Advising Men Without Symptoms Of Prostate Disease Who Ask About The Psa Test
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This prostate cancer risk management programme information helps GPs give clear and balanced information to asymptomatic men who ask about prostate specific antigen testing. The PSA test is available free to any man aged 50 and over who requests it.
GPs should use their clinical judgement to manage asymptomatic men and those aged under 50 who they consider to be at increased risk of prostate cancer.
GPs should follow National Institute for Health and Care Excellence guideline NG12 for the management of men who have symptoms of prostate disease.
What Is A Dangerous Psa Level
PSA levels are measured as a number of nanograms in each milliliter of fluid tested. This is written as ng/mL.
- PSA level 2.5 ng/mL or lower: This is a normal PSA level for those under age 60, but in some cases, prostate cancer may still be present.
- PSA level between 2.5 and 4 ng/mL: This is a normal PSA level for most people.
- PSA level between 4 and 10 ng/mL: This indicates that prostate cancer might be present. At this level, there is about a 25% chance that you have prostate cancer.
- PSA level 10 ng/mL or above: There is a 50 percent chance that prostate cancer is present. The higher the PSA rises above 10 ng/mL, the greater the chance that you have prostate cancer.
Your doctor may also monitor your PSA velocity, or doubling time, which means recording your baseline PSA the level at your very first PSA test and seeing how fast the PSA level increases over time. Rapid increases in PSA readings can suggest cancer. If your PSA is slightly high, you and your doctor may decide to keep an eye on your levels on a regular basis to look for any change in the PSA velocity.
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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Do I Need The Psa Test
The PSA test is not recommended for men who dont have symptoms of prostate cancer, as it can lead to unnecessary investigations and treatments that have serious side effects.
If you are at higher risk of developing prostate cancer, or if you have symptoms that may indicate cancer, PSA testing may be of more benefit.
Cancer Council Australia and the Royal Australian College of General Practitioners both recommend against routine screening in men without symptoms. That is because the PSA test is not very accurate for screening men without symptoms. High PSA levels can be due to many things, and cancer is just one of them. And a man with prostate cancer can have a normal PSA level.
As there is a range of risks and potential benefits of PSA testing, talk to your doctor to help make an informed decision.
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 .
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If Screening Test Results Arent Normal
If you are screened for prostate cancer and your initial blood PSA level is higher than normal, it doesnt always mean that you have prostate cancer. Many men with higher than normal PSA levels do not have cancer. Still, further testing will be needed to help find out what is going on. Your doctor may advise one of these options:
- Waiting a while and having a second PSA test
- Getting another type of test to get a better idea of if you might have cancer
- Getting a prostate biopsy to find out if you have cancer
Its important to discuss your options, including their possible pros and cons, with your doctor to help you choose one you are comfortable with. Factors that might affect which option is best for you include:
- Your age and overall health
- The likelihood that you have prostate cancer
- Your own comfort level with waiting or getting further tests
If your initial PSA test was ordered by your primary care provider, you may be referred to a urologist for this discussion or for further testing.
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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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.
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
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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.
What Is The Success Rate Of Hifu For Prostate Cancer
A large study discovered that patient success rates for prostate cancer treatment with high-intensity focused radiation ranged from 61% to 95%. That is a wide range of possible outcomes. Robert Pugach, MD has more than 17 years of experience treating patients with prostate cancer with high-intensity focused radiation.
A long-term evaluation of total HIFU treatment for prostate cancer demonstrated its efficacy. According to cancer risk factors, specific survival rates for 10 years range from 92% to 99%, with survival rates without metastasis ranging from 86% to 100%. In 80% of patients, a couple retained their sexual function, while in over 94%, both couples had perfect continence. In the focal treatment of prostate cancer, there is excellent long-term preservation of quality of life, with minimal impact on incontinence or sexual function . The primary side effects of total HFU treatment are listed below. Hemi-ablation was used in a study comparing treatment for bilateral prostate cancer with radical prostatectomy.
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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.
If you have any questions, to schedule a consultation or if you need a second opinion, pleasecontact us or call:
How Is Psa Testing Used For Pretreatment Staging Of Prostate Cancer
Once prostate cancer is diagnosed by the presence of cancer cells on prostate biopsy and assigned a cancer grade , PSA is used in combination with the grade of the prostate cancer to determine further medical studies needed for cancer staging. Staging determines if the cancer is localized or metastatic . Staging therefore drives the best management and appropriate treatment for the cancer. As mentioned earlier, serum PSA levels correlate with the risk of prostate cancer extension outside of the prostate including seminal vesicle invasion as well as metastasis to the pelvic lymph nodes.
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If Your Psa Is Above 25 You May Have Prostate Cancer: What To Know
A PSA level greater than 2.5 ng/ml in men aged 40 and 50 is considered abnormal. PSA levels between 0.6 and 0.7 ng/ml for this age group are typical. A PSA level of more than 4.0 ng/ml is considered abnormal in men over the age of 60. A PSA level of 10 ng/ml or higher indicates a higher risk of prostate cancer. Prostatal cancer, in addition to being lethal, can be prevented by catching it early. Men should have their PSA levels checked on a regular basis and have any concerns addressed with their doctor.
If I Have Elevated Psa Levels What Should I Ask My Healthcare Provider
If you have any symptoms of prostate cancer, or if it runs in your family, ask your provider:
- Should I have regular tests to check my PSA level?
- What can I do to lower my risk for prostate cancer?
- What other tests or monitoring do I need?
- What are my treatment options if I get prostate cancer?
- What other signs or symptoms should I look out for?
A note from Cleveland Clinic
An elevated PSA level can be a sign of prostate cancer, but it doesnt always mean you have cancer. Your healthcare provider will watch you and do more tests to arrive at a diagnosis. Prostate cancer is often slow-growing and may never become life-threatening. If you have symptoms of prostate problems, such as difficulty urinating, don’t hesitate to let your provider know.
Last reviewed by a Cleveland Clinic medical professional on 04/06/2021.
References
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The Role Of Psa In Choosing The Best Treatment
If you have received a diagnosis of prostate cancer, your PSA levels can be used along with the results of other tests and physical exams and your tumors Gleason score to help determine which tests are needed for further evaluation and to decide on the best treatment plan. After treatment has begun, your PSA and other tests will be used to determine how well the treatment is working: The more successful the therapy, the lower the PSA.
What Is A Normal Psa Reading For A 70 Year Old
A normal PSA reading for a 70 year old male is between 0 and 4 ng/mL. A PSA level above 4 ng/mL may be a sign of prostate cancer.
PSA, as a valuable marker of prostate cancer, can provide some benefit, but its true utility is unknown. The presence of age, prostatitis, or BPH has been linked to increased PSA levels. Prominent lifestyle changes can be beneficial in improving your prostate health. Your PSA-reduction diet plan is just a mouse click away. If you have a number of known risk factors, a high PSA level is more likely to be associated with prostate cancer. Parathyroid hormone causes prostate cancer, indicating that it has a direct effect on prostate cancer. Because PSA screening can be difficult with other conditions, it is not a singular indicator of prostate cancer.
You start to notice that the prostate gland becomes larger and produces more PSA as you get older. PSA screening should be avoided for men under the age of 54, according to the American Urological Association. If your PSA test result is high for your age or if your PSA level is consistently increasing, you may need to have a prostate biopsy. Following a diagnosis of prostate cancer, lifestyle factors are thought to play a role as well. Pomegranate juice 8 oz significantly reduced PSA levels (Pantuck et al., 2005 Pantuck et al., 2007 Pantuck et al.,
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