What Is The 4k Biomarker
The 4kscore test measures free and total PSA, human kallikrein 2 , and intact PSA and considers age, digital rectal exam results, and prior biopsy status. The test result reports the percent likelihood of finding high-grade prostate cancer on a prostate biopsy result. This test is not approved by the FDA, rather it is regulated as a laboratory-developed test. No cutoff threshold has been established for this test. Currently, the NCCN recommendations are that this test can be considered in patients prior to biopsy and for those with a prior negative prostate biopsy who are thought to be at higher risk for a high grade prostate cancer.
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.
During And After The Test
A laboratory technician or nurse will draw your PSA after receiving an order from your physician.
When you are in the lab or exam room, the technician will cleanse your arm with an antiseptic and perform a venipuncture . After taking the sample, she will hold pressure on the site for a few moments and then cover the site with a bandage.
If you notice any bleeding or bruising, applying light pressure for several minutes is all that is usually needed. There are no restrictions following the blood draw, though it’s usually advised to keep the site clean and covered for a day or two.
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Who Can Have The Psa Test
Although there is no screening programme, if you are aged over 50 you can ask your GP for the PSA test. Or you may be offered one as part of a general health check.
Before you have the test, your GP or nurse will talk through the benefits and disadvantages of having your PSA checked. If you are aged under 50 but at higher risk of prostate cancer, you can talk to your GP about having the PSA test.
Clinical Information Discusses Physiology Pathophysiology And General Clinical Aspects As They Relate To A Laboratory Test
Prostate-specific antigen is a glycoprotein that is produced by the prostate gland, the lining of the urethra, and the bulbourethral gland. Normally, very little PSA is secreted in the blood. Increases in glandular size and tissue damage caused by benign prostatic hypertrophy, prostatitis, or prostate cancer may increase circulating PSA levels.
PSA exists in serum in multiple forms: complexed to alpha-1-anti-chymotrypsin , unbound , and enveloped by alpha-2-macroglobulin .
Higher total PSA levels and lower percentages of free PSA are associated with higher risks of prostate cancer.
Most prostate cancers are slow growing, so the utility of prostate cancer screening is marginal in most men with a life expectancy of less than 10 years.
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The prostate is a walnut-sized gland found between the bladder and the rectum in males. Its primary job is to produce seminal fluid. The prostate creates a protein, the prostate-specific antigen, or PSA. A PSA screening test is a blood test approved by the FDA in 1994 to measure the levels of PSA in a mans blood.
Small amounts of PSA ordinarily circulate in the bloodstream and can be measured by a PSA test to monitor the health of the prostate. This test is intended to screen for prostate cancer, find other prostate-related conditions, or monitor PSA levels in those in treatment for prostate cancer. This is a simple blood test which reports PSA levels as nanograms of PSA per milliliter of blood.
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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How Is Psa Testing Used For Pretreatment Staging Of Prostate Cancer
Once prostate cancer is diagnosed by the presence of cancer cells on prostate biopsy and assigned a cancer grade , PSA is used in combination with the grade of the prostate cancer to determine further medical studies needed for cancer staging. Staging determines if the cancer is localized or metastatic . Staging therefore drives the best management and appropriate treatment for the cancer. As mentioned earlier, serum PSA levels correlate with the risk of prostate cancer extension outside of the prostate including seminal vesicle invasion as well as metastasis to the pelvic lymph nodes.
Getting A Prostate Biopsy
For some men, getting a prostate biopsy might be the best option, especially if the initial PSA level is high. A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. This test is the only way to know for sure if a man has prostate cancer. If prostate cancer is found on a biopsy, this test can also help tell how likely it is that the cancer will grow and spread quickly.
For more details on the prostate biopsy and how it is done, see Tests to Diagnose and Stage Prostate Cancer.
For more information about the possible results of a prostate biopsy, see the Prostate Pathology section of our website.
