Optimal Total Psa Cut
No single total PSA cut-off separates men at high risk for PCa from men at low risk, nor men affected with high-grade disease from those with low-grade disease. At a total PSA cut-off of 4 ng/mL, a significant number of PCas remain undetected. In addition, intervention at lower total PSA levels has been proposed to improve patient outcomes. Catalona et al. found that 22% of men with a normal digital rectal examination and a serum total PSA level between 2.6 and 4.0 ng/mL have PCa, and 81% of them have organ-confined disease. Data from the Prostate Cancer Prevention Trial revealed that as many as 15% of men with normal DRE and a serum total PSA less than 4.0 ng/mL have PCa. Among men with total PSA levels 0.5, 0.61.0, 1.12.0, 2.13.0, and 3.14.0 ng/mL, PCa was detected in 6.6%, 10.1%, 17.0%, 23.9%, and 26.9%, respectively. Moreover, approximately 25% of these men had a tumor with Gleason score of 7 or higher. These and other investigators demonstrated that increasing levels of total PSA are associated with increasing probability of PCa risk within the 0-4.0 ng/mL interval. There is no total PSA threshold at age 62-91 below which PCa can be ruled out with high specificty. No single total PSA cut-off separates men with significant cancer from those with low-grade, possibly insignificant cancer. Similar to PCa presence, high-grade cancer can be found in men with low total PSA levels.
Why Are Prostate Cancer Markers Important
Prostate cancer markers are greatly impacting the world of prostate cancer from early detection through diagnosis, by helping men to better understand their risk of having the disease and identifying the aggressiveness of the disease if present. These tests can also help doctors to learn more about your cancer and help to plan treatment.
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.
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What Is Being Tested
The PSA blood test can help detect or monitor prostate cancer.
The prostate is a small gland at the base of the bladder in men. It is part of the male reproductive system, and produces the protein PSA. PSA is released into semen but some also enters the bloodstream.
High levels of PSA can be caused by prostate cancer, but they are usually caused by other conditions.
If you have prostate symptoms, you might be asked to have a PSA test. It might help point your doctor in certain directions, but it doesnt diagnose prostate cancer. The only way to do that is with a biopsy.
If you have been diagnosed with prostate cancer, the PSA test can help monitor your condition. When the levels go up, this suggests the cancer is growing. When they go down, this suggests it might be shrinking.
Additional Diagnostic Methods For Cancer
Routine bloodwork can help detect cancer, but doctors will use additional methods to confirm a cancer diagnosis. Other diagnostic tools for cancer include:
- Genetic testing
- Additional specific blood tests
Not all cancers can be detected with blood tests either. For example, to diagnose skin cancer, patients will always require a skin biopsy. Breast cancer is diagnosed with imaging, specifically mammograms, and pap smears are used to screen for cervical cancer.
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What Is A Dangerous Psa Level
The higher your PSA level, the higher the risk for prostate cancer. While PSA levels may fluctuate during your lifetime, a consistent rise in PSA over time can indicate prostate cancer.
If you have a PSA level , youre considered to be in the borderline range, according to the ACS. You have a 1 in 4 chance of having prostate cancer.
If PSA levels rise above 10, theres a 50 percent chance you have prostate cancer.
How Tumor Marker Tests Work
Tumor marker tests detect the presence of tumor markers for various cancers. Tumor markers are substances made by your bodyâs normal response to cancer or cancerous cells. Tumor markers can indicate a specific type of cancer or several different types. Scientists are still learning about known tumor markers and researching new ones.
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What Are The Prostate Cancer Symptoms I Need To Look Out For
In its early stages, prostate cancer may not show any symptoms. Symptoms of early prostate cancer can include:
- difficulty passing urine
- a slow, interrupted flow of urine
- frequent passing of urine, including at night
- incontinence.
Symptoms associated with advanced prostate cancer include:
- blood in urine
- pain during urination
- lower back or pelvic pain.
These symptoms are also found in men who may have benign prostatic hyperplasia , a common, non-cancerous enlargement of the prostate gland.
If you experience these symptoms, visit your doctor.
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.
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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
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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What Are Some Of The Limitations And Potential Harms Of The Psa Test For Prostate Cancer Screening
Detecting prostate cancer early may not reduce the chance of dying from prostate cancer. When used in screening, the PSA test can help detect small tumors. Having a small tumor found and treated may not, however, reduce the chance of dying from prostate cancer. That is because many tumors found through PSA testing grow so slowly that they are unlikely to be life threatening. Detecting such tumors is called overdiagnosis, and treating them is called overtreatment.
Overtreatment exposes a person unnecessarily to the potential complications associated with prostate surgery and radiation therapy. These include urinary , gastrointestinal , and sexual side effects .
In addition, finding cancer early may not help someone who has a fast-growing or aggressive prostate tumor that may have spread to other parts of the body before being detected.
