What Is The Prostate
The prostate is a small gland in the pelvis and is part of the male reproductive system.
About the size of a walnut, it’s located between the penis and the bladder, and surrounds the urethra.
The main function of the prostate is to produce a thick white fluid that creates semen when mixed with the sperm produced by the testicles.
What Do My Test Results Mean
Your doctor will look at your test results to find out if the cancer has spread and how quickly it might be growing.
How far has my cancer spread?
The stage of your cancer tells you whether it has spread outside the prostate and how far it has spread. You might need scans, such as an MRI, CT or bone scan, to find out the stage of your cancer.
Depending on the results, your cancer may be treated as:
- localised prostate cancer it’s contained inside the prostate
- locally advanced prostate cancer its started to break out of the prostate or has spread to the area just outside it
- advanced prostate cancer its spread from the prostate to other parts of the body.
Is my cancer likely to spread?
Your doctor may talk to you about the risk of your cancer spreading outside the prostate or coming back after treatment.
Your prostate biopsy results will show how aggressive the cancer is in other words, how likely it is to spread outside the prostate. You might hear this called your Gleason grade, Gleason score, or grade group.
To work out your risk, your doctor will look at your PSA level, your Gleason score and the T stage of your cancer.
Low risk
Your cancer may be low risk if:
- your PSA level is less than 10 ng/ml, and
- your Gleason score is 6 or less , and
- the stage of your cancer is T1 to T2a.
Medium risk
Your cancer may be medium risk if:
- your PSA level is between 10 and 20 ng/ml, or
- your Gleason score is 7 , or
- the stage of your cancer is T2b.
High risk
What happens next?
What Is Prostate Cancer
Prostate cancer develops when abnormal cells in the prostate gland grow in an uncontrolled way, forming a malignant tumour.
Prostate cancer is the second most common cancer diagnosed in men in Australia and the third most common cause of cancer death. It is estimated that 18,110 new cases of prostate cancer will be diagnosed in Australia in 2021. One in 6 men will be diagnosed with prostate cancer by the age of 85. It is more common in older men, with over 63% of cases diagnosed in men over 65 years of age.
Early prostate cancer refers to cancer cells that have grown but do not appear to have spread beyond the prostate.
There are two stages of advanced prostate cancer:
- locally advanced prostate cancer where the cancer has spread outside the prostate to nearby parts of the body or glands close to the prostate
- metastatic prostate cancer where the cancer has spread to distant parts of the body.
The five year survival rate for prostate cancer is 95%.
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What Causes An Elevated Psa Level
Prostate cancer is the main cause of an elevated PSA level. But PSA levels increase with age and can reflect different prostate conditions. Other factors that may raise a persons PSA level include:
- Prostate enlargement and inflammation .
- Urinary tract infection.
- Urinary catheter placement.
Your healthcare provider will also consider whether your medications affect PSA levels. For example, 5-alpha reductase blockers treat enlarged prostates and will lower PSA levels.
What Is The Psa Test
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a mans blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.
The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the use of the PSA test in conjunction with a digital rectal exam to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing to help doctors determine the nature of the problem.
In addition to prostate cancer, a number of benign conditions can cause a mans PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis and benign prostatic hyperplasia . There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
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Medical Procedures Can Cause Psa To Rise
“Anything that traumatically interferes with the architecture around the prostate gland can make PSA go up,” says Dr. Milner. “One of the most common causes of significantly high PSA from this type of trauma is the placing of a catheter into the bladder.”
Another cause is a prostate or bladder exam that involves passing a scope or taking a biopsy.
“Since 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,” Milner says.
Causes Of Prostate Cancer
The causes of prostate cancer are largely unknown. But certain things can increase your risk of developing the condition.
The chances of developing prostate cancer increase as you get older. Most cases develop in men aged 50 or older.
For reasons not yet understood, prostate cancer is more common in black men and less common in Asian men.
Men whose father or brother were affected by prostate cancer are at slightly increased risk themselves.
Recent research also suggests that obesity increases the risk of prostate cancer.
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Symptoms Of Prostate Cancer
Symptoms of prostate cancer do not usually appear until the prostate is large enough to affect the tube that carries urine from the bladder out of the penis .
