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 and 18F-DCFPyl , 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.
The pictures from a PET scan arent as detailed as MRI or CT scan images, but they can often show areas of cancer anywhere in the body. Some machines can do a PET scan and either an MRI or a CT scan at the same time, which can give more detail about areas that show up on the PET scan.
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 cancer and colon cancer, 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
- Complications and side effects from biopsies to confirm a diagnosis
- The possibility that a prostate cancer diagnosis wont extend lifespan or improve quality of life
How Do I Prepare For A Blood Test
Your healthcare provider will give you specific instructions on how to prepare for your blood test. The instructions may differ depending on the type of test and other bloodwork youre having at the same time.
You may have to fast for eight to 12 hours. That means you shouldnt eat or drink anything besides water. You also may have to avoid certain medications beforehand.
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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.
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
Experts In Urology Care
If you are experiencing symptoms consistent with urinary issues, we urge you to complete our urologic cancer risk assessment form.
Not everyone should get a PSA test. Why? Because many men 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 . So a PSA test is recommended only for men who might be at greater risk for dying of prostate cancer for example, younger men with a family history of prostate cancer or African-American men.
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.
The NCCN recommends that only men in these categories receive a PSA test for early detection of prostate cancer:
Tests Your Specialist Might Do
Depending on the results of your tests, your GP might refer you to a specialist. You usually see a urologist. This is a doctor who specialises in treating problems of the urinary tract such as the prostate, bladder and kidneys.
Your specialist usually does more tests. These include:
- an MRI scan
- bone scan
What Does A Dre Involve
You might have a DRE at your GP surgery or at the hospital.
The doctor or nurse will ask you to lie on your side on an examination table, with your knees brought up towards your chest. They will slide a finger gently into your back passage. Theyll wear gloves and put some gel on their finger to make it more comfortable.
You may find the DRE slightly uncomfortable or embarrassing, but the test isnt usually painful and it doesnt take long.
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Other Tests To Help Confirm Diagnosis
- Multiparametric-magnetic resonance imaging : This advanced imaging technology may be used to detect, assess and stage prostate tumors.
- Prostate cancer gene 3 test: This is a urine-based prostate cancer test designed to look for the PCA3 gene. Higher quantities of this gene in the urine have been linked to prostate cancer.
- Prostate Health Index : This blood test calculates a score using different forms of PSA, generating more specific prostate cancer blood test results than the standard PSA test. It can provide additional information regarding elevated PSA levels while helping predict biopsy results.
Transrectal Ultrasound Scan Guided Biopsy
Your doctor takes a series of small tissue samples from the prostate to examine under a microscope. You have the biopsy through the back passage using a transrectal ultrasound scanner.
A TRUS guided biopsy can be uncomfortable. You usually have a local anaesthetic to numb the area and reduce any pain.
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Determining Whether Prostate Cancer Is Aggressive
If a biopsy sample is found to contain cancer, the pathologist analyzing the specimen takes a deeper look at the cancer cells to determine how aggressive the disease is likely to be.
If the cancer cells appear significantly abnormal and dissimilar from healthy cells under a microscope, the cancer is considered more aggressive and expected to advance quickly. Conversely, cancer cells that look relatively similar to healthy cells indicate that its less aggressive and may not spread as fast.
Prostate cancers are assigned a Gleason score depending on how abnormal the cells look..
Gleason score: Gleason scores range from 2 to 10, going from least to most aggressive prostate cancers.
There are different types of cancer cells in a prostate tumor, so the final Gleason score is determined by adding the scores of the two main areas of the tumor.
First, the primary part of the tumor is assigned a number between 1 and 5. Lower numbers indicate that the cells appear relatively similar to healthy cells, while higher numbers show that the cells are abnormal-looking. Then, another number between 1 and 5 is assigned to describe the second most prevalent area of the tumor.
Finally, the two numbers assigned to the different parts of the prostate tumor are added. So, if most of the tumor is given a 4, and some of the tumor is more aggressive and given a 5, the final Gleason score would be 9.
There are many biomarker tests, including:
- Oncotype DX® Genomic Prostate Score
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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A Note On Suspicious Results
A suspicious result indicates that the biopsy sample contained some abnormalities but no cancer was found. There are a couple of potential explanations for a suspicious prostate biopsy result, including:
- Prostatic intraepithelial neoplasia refers to changes within prostate cells that are abnormal, but not indicative of cancer. This condition is low-grade or high-grade, depending on how abnormal the cells are. Low-grade PIN is very common and isnt associated with prostate cancer. High-grade PIN, however, is associated with a higher risk of prostate cancer. If you have high-grade PIN after a prostate biopsy, your doctor may recommend that biomarker tests be performed on the sample to learn more about the cells. Alternatively, another prostate biopsy may be suggested.
- Atypical small acinar proliferation indicates that the biopsy sample contains some cells that appear to be cancerous, but not enough to confirm the diagnosis. In most cases, this finding suggests that another prostate biopsy is needed.