The PSA test may give false-positive results. A false-positive test result occurs when the PSA level is elevated but no cancer is actually present. A false-positive test result may create anxiety and lead to additional medical procedures, such as a prostate biopsy, that can be harmful. Possible side effects of biopsies include serious infections, pain, and bleeding.
False-positive test results are common with PSA screening only about 25% of people who have a prostate biopsy due to an elevated PSA level are found to have prostate cancer when a biopsy is done .
How Much Does The Test Cost
The price of a PSA test will vary based on where the test is conducted and whether you have health insurance. If you have health care coverage, you can reach out to your insurance provider directly to find out what a PSA test will cost under your plan. Depending on your plan, you may be responsible for out-of-pocket costs, such as copays and deductibles.
The cost of at-home PSA testing ranges from about $30 to $70.
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How Blood Protein Testing Works
Blood protein testing uses a process called electrophoresis to measure two types of proteins in the blood: globulin and albumin. Albumin is the most abundant protein in the blood. Low levels of albumin can signal myeloma as the cancer may block its production. High levels of globulin can signal myeloma as it can cause an increase in production of globulin.
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:
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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
- Recent intercourse or ejaculation
Your provider will consider the following things when deciding on the next step:
- Your age
- 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.
Psa In Other Biologic Fluids And Tissues
Concentration of PSA in human body fluids
| Fluid | |
|---|---|
| female serum | 0.01 – 0.53 |
It is now clear that the term prostate-specific antigen is a misnomer: it is an antigen but is not specific to the prostate. Although present in large amounts in prostatic tissue and semen, it has been detected in other body fluids and tissues.
In women, PSA is found in female ejaculate at concentrations roughly equal to that found in male semen. Other than semen and female ejaculate, the greatest concentrations of PSA in biological fluids are detected in breast milk and amniotic fluid. Low concentrations of PSA have been identified in the urethral glands, endometrium, normal breast tissue and salivary gland tissue. PSA also is found in the serum of women with breast, lung, or uterine cancer and in some patients with renal cancer.
Tissue samples can be stained for the presence of PSA in order to determine the origin of malignant cells that have metastasized.
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What Is The Psa Test Used For
PSA is measured in a routine blood test of middle and elderly men as a marker for the screening and prognosis for prostate cancer.
It is recommended, for age 50 or above, to perform a PSA test each year. Men having a first-degree relative with prostate cancer should begin at age 45 or even at 40.
Prostate Specific Antigen is a tumor marker and it is a good indicator for prostate cancer, although it is also high in other conditions. If PSA is high in a blood test, it is necessary to perform additional screening tests to know if it is due to a prostate cancer or another type of prostate disorder.
PSA in the blood is found high in two different conditions:
- Benign Prostatic Hyperplasia : due to an increase in free PSA
- Prostate cancer: due to an increase in conjugated PSA
For that reason, when there is a high PSA in the blood it is recommended to know the free PSA in order to know the rate Free PSA / Total PSA. High levels of free PSA suggest a benign process, whereas low free PSA correlates more closely with prostate cancer.
A high PSA level in the blood may be also a sign of infection or prostate trauma.
The greatest value of PSA is as a marker in the follow-up of patients at high risk for disease progression. Ideally, the PSA should decline to undetectable levels within 2 or 3 weeks of radical prostatectomy. The level of PSA following prostatectomy should be below 0.5 ng/ml.
Who Should Receive Cbc Tests
A complete blood count test is usually ordered as part of a routine yearly physical exam for all adults 30 years and older. Additional reasons for a CBC are:
- If you are ill with a fever
- Suspect an infection
- Are losing weight without trying
- If you have signs of cancer like general weakness, bruising, or bleeding
If you have a medical condition that requires you to take medication, you may have CBCs regularly to ensure your blood counts remain consistent.
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Prostate Cancer Screening Ages 55 To 69
This is the age range where men will benefit the most from screening.Thats because this is the time when:
- Men are most likely to get cancer
- Treatment makes the most sense, meaning when treatment benefits outweigh any potential risk of treatment side effects
Most men will get prostate cancer if they live long enough. Some prostatecancers are more aggressive others can be slow-growing. Doctors will takeyour age and other factors into consideration before weighing the risks andbenefits of treatment.
You should ask your doctor how often he or she recommends you get screened.For most men, every two to three years is enough.
Depending on the results of your first PSA test, your doctor may recommendyou get screened less frequently.
Refining The Definition Of Prostate Cancer Biomarker
According to the National Institute of Health in the US, a biomarker is a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes or pharmaceutical responses to a therapeutic intervention . Cancer biomarkers are either produced by the tumor or by the body in response to the tumor. Six different types of biomarker can be differentiated in PCa:
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Which Blood Tests Detect Cancer
Blood work that tests for cancer falls into four general categories: