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Prostate Cancer With Normal Psa

What Is The Accuracy Of The Psa Test

What Is a Normal PSA for a Man Without Prostate Cancer? | Ask a Prostate Expert, Mark Scholz, MD

One of the limitations of the PSA test is that PSA is not specific to prostate cancer and that it can be affected by several common conditions such as benign enlargement of the prostate, inflammation, and infection of the prostate. Furthermore, there is some variability in PSA results when using different testing equipment. One study showed that 25% men who had an initial PSA result between 4 ng/mL and 10 ng/mL had a normal test result when it was repeated.

Limitations of PSA testing include a high false-positive rate . In fact, only about 25% of men who have an elevated PSA between 4 ng/mL and 10 ng/mL will have prostate cancer identified on prostate biopsy and 75% will not. If one uses a lower cutoff of 3.1 ng/mL, PSA had a sensitivity of 32% and specificity of 87% for identifying prostate cancer.

Another concern in addition to the low specificity in detecting the presence of prostate cancer is the inability of the test to discriminate between a more aggressive, high-risk, prostate cancer from one that is less likely to cause harm, or a low-risk prostate cancer. This is thought to lead to overtreatment in up to 50% of men with prostate cancer.

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

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 that do not cause symptoms. Finding a small tumor, however, may not necessarily reduce a mans chance of dying from prostate cancer. Many tumors found through PSA testing grow so slowly that they are unlikely to threaten a mans life. Detecting tumors that are not life-threatening

that requires treatment.

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Is It Normal To Have Elevated Psa Levels

These higher levels of PSA can be normal for an older man but a doctor will most likely want to do some other testing just to be sure there is nothing more serious developing. BPH is an enlargement of the prostate gland but is not cancerous or considered to be prostate cancer. More cells are producing PSA making the number increase.

Questions To Think About Before Having A Psa Test

How To Treat Elevated PSA Levels.

To help you make your decision, you could think about the following questions:

  • What would you do if your PSA level is high?
  • What would you do if further tests find that you have an early prostate cancer?
  • What difference will it make for you to know about an early prostate cancer?

Before you decide whether to have the PSA test, you may want to talk to your GP about it. You can also call our cancer support specialists on 0808 808 00 00. They can discuss the options with you and send you more information.

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Does Your Psa Indicate Cancer

Prostate Specific Antigen or PSA, is an enzyme found in a man’s blood produced exclusively by prostate cells. An abnormal rise in PSA, can indicate Prostate Cancer. Higher levels of PSA can be found in the blood as prostate cancer cells begin to proliferate in an uncontrolled way.

Normal PSA levels in the blood are very small amounts between 0-2.5 ng/ml. As a man ages his prostate can become larger, leading to slightly higher normal levels of PSA. It is important to have your PSA and prostate exam as part of your yearly physical.

Testing for PSA, requires that a man’s blood be drawn and sent to the lab for analysis. If higher than normal levels are discovered, action is recommended. Levels greater than 2.5 ng/ml, can have many different causes. Prostate Cancer is one cause. But elevated PSA levels doesn’t necessarily mean prostate cancer. PSA can also rise for benign, non-cancerous conditions such as enlarged prostate, prostate inflammation, infection, or trauma. Get checked by your doctor.

IMPORTANT: All elevated readings of PSA should be checked.

Prostate Specific Antigen or PSA, is an enzyme found in a man’s blood produced exclusively by prostate cells. An abnormal rise in PSA, can indicate Prostate Cancer. Higher levels of PSA can be found in the blood as prostate cancer cells begin to proliferate in an uncontrolled way.

IMPORTANT: All elevated readings of PSA should be checked.

What Is Biopsy And How Is It Done

Once we find an abnormal area in the prostate on ultrasound, we need to remove small pieces of prostate for pathological examination called prostate biopsy.

While the ultrasound probe is in the rectum, a biopsy needle is inserted through the probe and under the ultrasound guidance, biopsies are performed. Six to twelve tine pieces of tissue are taken from the prostate. These pieces of prostate tissue are then sent to a Laboratory where a pathologist who is an expert in prostate cancer examined these pieces under the microscope to determine.

  • Whether cancer is present
  • Evaluate microscopic features of cancer
  • Whether suspicious lesions are present
  • Or the biopsy is negative for cancer
  • Whether inflammation is present

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What Research Has Been Done To Study Prostate Cancer Screening

Several randomized clinical trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and DRE were evaluated for their ability to decrease a mans chances of dying from prostate cancer.

The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but the same rate of deaths from the disease . Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment.

A second large trial, the European Randomized Study of Screening for Prostate Cancer , compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer .

Intermittent Versus Continuous Hormone Therapy

What is a Normal PSA Test?

Most prostate cancers treated with hormone therapy become resistant to this treatment over a period of months or years. Some doctors believe that constant androgen suppression might not be needed, so they advise intermittent treatment. The hope is that giving men a break from androgen suppression will also give them a break from side effects like decreased energy, sexual problems, and hot flashes.

In one form of intermittent hormone therapy, treatment is stopped once the PSA drops to a very low level. If the PSA level begins to rise, the drugs are started again. Another form of intermittent therapy uses hormone therapy for fixed periods of time for example, 6 months on followed by 6 months off.

At this time, it isnt clear how this approach compares to continuous hormone therapy. Some studies have found that continuous therapy might help men live longer, but other studies have not found such a difference.

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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 Does A High Psa Level Mean

High PSA levels could be a sign of prostate cancer or a different condition like prostatitis or an enlarged prostate.