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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:
Concerns About Psa Screening
The shift comes on the heels of a growing body of evidence that shows the benefits of PSA screening may not outweigh the potential harm of unnecessary treatment. PSA screening has always been somewhat controversial. That’s because PSA tests often alert doctors to the presence of cancer, but there is no precise way to determine, definitively, whether the cancers detected would have ever caused symptoms or harm during a man’s lifetime. One study estimated overdetection to rise with age, from 27% at age 55 to 56% by age 75.
Despite this, to be on the safe side, most men with elevated PSA levels will opt for treatment, frequently suffering side effects such as incontinence and impotence. Increasingly, there are questions about the effectiveness of PSA screening for prostate cancer. Just how many lives are actually being saved? And is the emotional and physical toll on the millions of men who are being overdiagnosed and overtreated worth it?
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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.
Noncancerous Prostatic Disease And Urologic Manipulation
The serum PSA level can also be altered by noncancerous prostatic disease and urologic manipulations. Elevation of PSA levels has been demonstrated in acute prostatitis, subclinical or chronic prostatitis, and urinary retention. Nadler et al reported that serum PSA levels higher than 4.0 ng/mL in 148 men with subclinical prostatitis could be attributed to their disease because all these men had negative findings from biopsies repeated on multiple occasions.
No significant change occurs in the PSA level after a digital rectal examination , but a vigorous prostate massage can produce a short-term 2-fold increase. Cystoscopy, urethral catheterization, and transrectal ultrasonography of the prostate do not tend to elevate the PSA level. Needle biopsy of the prostate raises the PSA level by a median of 7.9 ng/mL within 5 minutes after the biopsy, and this level persists for 24 hours.
The time it takes for PSA to return to baseline levels depends on the precipitating event and the half-life . After a biopsy, 2 to 4 weeks may elapse before the PSA returns to its original level. If an infection occurs as a result of the biopsy, the return to baseline levels may take longer. After ejaculation, PSA levels have been reported to return to their original levels within 48 hours, whereas fPSA returns to baseline at 6 hours because of its shorter half-life .
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The Paradox Of A Mans Most
Should I get a PSA test? During the course of researching my book, I heard this question a lot. Even when it wasnt asked straight out, I could feel it in the air, hovering above my conversations with men about their prostates.
Is the test any good? What sort of number should I have? What sort of number do I want to have? Could I have cancer, or is it a false positive? Do I really need to take the test? These questions were often asked through a haze of worry so much so that I started to think of PSA as prostate-specific angst instead of prostate-specific antigen. And that the PSA test is causing the angst, not the prostate.
As it turns out, the prostate-specific antigen test a simple blood test is one of the most lauded yet also most controversial tests for prostate cancer.
But before I get into the social complexity of a simple blood test, let me provide a bit of background: prostate-specific antigen is a proteolytic enzyme , secreted by the prostate into the ejaculate, that liquefies the seminal plasma, thereby allowing sperm to swim more freely. Small amounts of it also leak into the blood. Measuring this amount in the blood can indicate if there is an increased risk of cancer in the prostate.
The angst I see men experiencing seems specifically generated by the threat of prostate cancer that the PSA test awakens.
What Is Digital Rectal Examination
Most prostate cancers are located in the peripheral zone of the prostate and may be detected by DRE. During this examination a doctor inserts a finger into the rectum to feel the prostate for lumps, size, shape, tenderness, and hardness. A suspect DRE is an absolute indication for prostate biopsy, regardless of the PSA level. In about 18% of patients with abnormal DRE, prostate cancer will be detected regardless of the PSA level.
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Cell Cycle Inhibitor P27
The cell cycle inhibitor p27 is a putative tumor suppressor gene. Loss of p27 is associated with a poor prognosis in patients with breast, colorectal, and prostate carcinoma. In men treated with radical prostatectomy, loss of p27 expression correlates with an increased probability of cancer recurrence and lower survival rates. Decreased p27 expression also is associated with high-grade cancer cells, positive surgical margins, seminal vesicle invasion, and lymph node metastases.
