New Blood Test Improves Prostate Cancer Screening
Researchers at Karolinska Institutet recently reported that magnetic resonance imaging could reduce overdiagnoses and thereby improve prostate cancer screening.
Now, the same research group has published a study in The Lancet Oncology, which shows that the addition of a novel blood test, the Stockholm3 test, can reduce the number of MRIs performed by a third while further preventing the detection of minor, low-risk tumours.
Image credit: Darko Stojanovic via pixabay.com, free licence
Overall, our studies show that we have identified the tools needed to be able to carry out effective and safe screening for prostate cancer. After many years of debate and research, it feels fantastic to be able to present knowledge that can improve healthcare for men, says Tobias NordstrÃ¶m, associate professor of urology at the Department of Clinical Sciences, Danderyd Hospital at Karolinska Institutet, who is responsible for the STHLM3MRI study.
Current screening methods PSA tests combined with traditional biopsies result in unnecessary biopsies and the detection of numerous minor, low-risk tumours . Consequently, no country except Lithuania has chosen to introduce a nationwide prostate cancer screening programme, as the benefits do not outweigh the disadvantages.
In Men Over : Bph May Be The Cause Of High Psa
BPH is the most common prostate problem in men over age 50. It may not need to be treated unless its causing frequent or difficult urination.
Your primary care doctor may be able to tell the difference between BPH and prostate cancer by doing a digital rectal exam, but commonly this will require evaluation by a urologist and further testing, such as a biopsy or imaging studies.
Potential Harms Of Screening And Treatment
Potential Harms of Screening and Diagnosis
In addition to the ERSPC and PLCO trials, the USPSTF examined the results of a good-quality cohort study embedded within the ProtecT trial , a fair-quality cohort study conducted in the US Department of Veterans Affairs health system, as well as a report on complications of prostate biopsy from the ERSPC Rotterdam site to understand the potential harms of screening and diagnosis.3
In the large RCTs, one-fourth to one-third of men offered PSA-based screening had at least 1 positive screening test result. In the PLCO trial, 13% of men had undergone at least 1 biopsy. In the ERSPC trial, nearly 28 biopsies were performed for every 100 men randomized to screening.3 In the ProbE trial, 7.3% of men reported moderate or greater pain, 5.5% reported moderate to severe fever, and 26.6% reported troublesome hematospermia within the 35 days after biopsy.28 Complications from transrectal prostate biopsy resulted in 1.3% of men in the UK cohort, 1.6% of men in the VA cohort, and 0.5% of men in the Rotterdam cohort requiring hospitalization.30-32 In these studies, two-thirds to three-fourths of biopsies demonstrated that the PSA screening test was a false positive.3
Potential Harms of Treatment
In several studies, men older than 70 years had a significantly increased risk of medical complications and perioperative mortality after radical prostatectomy compared with younger men.3
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When Is It Time To Stop Being Checked For Prostate Cancer
Its essential to be fully informed about the potential risks of PSA testing, which includecomplications from biopsies and teratments.
The answer depends on your current health and your level of concern about cancer.
Routine PSA testing to check for prostate cancer is no longer recommended for most men. But despite what the experts suggest, many men continue to opt for annual PSA tests. This includes a surprisingly large number of men in their 70s. In a recent study in the journal Cancer, more than half of a group of men 75 and older had PSA tests and biopsies.
These men have placed their hope in the value of early diagnosis and treatment, yet stand to gain less from PSA testing than younger men. Across all ages, routine PSA screening leads to life-saving treatment for cancer in about one in every 1,000 men screened.
Force guidelines: These independent experts on preventive medicine do not recommend PSA screening for prostate cancer in men at any age, due to a lack of definitive evidence that the benefits of PSA testing are greater than the risks.
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What Are Clinical Trials And Are They Right For You
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.
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What’s A Raised Psa Level
The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood .
If you’re aged 50 to 69, raised PSA is 3ng/ml or higher.
A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of another condition that’s not cancer, such as:
What Is The Test To See If I Have Elevated Psa
Healthcare providers use a blood test to measure PSA levels.
You may have a digital rectal exam together with a PSA test to check for signs of prostate cancer. During a DRE, your provider inserts a gloved finger into the rectum to check for bumps or other irregularities.
Depending on the results of your initial test, your provider may want you to repeat the test. PSA levels can change. A second test gives your provider more details about your prostate health.
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Research Needs And Gaps
There are many areas in need of research to improve screening for and treatment of prostate cancer, including
- Comparing different screening strategies, including different screening intervals, to fully understand the effects on benefits and harms
- Developing, validating, and providing longer-term follow-up of screening and diagnostic techniques, including risk stratification tools, use of baseline PSA level as a risk factor, and use of nonâPSA-based adjunctive tests that can distinguish nonprogressive and slowly progressive cancer from cancer that is likely to become symptomatic and affect quality or length of life, to reduce overdiagnosis and overtreatment
- Screening for and treatment of prostate cancer in African American men, including understanding the potential benefits and harms of different starting ages and screening intervals and the use of active surveillance given the large disparities in prostate cancer mortality in African American men, this should be a national priority
- How to better inform men with a family history of prostate cancer about the benefits and harms of PSA-based screening for prostate cancer, including the potential differences in outcomes between men with relatives who died of prostate cancer and men with relatives diagnosed with prostate cancer who died of other causes
- How to refine active prostate cancer treatments to minimize harms
What Do The Results Mean
There is no specific normal or abnormal level for PSA in blood. In general, the higher your PSA level, the more likely it is that you have cancer. But it’s possible to have a high PSA without prostate cancer, or a low PSA with prostate cancer.
