing and whether the tests pick up cancers that may be too slow-growing to ever cause a problem.
In May, the U.S. Preventive Services Task Force, a panel of advisors on government medical guidelines, reviewed existing research and reported in its final recommendation that healthy men of all ages should not take a PSA test because the potential harms from a positive test outweigh the benefits from catching the cancer early.
The study tracked 731 men with early-stage prostate cancer found through PSA testing, average age of 67, who agreed to be randomized to either receive radical prostatectomy or just observation from a doctor between November 1994 through January 2002. The men were followed-up with by January 2010 to see how they fared.
What Is A High Psa Level
The PSA test alone cant diagnose any disease. As discussed, elevated PSA levels do not always mean that you have prostate cancer or any other prostate problem.
Many factors can affect your PSA levels so that the doctor wont consider your PSA level on its own.
There is no specific normal or abnormal level of PSA. Factors such as age and ethnicity make it hard for researchers to establish a normal range.
However, most doctors consider PSA levels of 4.0 ng/ml as high and would often recommend a prostate biopsy. One study shows that men with this level of PSA often have prostate cancer.
Low PSA levels also dont always mean that you dont have prostate cancer. Studies show that some men with a PSA below 4.0 ng/ml do have prostate cancer.
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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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Medical Procedures Can Cause Psa To Rise
âAnything that traumatically interferes with the architecture around the prostate gland can make PSA go up,â says Dr. Milner. âOne of the most common causes of significantly high PSA from this type of trauma is the placing of a catheter into the bladder.â
Another cause is a prostate or bladder exam that involves passing a scope or taking a biopsy.
âSince it takes about two to three days for PSA to go down by half, you should wait two to three weeks after this type of trauma to do a PSA test,â Milner says.
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How Is The Psa Test Used In Men Who Have Been Treated For Prostate Cancer
The PSA test is often used to monitor patients who have a history of prostate cancer to see if their cancer has recurred . If a mans PSA level begins to rise after prostate cancer treatment, it may be the first sign of a recurrence. Such a biochemical relapse typically appears months or years before other clinical signs and symptoms of prostate cancer recurrence.
However, a single elevated PSA measurement in a patient who has a history of prostate cancer does not always mean that the cancer has come back. A man who has been treated for prostate cancer should discuss an elevated PSA level with his doctor. The doctor may recommend repeating the PSA test or performing other tests to check for evidence of a recurrence. The doctor may look for a trend of rising PSA level over time rather than a single elevated PSA level.
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When Is A Psa Test Needed
If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.
Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.
- You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
- Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
- If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
04/2014
When To See A Doctor
Some of the first symptoms of patients who have an elevated PSA level is difficult or painful urination, pain in the abdomen or pelvic area, and a frequent urge to urinate. These symptoms can be signs of BPH, prostatitis, prostate cancer, and kidney stonesall of which require different treatment. If you are experiencing any of these symptoms, it is important to talk with your doctor. Your doctor will be able to help determine the cause of your problems and provide an individualized treatment plan.
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Why A Psa Test Is Done
The PSA test may help to diagnose very early prostate cancer before any symptoms develop. But there are benefits and disadvantages of having treatment for early prostate cancer.
Sometimes a PSA test can lead to an earlier diagnosis of prostate cancer, when treatment to cure the cancer could be more effective. This is particularly the case if you have higher risk factors of prostate cancer.
Some prostate cancers grow very slowly. With early prostate cancer, you are not likely to die from it within the next 10 years. For some people, the possible side effects of treatment may be worse than the effects of the cancer itself.
You may decide you do not want to know if you have prostate cancer because of the anxiety or uncertainty it might cause you. You may not want further tests, or to make difficult decisions about treatment. Or you may have concerns about the side effects of treatment. Some treatment for prostate cancer may cause urinary incontinence or bowel problems, or affect your ability to get an erection.
- If you have risk factors
It is important to talk to your doctor about any risk factors when discussing a PSA test. You should be able to get PSA test from the age of 50. But if you have higher risk factors of prostate cancer you should be able to get it from 45 or younger. For example:
- if you are a black man your risk of prostate cancer is much higher
- if you have a family history of prostate cancer and breast cancer your risk is also higher.
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An enlarged prostate can also be the cause of other problems. If the enlarged prostate is causing symptoms, the best treatment would be a natural remedy. In the meantime, there are treatments for a wide range of conditions that cause a man to experience pain. A common surgical procedure involves an electric loop, laser, or electro-stimulation. The procedure is a safe and effective option for treating enlarged or symptomatic BPH.
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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.
An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.
Diseases That Cause Elevated Psa Levels
1. Age-related benign prostatic hyperplasia
A significant enlargement of the prostate gland can cause your PSA level to rise. While the overall volume of the prostate tends to increase in men as they age, the increase actually develops only in the transitional zone of the prostate as an abundance of nodules form and begins to compress the peripheral zone. While men often donât notice the growth directly, it can manifest itself in a more frequent urge to urinate.