What Is The Accuracy Of The Psa Test
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.
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Does My Psa Level Determine Whether I Have Prostate Cancer
Your provider looks at two factors related to your PSA:
- Your PSA level: A higher level means a higher risk of prostate cancer.
- A continuous rise: PSA levels that continue to rise after two or more tests may mean you have cancer.
But the PSA level alone doesnt determine if you have cancer or not. Two men can even have the same PSA levels but different risks of prostate cancer. And a high PSA level may reflect prostate problems that arent cancer.
Controversy About The Psa Test
PSA tests are controversial because doctors and experts arent sure if the benefits of early detection outweigh the risks of misdiagnosis. Its also not clear if the screening test actually saves lives.
Because the test is very sensitive and can detect increased PSA numbers at low concentrations, it may detect cancer thats so small it would never become life-threatening. Just the same, most primary care physicians and urologists do choose to order the PSA as a screening test in men over the age of 50.
This is called overdiagnosis. More men may face complications and risks of side effects from the treatment of a small growth than they would if their cancer was left undiagnosed.
Its doubtful those small cancers would ever cause major symptoms and complications because prostate cancer, in most but not all cases, is a very slow-growing cancer.
Theres also no specific level of PSA thats considered normal for all men. In the past, doctors considered a PSA level of 4.0 nanograms per milliliter or lower to be normal, reports the National Cancer Institute.
However, recent research has shown that some men with lower levels of PSA have prostate cancer and many men with higher levels of PSA dont have cancer. Prostatitis, urinary tract infections, certain medications, and other factors can also cause your PSA levels to fluctuate.
All men are at risk of prostate cancer, but a few populations are more likely to develop it. These include:
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Why Do I Need A Psa Test
You may get a PSA test if you have certain risk factors for prostate cancer. These include:
- A father or brother with prostate cancer
- Being African-American. Prostate cancer is more common in African American men. The reason for this is unknown.
- Your age. Prostate cancer is more common in men over the age of 50.
You may also get a PSA test if:
- You have symptoms such as painful or frequent urination, and pelvic and/or back pain.
- You’ve already been diagnosed with prostate cancer. The PSA test can help monitor the effects of your treatment.
What Is A Normal Psa Level
Your doctor may talk about a normal PSA level. Unlike some other blood tests, there is not one normal PSA level for everyone. The PSA level naturally gets higher as you get older and varies depending on the size of your prostate. The size of the prostate is different for each individual and the prostate gets bigger with age.
Your doctor will tell you what they think the normal level of PSA should be for you. They generally use these levels:
- A PSA level of up to 3 nanograms per millilitre of blood if you are in your 50s.
- A PSA level of up to 4ng/ml if you are in your 60s.
- A PSA level of up to 5ng/ml if you are in your 70s.
- There are no PSA level limits if you are aged 80 and over.
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How Is The Psa Count Measured
PSA is measured by a simple blood test that does not require fasting or special preparation. Since the amount of PSA in the blood is very low, detection of it requires a very sensitive type of technology . The PSA protein can exist in the blood by itself or be bound with other substances . PSA is mostly bound to three substances: alpha-2-macroglobulin, alpha 1-antichymotrypsin , and albumin. Total PSA is the sum of the free and the bound forms. The total PSA is what is measured with the standard PSA test. More recently, a precursor of PSA, proenzyme PSA , has been identified, which may be helpful in determining prostate cancer risk in men with a PSA under 10 and a normal digital rectal examination. The prostate health index is a new approved test that measures the total PSA, free PSA, and proenzyme PSA. The National Comprehensive Cancer Network guidelines include use of PHI as a secondary test option for men making decisions about an initial or repeat biopsy. The 4K score test is another test that incorporates PSA. The 4K score uses a prediction model based on clinical variables and laboratory measurements of total PSA, free PSA, intact PSA, and a related protein known as hK2 .