Other things can affect your PSA level:

  • Age. Your PSA will normally go up slowly as you get older, even if you have no prostate problems.
  • Medications. Some drugs may affect blood PSA levels. Tell your doctor if youâre taking dutasteride or finasteride . These drugs may falsely lower PSA levels by half of what they should be.

If your PSA level is high, your doctor may suggest that you get a prostate biopsy to test for cancer.

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What Is A Psa Test

The PSA test is the leading method of screening for prostate cancer. PSA screening can help catch the disease at an early stage when treatment may be more effective and potentially have fewer side effects. The PSA test may be done along with a digital rectal exam , in which a physician inserts a gloved finger into the rectum to examine the prostate for irregularities.

If Screening Test Results Arent Normal

PSA prostate levels  all the info you must have

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.

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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
  • A premalignant condition
  • 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
  • Atypia

Normal Psa Levels By Age Chart

We mentioned earlier in this article that PSA levels increase with age due to age related growth of the prostate gland. A doctor will therefore take into account an age-adjusted PSA level when discussing your prostate health:

Age Range

0 to 6.5

Although there are normal PSA levels by age range, it is still important to screen routinely to ensure these normal levels are not rising.

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Special Types Of Psa Tests

The PSA level from a screening test is sometimes referred to as total PSA, because it includes the different forms of PSA . If you decide to get a PSA screening test and the result isnt normal, some doctors might consider using different types of PSA tests to help decide if you need a prostate biopsy, although not all doctors agree on how to use these tests. If your PSA test result isnt normal, ask your doctor to discuss your cancer risk and your need for further tests.

Percent-free PSA: PSA occurs in 2 major forms in the blood. One form is attached to blood proteins, while the other circulates free . The percent-free PSA is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not.

If your PSA test result is in the borderline range , the percent-free PSA might be used to help decide if you should have a prostate biopsy. A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy.

Many doctors recommend a prostate biopsy for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. Using these cutoffs detects most cancers and helps some men avoid unnecessary biopsies. This test is widely used, but not all doctors agree that 25% is the best cutoff point to decide on a biopsy, and the cutoff may change depending on the overall PSA level.

Individualized Prostate Cancer Screening

PSA values and correspondence with prostate cancer

Coltman says that men and their doctors can no longer rely on PSA levels alone when deciding whether to have a prostate biopsy.

“The situation now is that the individual man with his individual urologist will have to assess what the person feels are his risk factors,” he says. “In consultation with his doctor, the individual man must come to grips with the question of whether or not a biopsy should be done. It will become a more personalized interaction.”

Who’s at high risk? Men with the following factors have the highest risk of prostate cancer:

  • Age. A man’s risk of prostate cancer increases with age.
  • Race. “African American men have the highest incidence of prostate cancer and the highest death rate from prostate cancer of any men in the world,” Coltman says.
  • Family history. A man’s risk increases if his brother or father has had prostate cancer.

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Screening For Prostate Cancer

There are no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer. However, early detection and treatment can significantly improve prostate cancer survival.

The test most commonly used to aid early detection of prostate cancer is the prostate specific antigen blood test. This is not a diagnostic test as it can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.

There are no proven measures to prevent prostate cancer.

Drugs That Stop Androgens From Working

Anti-androgens

For most prostate cancer cells to grow, androgens have to attach to a protein in the prostate cancer cell called an androgen receptor. Anti-androgens are drugs that also connect to these receptors, keeping the androgens from causing tumor growth. Anti-androgens are also sometimes called androgen receptor antagonists.

Drugs of this type include:

  • Flutamide

They are taken daily as pills.

In the United States, anti-androgens are not often used by themselves:

  • An anti-androgen may be added to treatment if orchiectomy or an LHRH agonist or antagonist is no longer working by itself.
  • An anti-androgen is also sometimes given for a few weeks when an LHRH agonist is first started to prevent a tumor flare.
  • An anti-androgen can also be combined with orchiectomy or an LHRH agonist as first-line hormone therapy. This is called combined androgen blockade . There is still some debate as to whether CAB is more effective in this setting than using orchiectomy or an LHRH agonist alone. If there is a benefit, it appears to be small.
  • In some men, if an anti-androgen is no longer working, simply stopping the anti-androgen can cause the cancer to stop growing for a short time. This is called the anti-androgen withdrawal effect, although they are not sure why it happens.

Newer anti-androgens

Enzalutamide , apalutamide and darolutamide are newer types of anti-androgens.

These drugs are taken as pills each day.

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Prostate Cancer And The Psa

Tanya Harter Pierce, M.A. MFCCAuthor of OUTSMART YOUR CANCER: Alternative Non-Toxic Treatments That Work

Prostate cancer is the second most commonly diagnosed type of cancer in men, with lung cancer being the first. Luckily, prostate cancer also happens to be a type of cancer that responds extremely well to alternative cancer treatments. On the other hand, mainstream medicine has NOT had significant success bringing about long-term cures, especially once the cancer has metastasized, and this is largely because of some very important common misunderstandings about prostate cancer, the PSA, and the role of testosterone that have propagated throughout mainstream medicine. Oncologists have been duped with the wrong information. So if you are a man, you need to know the truth. Your life may depend on it.

First, here are some basics about prostate cancer. For most of the last century, prostate cancer has occurred primarily in older men and was long known for being slow-growing in most cases ¾ so slow-growing in fact that men over 65 could often simply live with their cancer without getting any treatment at all. This was because they had a good chance of dying of old age before dying from their cancer.

  • Surgery
  • Chemotherapy
  • Hormone-Blocking Drugs

The surgical option involves removal of all or part of the prostate gland. This may sound good at first, but it is often an immasculating procedure with a high likelihood of some degree of impotence and incontinence occurring as a result.

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