- Proliferative inflammatory atrophy describes a prostate biopsy that reveals inflammation in the prostate and abnormally small prostate cells. While these cells arent cancerous, having PIA may be associated with an increased risk of developing prostate cancer.
Your Psa Is Going Up Whats Going On With Your Prostate Good News: Second
Your PSA is going up. Whats going on with your prostate? Do you need a biopsy? Or, maybe youve already had a biopsy that didnt find cancer, but your urologist is wondering whether you need another one. Whats the next step?
Good news: You dont have to move directly to having needles stuck in your prostate! Its not the Monopoly bad-case-scenario of Do not pass Go, do not collect $200! There is a next step! Its a second-line test: a blood or urine test that can provide other layers of information beyond the basic PSA test. There are several good ones out there. Which one do you need? Well, as Marlon Brando said in the classic 1953 movie, The Wild One: Whadya got?
Theres no shortage of options! There are blood tests that provide more nuanced information than the basic PSA test, plus urine tests and even, if youve already had a biopsy, molecular biomarker tests, which arent done on body fluids but on tissue samples. These tests can be helpful, not only in diagnosing cancer, but in risk stratification predicting which cancer is more likely to be aggressive, and which cancer is less likely to need immediate treatment.
Now, about those other blood tests: In addition to the free PSA test, here are two more that include free and total PSA, but look for other factors, as well:
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What Happens If You Have A Likert Score Of 1 Or 2
Your doctor may not recommend a biopsy if you have a low Likert score. But you can still have one if you want to. Your doctor will explain the possible benefits and risks of having a biopsy.
When recommending whether you need a biopsy or not, your doctor also looks at other factors. These include:
- your age
- other test results such as PSA level and prostate examination
- the size of your prostate and the corrected PSA for its size. This is called the PSA density
- any other health conditions that you might have
- how well youd cope with prostate cancer treatment and whether it would benefit you
They might decide not to recommend a biopsy if you’re unwell or not likely to be able to have treatment.
If you don’t have a biopsy, your doctor may recommend monitoring your PSA level. They will recommend what your PSA level should be. You are usually discharged back to your GP to be monitored. Your GP can refer you back if the PSA levels go up.
What If My Psa Is High
PSA screening is just the first step, alerting you and your doctor that more testing may be needed. If PSA is only slightly elevated, your doctor may recommend repeating the test a couple of weeks later. From there, other types of tests can help with the decision on whether you need a biopsy, including:
- Digital rectal exam , if not already done
- Free PSA test
- PSA velocity, or the rate of rise over time
- PSA density, or the PSA per volume of prostate
- PSA-based markers
- Other markers, a urinary PCA3 or SelectMDx test
- Magnetic resonance imaging of the prostate
Each time you see your doctor for a checkup, have a conversation about prostate health and prostate cancer screening. PCF recommends that you make a about PSA screening with your doctor, starting at age 45, or age 40 if you have a family history of prostate or other cancers or are Black.
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Is A Prostate Biopsy Painful
Chances of feeling any significant pain during a prostate biopsy are generally low, because your doctor will numb the area with an anesthetic shot.
However, you may feel some pain after the procedure, especially when sitting. Pain may occur in the area between the anus and scrotum and can last for a day or two. Your doctor may prescribe pain medications and suggest that you take it easy for a few days after the procedure.
Genetic Testing For Some Men With Prostate Cancer
Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.
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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:
Signs That Warrant An Immediate Trip To A Doctor
Some common cancer signs that should result in a visit to the emergency room or to a doctor as soon as possible include:
- coughing up mucus tinged with blood
- blood in stools or urine
- lump in the breast, testicles, under the arm, or anywhere that it didnt exist before
- unexplained but noticeable weight loss
- severe unexplained pain in the head, neck, chest, abdomen, or pelvis
These and other signs and symptoms will be evaluated. Screenings, such as blood and urine tests and imaging tests, will be used if your doctor thinks its appropriate.
These tests are done both to help make a diagnosis as well as rule out various causes of your signs and symptoms.
When seeing a doctor, be prepared to share the following information:
- your personal medical history, including all symptoms you have experienced, as well as when they began
- family history of cancer or other chronic conditions
- list of all medications and supplements you take
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When Should I Get A Psa Test
The guidelines below are adapted from the NCCN Clinical Practice Guidelines In Oncology for Prostate Cancer Early Detection. Please use these guidelines to have a discussion with your physician about your personal risk and make a plan for screening.
- If you are between ages 45 and 75:
- Discuss the risks and benefits of prostate cancer screening with your doctor, have a baseline PSA, and consider a baseline DRE
- If your PSA is below 1 ng/mL and your DRE is normal, repeat testing every 2-4 years
- If your PSA is between 1 and 3 ng/mL and your DRE is normal, repeat testing every 1-2 years
- If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy