What Is Screening For Prostate Cancer
Some men get a PSA test to screen for prostate cancer. Talk to your doctor, learn what is involved, and decide if a PSA test is right for you.
Cancer screening means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.
If you are thinking about being screened, learn about the possible benefits and harms of screening, diagnosis, and treatment, and talk to your doctor about your personal risk factors.
There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.
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.
Improving Sensitivity Of Psa Testing
Prostate-specific antigen testing with a cutoff of 4.0 ng/mL has a sensitivity of 67.5-80%, which implies that 20-30% of cancers are missed when only the PSA level is obtained. Sensitivity can be improved by lowering the cutoff or by monitoring PSA values so that a rise in PSA level of more than 20-25% per year or an increase of 0.75 ng/mL in 1 year would trigger performance of a biopsy regardless of the PSA value.
The specificity of PSA at levels higher than 4.0 ng/mL is 60-70%. Specificity can be improved by using age-adjusted values, PSA velocity , and the ratio of free PSA to total PSA . Another method is to adjust the PSA according to the size of the prostate or volume determinations of the transitional zone, which produces most of the PSA, and the peripheral zone, which produces less PSA but a majority of prostate cancers.
In the European Randomized Study of Screening for Prostate Cancer, Schroder et al studied a strategy for the early detection of prostate cancer that excluded digital rectal examination results and used a PSA cutoff of 3.0 ng/mL as the only indication for a biopsy. This protocol was compared with one in which a PSA level of 4.0 ng/mL or higher or the presence of a positive DRE or transrectal ultrasound was the indication for a biopsy. In a follow-up study, Schroder et al confirmed a substantial reduction in mortality from prostate cancer as a result of PSA testing.
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Fruit And Fruit Extracts
Fruits are rich sources of phytochemicals carrying multiple antioxidant and anti-inflammatory properties, and for this, a diet rich in fruits is often recruited to reduce oxidative stress in conditions with an elevated inflammatory state . In parallel, fruit extracts derived usually via exploitation of fruit residues are often used in phytomedicine as nutraceuticals with postulated cancer-related outcomes . In BPH and PCa, in particular, apart from antioxidant and anti-inflammatory properties, fruits and fruit extracts are also expected to exhibit antiproliferative, anti-androgenic, and anti-estrogenic properties .
Cranberries are rich in bioactive compounds , including organic and phenolic acids, flavonoids and flavonoid glycosides, ursane triterpenoids, anthocyanins and proanthocyanidins , with many preclinical studies advocating for their effectiveness as an adjuvant PCa therapy . One RCT examined the effects of daily cranberry powder ONS compared with placebo on men with PCa, revealing a 22.5% reduction of PSA concentrations in the cranberry intervention arm after 30 days of supplementation. As far as PCa risk is concerned, another Czech RCT evaluated the efficacy of cranberry powder ONSwithout a comparator, reporting a reduction in PSA after 6 months of daily intake among men with lower urinary tract symptoms , elevated PSA, but negative prostate biopsy .
What Is Considered An Elevated Prostate
Researchers havent settled on a single normal PSA level. Previously, a level of 4.0 ng/mL or higher would lead to more testing, usually a prostate biopsy. During the biopsy, a healthcare provider removes a small sample of prostate tissue to check it for cancer.
However, healthcare providers now consider other issues together with the PSA level to decide whether to perform a biopsy. Your age, general health, family history and health history factor into the decision.
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Post Prostatectomy: What Do Rising Psa Levels Mean
New to group! Wish I had checked this out 2 years ago while supporting my husband! Now over e years post prostatectomy, wondering what might make psa go from all 0 to 2.6
Welcome to the Prostate Cancer group, @hoard.You ask a good question. What can rising PSA levels means years after having had a prostatectomy?There are several reasons why oneâs PSA level may rise after being stable for a time. This article explains it well: PSA levels after prostatectomy
Hereâs an excerpt from the article:âSeeing a rise in PSA level does not always mean that prostate cancer is returning or spreading. The test is very sensitive and can pick up small changes in PSA levels. Doctors will usually want to know how quickly levels of PSA in the blood are rising. To find this out, a person will need to have regular PSA tests. If levels of PSA remain stable or rise very slowly, treatment may not be necessary.
In some cases, high PSA levels in the blood are not due to cancer cells. Some factors that can affect PSA levels include: older age ethnicity medicationA doctor will take these factors and the personâs medical history into account when looking at test results. This can help them decide if PSA levels are high enough to cause concern.â
Thank you! Relieves my mind somewhat! Next PSA in November.. long wait.
What Should I Expect If Im Told I Have Elevated Psa
If your provider finds an elevated PSA level, youll have repeat tests to check your prostate. Many men with elevated PSA levels even those who have prostate cancer live long, healthy lives. Prostate cancer may not need treatment, depending on how slowly the tumor is growing. Keep up with your regular appointments and tests so your care team can keep tabs on your health.
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What Is A Psa Test How To Understand Your Levels
Perhaps one of the most feared cancers for men, prostate cancer can be deadly if detected too late. It causes about 26,000 deaths per year and affects one out of every seven men. Helping detect cases of prostate cancer, the PSA blood test is a crucial tool for early diagnosis.
The first step in prostate cancer early detection is the prostate-specific antigen test or PSA test.
What Is Prostate Intraepithelial Neoplasia Or Atypical Or Suspicious Cells On Biopsy
In about 10% of prostate needle biopsy reports, the pathologist will tell us that the final diagnosis is neither benign nor malignant. They describe this condition as
- High Grade Intraepithelial Neoplasia
- Biopsy should be repeated soon
- 25% risk of cancer on repeat biopsy
- Low Grade Intraepithelial Neoplasia
- Repeat biopsy is not indicated unless there is a rise in PSA
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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 .
Risk Factors That Can Affect Psa Levels
There are many other risk factors that can raise PSA levels, including:
- Enlarged prostate, also called benign prostatic hyperplasia , which is common in older men
- Older age, which naturally results in higher PSA levels
- Riding a bicycle, which may raise levels for a short time after
- Certain urologic procedures, like cystoscopy
- Certain medicines, such as male hormones
Factors that may specifically lower PSA levelseven among men with prostate cancerinclude:
- 5-alpha reductase inhibitors, which treat BPH or other urinary symptoms
- Some medications, such as aspirin or statins
- Herbal mixtures or supplements, which could skew the results
In certain cases, a factor that lowers PSA does lower the risk of developing prostate cancer. In others, however, lowering the PSA level has no effect and could be harmful, as prostate cancer could go undetected if the level drops too far.
For all of these reasons, its important to speak with your doctor about factors that might apply to you when considering testing and interpreting test results.
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What Is Transrectal Ultrasound
Transrectal ultrasound is the examination of prostate using a machine called ultrasound. We insert a finger like probe into the rectum to examine the prostate. Ultrasound creates a picture of prostate using high-frequency sound waves. These sound waves come out of the probe and are transmitted through body tissues. The sound waves then bounce off the tissue and return to the probe. These returning sound waves are called echoes and are translated and recorded into photographic images. Transrectal Ultrasonography provides excellent visualization of the prostate and abnormalities that may be present in the prostate. We can also easily guide the biopsy needle under ultrasound guidance into the prostate where cancer is suspected.
The ultrasound machines in our offices are capable of doing color doppler studies and three dimensional reconstruction of the gland. Usually there is increased blood flow within the cancerous lesion or adjacent to the lesion and color doppler helps us precisely guide the biopsy needle into the lesion for accurate biopsy.
Transrectal ultrasonography is also used to estimate the prostate volume accurately to calculate PSA density.
Transrectal ultrasonography also provides images sensitive enough to defect capsular involvement and extention of cancer into the seminal vesicles .
Next Steps After A Psa Test
The next steps after a PSA test depend on many factors. If your PSA level was normal, your doctor will likely schedule another PSA test in two to four years if you are still within the age range to be tested.
An examination that your doctor may perform is a digital rectal exam to feel the prostate. During this examination your doctor will insert their finger into your rectum to feel whether your prostate has an abnormal shape, texture or size. While the digital rectal exam can be uncomfortable for some, it can help differentiate different causes of elevated PSA in some cases.
If your PSA was high, your doctor will take into consideration your age, medical history, lab results and examination to help determine whether you may need additional testing to determine the cause of elevated PSA. Additional testing may include repeating the PSA test after a few months to see how the level has changed.
If your doctor is concerned that you may have prostate cancer, they may recommend undergoing a prostate biopsy. During this procedure, a needle is placed into the prostate to get samples. The samples are then visualized by a specialist under the microscope to determine whether or not you have prostate cancer. If you do have prostate cancer, you will most likely be referred to a doctor who specializes in the treatment of prostate cancer.
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There Are Risks To Getting Prostate Cancer Tests And Treatments
If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.
Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.
I Have High Psa Levels: How Do I Find Out If I Have Prostate Cancer
Prostate cancer is the most common form of cancer in men. The first test most doctors use to screen for prostate cancer is the PSA test. A high PSA level can indicate the presence of cancer. But other factors besides cancer can cause an elevated PSA level. If your PSA level is rising, learn more about your options for finding out if you have prostate cancer.
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Psa Levels And How They Can Vary
Experts views regarding PSA levels have changed over the years.
Previously, PSA levels of 4.0 ng/mL and lower were considered normal. For men with test results showing levels above 4.0 ng/mL, doctors would recommend a prostate biopsy. But in more recent years, studies have demonstrated that some men with PSA levels lower than 4.0 ng/mL can have prostate cancer, and many men with PSA levels higher than 4.0 ng/mL dont have prostate cancer.
Moreover, a number of factors can cause PSA levels to fluctuate. Prostatitis, urinary tract infections, prostate biopsies, and prostate surgery may also cause PSA levels to rise. On the other hand, certain drugs can cause PSA levels to lower, such as finasteride and dutasteride .
Generally, the higher the PSA level, the more indicative it is of prostate cancer, and an ongoing rise in PSA levels may also signal prostate cancer.
- Men whose PSA level is between 4.0 ng/mL and 10 ng/mL have a 1 in 4 chance of having prostate cancer.
- When a PSA level is over 10 ng/mL, there is a more than 50 percent chance of having prostate cancer.
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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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.
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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Discuss Prostate Cancer Testing With Your Doctor
Medical authorities do not recommend that all men should be tested for prostate cancer. In fact, most authorities suggest that men should make their own choice about whether or not to have a PSA test. If you decide to be tested, it is recommended that it should be done every two years from 50 to 69 years of age, and only if your health is such that you expect to live for at least another seven years.
Men at high risk of prostate cancer, such as men with a family history of prostate cancer , or men who have previously had an elevated test result, can start two-yearly testing from age 45. Your doctor can help you decide whether this is necessary.
While there is now some evidence that regular testing may prevent prostate cancer deaths, there are concerns that many men may be diagnosed and treated unnecessarily as a result of being screened, with a high cost to their health and quality of life .
However, the option of active surveillance, where a low-risk cancer is watched closely instead of being treated, helps to lower these risks. Active surveillance is now used quite commonly in Australia for men with low-risk prostate cancer.
If you are unsure whether or not to be tested after considering the benefits and uncertainties of testing and your own risk of prostate cancer, discuss it with your doctor.
In Australia, if you choose to be tested for prostate cancer the tests are covered by Medicare.