2. Age-related BPH combined with chronic inflammation
In addition to BPH, chronic inflammation of the prostate can also lead to an elevated PSA level. In such cases, the two factors can act independently of one another, with each contributing to varying degrees to an increase in your PSA level.
3. Age-related BPH combined with prostate cancer
After learning from their urologists that they have benign prostatic hyperplasia, many men assume that this must also be the reason for their elevated PSA levels. However, while the enlargement will certainly tend to increase their PSA levels, prostate cancer may also be playing a role, for instance, by causing a continuous rise in their PSA levels.
4. Age-related BPH combined with acute prostatitis
5. Age-related BPH combined with multiple different tumors
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What Does An Elevated Psa Level Mean If Ive Had Prostate Cancer In The Past
If youve ever had treatment for prostate cancer, youll have regular PSA screenings for the rest of your life. An increasing PSA level may mean the cancer has returned. Your care team may use other tests, including imaging scans and biopsies, to check for signs of cancer. If cancer returns, your team will discuss your treatment options with you.
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Noncancerous Prostatic Disease And Urologic Manipulation
The serum PSA level can also be altered by noncancerous prostatic disease and urologic manipulations. Elevation of PSA levels has been demonstrated in acute prostatitis, subclinical or chronic prostatitis, and urinary retention. Nadler et al reported that serum PSA levels higher than 4.0 ng/mL in 148 men with subclinical prostatitis could be attributed to their disease because all these men had negative findings from biopsies repeated on multiple occasions.
No significant change occurs in the PSA level after a digital rectal examination , but a vigorous prostate massage can produce a short-term 2-fold increase. Cystoscopy, urethral catheterization, and transrectal ultrasonography of the prostate do not tend to elevate the PSA level. Needle biopsy of the prostate raises the PSA level by a median of 7.9 ng/mL within 5 minutes after the biopsy, and this level persists for 24 hours.
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Is There A National Screening Programme For Prostate Cancer
Screening is a way to try to find cancer early in people who do not have any symptoms. In the UK, there are screening programmes for breast, bowel, and cervical cancer.
There is no UK national screening programme for prostate cancer. The PSA test on its own is not accurate enough to be used in a screening programme to diagnose early prostate cancer. It may falsely diagnose prostate cancer and may also miss some cancers.
Some studies show that lives may be saved by PSA screening because it may lead to prostate cancer being diagnosed at an early stage. But they also show that screening may lead to:
- more invasive tests, such as a prostate biopsy, which can cause complications
- more treatment of slow growing prostate cancers that would never have caused serious harm.
Treatment side effects include:
- or difficulty getting an erection.
For a screening programme to be effective, the benefits need to outweigh the disadvantages.
Considering Your Psa Velocity
It is useful to have your records of previous PSA testing if you have BPH. Comparing and making a timeline is fundamental in order to see the rate of prostate growth.
This is called PSA velocity. When the elevation of this measure is sudden and does not correspond with the average increase over the years, it can indicate prostate cancer.
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Urinary Tract Infection Or Irritation
An infection of the urinary tract, as well as irritation caused by medical procedures involving the urethra or bladder, may irritate the prostate and cause it to produce more PSA. If you have experienced any of these, be sure to let your doctor know. Youll need to give the area some time to heal and calm down before running a PSA test.
If You Have Bph And A High Psa Should You Be Worried
As noted above, PSA levels in BPH are higher than the average. But the same happens with prostate cancer. How can you tell if your elevated PSA corresponds to benign prostatic hyperplasia or prostate cancer?
Urologists have tried to figure out multiple ways to solve this problem and came up with a few solutions :
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A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.
While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.
How Is Hormone Therapy Used To Treat Hormone
Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer, including:
Early-stage prostate cancer with an intermediate or high risk of recurrence. Men with early-stage prostate cancer that has an intermediate or high risk of recurrence often receive hormone therapy before, during, and/or after radiation therapy, or after prostatectomy . Factors that are used to determine the risk of prostate cancer recurrence include the grade of the tumor , the extent to which the tumor has spread into surrounding tissue, and whether tumor cells are found in nearby lymph nodes during surgery.
The use of hormone therapy before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials.
Relapsed/recurrent prostate cancer. Hormone therapy used alone is the standard treatment for men who have a prostate cancer recurrence as documented by CT, MRI, or bone scan after treatment with radiation therapy or prostatectomy.
Hormone therapy is sometimes recommended for men who have a âbiochemicalâ recurrencea rise in prostate-specific antigen level following primary local treatment with surgery or radiationespecially if the PSA level doubles in fewer than 3 months.
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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.
Pros And Cons Of The Psa Test
Pros:
- it may reassure you if the test result is normal
- it can find early signs of cancer, meaning you can get treated early
- PSA testing may reduce your risk of dying if you do have cancer
Cons:
- it can miss cancer and provide false reassurance
- it may lead to unnecessary worry and medical tests when there’s no cancer
- it cannot tell the difference between slow-growing and fast-growing cancers
- it may make you worry by finding a slow-growing cancer that may never cause any problems
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