When this happens, you may notice things like:
- an increased need to pee
- straining while you pee
- a feeling that your bladder has not fully emptied
These symptoms should not be ignored, but they do not mean you have prostate cancer.
It’s more likely they’re caused by something else, such as prostate enlargement.
During Treatment For Advanced Prostate Cancer
When treatments such as hormone therapy, chemotherapy, or immunotherapy are used for more advanced prostate cancer, the PSA level can help show how well the treatment is working or when it might be time to try a different treatment.
Treatments should lower the PSA level , although in some cases they may just help keep it from rising further, or even just slow the rise. Of course, other factors, such as whether youre having symptoms from your cancer and whether imaging tests show it is growing, are also important when deciding if it might be time to change treatments.
If the cancer has spread outside the prostate, the actual PSA level is often not as important as whether it changes, and how quickly it changes. The PSA level itself does not predict whether or not a man will have symptoms or how long he will live. Many men have very high PSA levels and feel just fine. Other men with low PSA levels can have symptoms.
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High Psa Not Always A Negative Outcome Predictor
Prostate cancer patients with PSA levels above 20 ng/mL are not necessarily at high risk for negative outcomes such as prostate cancer-specific mortality , but a higher number of risk factors at diagnosis correlates significantly with unfavorable pathology, a study showed.
The investigation also revealed that biopsy Gleason score is strongest predictor of progression and PCSM.
They classified patients into four risk groups. Group 1 included men who only had a PSA level above 20 group 2 patients had a PSA level above 20 and clinical tumor stage greater than cT2. Group 3 included men who a PSA level above 20 and a biopsy Gleason score above 7. Group 4 consisted of subjects with a PSA level above 20, clinical tumor stage greater than cT2, and a biopsy Gleason score above 7. The mean follow-up period was 78.7 months.
Overall, the proportion of favorable parameters decreased significantly with an increasing number of high-risk factors .
Among subjects in group 1, 33% had pT2 cancer, 57.9% had a pathologic Gleason score below 7, 54% had negative surgical margins, and 85% were lymph node negative. In contrast, among patients in group 4, 2.3% had a pathologic Gleason score below 7 20.5% had negative margins and 49% were lymph node negative.
The 10-year PCSM was 5% for patients with a biopsy Gleason score of 7 or less compared with 35% for those with a biopsy Gleason score of 8 or higher.
Following Psa Levels During And After Prostate Cancer Treatment
A mans prostate-specific antigen blood level is often a good indicator of how effective treatment is or has been. Generally speaking, your PSA level should get very low after treatment. But PSA results arent always reliable, and sometimes doctors arent sure what they mean.
Before starting treatment, you might want to ask your doctor what your PSA level is expected to be during and after treatment, and what levels might cause concern. Its important to know that the PSA level is only one part of the overall picture. Other factors can also play a role in determining if cancer is still there, if it is growing, or if it has come back.
Its also important to know that PSA levels can sometimes fluctuate a bit on their own, even during or after treatment, so they may not always be a sign of what is actually happening with your cancer. Understandably, many men being treated for prostate cancer are very concerned about even very small changes in their PSA levels. The PSA level is an important tool to monitor the cancer, but not every rise in PSA means that the cancer is growing and requires treatment right away. To help limit unnecessary anxiety, be sure you understand what change in your PSA level might concern your doctor.
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Significance Of A Rising Psa
Many doctors use PSA levels to determine the diagnosis and treatment of prostate problems. Unfortunately, some urologists subscribe to the theory that almost any rise in a mans PSA value should be followed up with a prostate biopsy.
Men are also led to believe that PSA levels are all-important for diagnosing prostate cancer both by their peers and by the media. However, many situations can significantly rise in PSA that does not indicate cancer or require significant treatment.
Other conditions that can cause increased PSA levels include an enlarged prostate or an inflamed or infected prostate . In addition, PSA values can be temporarily increased by external stress on the prostate, such as bicycle or motorcycle riding as well as sexual activity, especially intense sexual or physical activity.
For older men, the general upper limit that is considered normal is 4.0 ng/mL. However, normal prostates emit a higher level of PSA as a man ages. The PSA level also tends to increase with the size of the prostate, especially with BPH. A CAT scan or an MRI can determine the size of a mans prostate, but such tests may not always be warranted.