If you had a PSA test for a prostate cancer screening or because you have prostate symptoms:
- High PSA levels can mean you have prostate cancer or a prostate condition that’s not cancer, such as an infection or an enlarged prostate. If your PSA levels are higher than normal, your provider may talk with you about having more tests to diagnose the cause. These tests may include:
- Another PSA test, more commonly if you don’t have any symptoms. PSA levels can go up and down, so it helpful to see if your PSA levels change over time.
- A digital rectal exam . For this test, your provider inserts a gloved, lubricated finger into your rectum to feel your prostate for lumps or anything unusual.
- A urine test. A sample of your urine is tested for infection.
- A prostate biopsy. A biopsy is minor surgery. A doctor removes samples of tissue from your prostate so it can be studied under a microscope to look for cancer cells. A biopsy is the only way to diagnose cancer. It may be recommended if your provider thinks you may have prostate cancer.
If you have questions about your results, talk with your provider.
Learn more about laboratory tests, reference ranges, and understanding results.
What Other Test Are Available For Men At Risk For Prostate Cancer
While traditionally, the options available to men at risk for prostate cancer were limited to PSA blood test and a prostate exam , a number of exciting innovative options are now available.
PSA is still a useful test but is being supplanted by more informative tests such as 4KScore and PHI , both of which incorporate the traditional PSA test as well. Thus, the report will list both the traditional PSA test and the 4KScore or PHI score respectively.
PHI is a new test that provides an incremental improvement over the PSA test alone when it comes to predicting the risk of prostate cancer. It can be used to reduce the need for unnecessary biopsies in some men.
Factors That Affect Psa Levels
It is important to note that PSA levels can rise naturally with age, and that a number of benign conditions can also affect PSA levels, such as prostatitis , benign prostatic hyperplasia , urinary tract infection , or even injury to the prostate.
Other factors such as sexual activity right before testing, certain exercises, or even diet can impact the PSA levels as well. It is essential to consult a doctor regarding the meaning and next steps of your PSA testing results.
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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.
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Further Tests For Prostate Cancer
If results of the PSA test or the DRE are abnormal, a urologist will likely recommend a biopsy, where small samples of tissue are removed from the prostate and examined.
If cancer is diagnosed, other tests may be used to check the progression of the cancer, including:
- magnetic resonance imaging scan of the prostate often done before a biopsy
- bone scan to check whether or not cancer cells have spread to the bones
- computed tomography scan a specialised x-ray
- pelvic lymph node dissection a nearby lymph node is removed and examined to check whether or not cancer cells have entered the lymphatic system .
Can I Have False Psa Results And No Cancer In My Prostate
What are the reasons cause false PSA high levels and false low PSA results, which means you have no cancer in your prostate at all and your PSA level was relatively incorrect, come to know and tell your doctor youre a cancer Free.A matter of concern for whom deal with prostate cancer testing with PSA blood test as an early cancer marker, you must be aware of things can alter your PSA interpretation, however the professional lab tech must ask you about them before taking a blood sample for prostate specific antigen test.If you dont understand the PSA just read> what is the PSA blood test meaning?What do cause False positive PSA results?PSA false results mean thats unlikely you have a prostate cancer and may come from:
Dont miss interpretation of high PSA at: What does elevated PSA mean?Understanding False Low PSA ResultsIn general, a low PSA is a good result. However, there are several reasons a PSA test level may be artificially low including:
- Taking statins to lower cholesterol, anti-inflammatory drugs and obesity: thats because body fat decreases the amount of PSA circulating in the blood stream.
- Over doses of some chemotherapeutic drugs, for instance cyclophosphamide and methotrexate, can cause false PSA increase or false PSA levels decrease.
What to do when your results show false PSA results?
Other blood tests for cancer detection can help make decision:
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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.
My Psa Is Elevated What Could It Mean
First, realize that having an elevated PSA does not necessarily mean you have cancer in your prostate. Other causes for an elevated PSA include:
- infection, instrumentation of the urinary tract, disruption, trauma, or manipulation of the prostate
- certain conditions like prostatitis or enlarged prostate
You and your doctor will work together to identify any of these possible contributing factors to your higher PSA through measures like checking for urine infection, reviewing for history of instrumentation, inflammation and discussing family health history. You and your doctor may identify such a cause, address it with treatment, and re-test PSA to see whether the level has appropriately decreased.
If you and your doctor do not rule out any other causes, you will likely need to undergo another PSA test and a digital rectal exam. During this exam, a physician inserts a lubricated, gloved finger into the rectum to reach the prostate and feel for any lumps or hard areas. Continued abnormal results from the PSA test or rectal exam call for further investigation to identify clinically significant prostate cancer.
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What Abnormal Results Mean
A high PSA level has been linked to an increased chance of having prostate cancer.
PSA testing is an important tool for detecting prostate cancer, but it is not foolproof. Other conditions can cause a rise in PSA, including:
- A larger prostate
- Recent tests on your bladder or prostate
- Catheter tube recently placed into your bladder to drain urine
Your provider will consider the following things when deciding on the next step:
- If you had a PSA test in the past and how much and how fast your PSA level has changed
- If a prostate lump was found during your exam
- Other symptoms you may have
- Other risk factors for prostate cancer, such as ethnicity and family history
Men at high risk may need to have more tests. These may include:
- Repeating your PSA test, most often sometime within 3 months. You may receive treatment for a prostate infection first.
- A prostate biopsy will be done if the first PSA level is high, or if the level keeps rising when the PSA is measured again.
- A follow-up test called a free PSA . This measures the percentage of PSA in your blood that is not bound to other proteins. The lower the level of this test, the more likely it is that prostate cancer is present.
Other tests may also be done. The exact role of these tests in deciding on treatment is unclear.
- A urine test called PCA-3.
- An MRI of the prostate may help identify cancer in an area of the prostate that is hard to reach during a biopsy.