Some doctors use rising PSA as a major factor in determining if a man needs a biopsy or further treatment, especially when the PSA rise is showing a steep slope.
Psa Level Risk Analysis
- 15% of men with a PSA level less than 4 ng/ml go on to develop prostate cancer.
- 31% of men with PSA levels between 4 10 ng/ml have shown to develop prostate cancer.
- 50% 65% of men with psa scores over 10 ng/ml develop prostate cancer.
An important part of the your results is finding both the
1. Total amount of PSA in your blood.
2. Ratio of free vs bound PSA.
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Psa Levels By Age Chart
The main difference between the PSA scores of prostatitis and an enlarged prostate, compared to prostate cancer, is the ratio of free vs bound PSA within your test sample.
- Prostate Cancer will have a higher bound PSA ratio.
- An enlarged prostate and prostatitis will have a higher free PSA ratio.
- If your free PSA results are less than 25%, your risk for developing prostate cancer is between 10% to 20%.
- If your free PSA results are less than 10%, your risk for developing prostate cancer jumps to around 50%.
Understanding Prostate Cancers Progression
To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score.
- Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
- Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.
After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan.
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What Is The Controversy Surrounding Psa Screening
In recent years, there has been some controversy surrounding the PSA test. In 2012, the U.S. Preventive Services Task Force assigned the PSA test a D rating. This meant that the USPSTF concluded the harms that resulted from PSA testing, such as unnecessary biopsies and negative treatment side effects, outweighed the benefits of finding and managing the disease early. This recommendation did not include exceptions for men at increased risk of developing the disease, such as African American men, those with a family history of the disease, and those with BRCA gene mutations. The USPSTF recommendation is important as it guides primary care physicians in preventive care and can impact insurance coverage and reimbursement for screening. Prior to its D rating, the PSA test had an I rating, meaning the USPSTF concluded there was insufficient evidence to assess the pros and cons of testing.
In May 2018, the USPSTF updated their recommendation on PSA screening. In response to new research demonstrating the benefits of PSA screening , an increase in the number of men choosing active surveillance, and advocacy efforts, the USPSTF released a draft recommendation in April 2017 that assigns the PSA test a C rating for men ages 55to 69 . This rating has now been certified official by the task force.
Symptoms Of Metastatic Prostate Cancer
Usually, prostate cancer is has no symptom but however, when symptoms do occur, they may include
- Frequent urination
- Producing less semen when ejaculating
- Blood in the urine or semen.
Many other conditions, including prostatitis and benign prostatic hypertrophy, can cause similar symptoms. However, anyone experiencing these symptoms should consul their doctor as soon as possible to rule out prostate cancer.
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How Doctors Diagnosed Metastatic Prostate Cancer
When a patient is diagnosed with prostate cancer, the doctor will order tests such as
- X-rays
- MRI scans
- PET scans
These tests focuses on the skeleton, the belly and pelvic areas and in the above ways doctors can check for signs that the cancer has spread or if the cancer is metastatic. If ones have symptoms such as bone pain and broken bones for no reason, the doctor may order a bone scan and it may show if you have signs of cancer spread in the bones. The doctor will also ask for blood tests, including a check of PSA levels, to look for other signs that the cancer is spreading.
Us Case Control Cohorts
The US cohort is part of the NCI-Maryland Prostate Cancer CaseControl Study and has been described previously. Recruitment was carried out between 2005 and 2015 under the ethics approval by the Institutional Review Boards at the NCI and the University of Maryland . Of the 976 cases that were recruited into the study, 489 were African Americans and 487 were European Americans . For the study herein, other patient clinical information collected from pathology reports and medical records of 202 of these US-AA and 232 US-EA cases were also available for analysis. Disease prognostic stage grouping, and risk classification followed the criteria as mentioned before for NZ cases. 486 US-AA and 548 US-EA healthy controls within the age range 47 to 92 were also recruited for the controls arm of the study. All cases and controls self-reported to be either US-AA or US-EA at an interview and signed an informed consent to participate in the study. The interview also evaluated lifestyle factors that included tobacco-smoking habits and alcohol consumption. Alcohol consumers were considered as those consuming more than 12 alcoholic beverages per year, such as beer, wine, wine coolers or liquor. At recruitment, participants were asked their current heights and weights for BMI estimation.
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