If I Choose Psa Testing What Are The Next Steps If You Have A Raised Psa Level
Instead of quickly jumping to surgery and drugs for a solution, there is another option: active surveillance.
Active surveillance is a non-invasive approach to prostate cancer treatment.
Active surveillance is the better option if your cancer shows all signs of being the good kind, i.e. slow-growing, low volume, and not aggressive. In this case, you can treat it without drugs, radiation, or surgery.
A benefit of monitoring low-risk cancer is that you might avoid having unnecessary surgery.
In fact, one study of men undergoing active surveillance found that, 15 years later, less than 1% of men developed metastatic disease. There are also other natural ways to treat prostate cancer.
Watchful waiting is also another option. Watchful waiting is usually used by men experiencing other health problems, who may be unable to handle surgery or radiotherapy.
It involves fewer tests than active surveillance and is less intensive, more often than not taking place at the GP surgery than a hospital.
If you do have treatment in the future, it will aim to control the cancer and manage any symptoms, rather than to cure it.
Average Psa Test Doubling Time
Another red flag. This calculation denotes the time it takes your PSA values to double.
Therefore it may signify the aggressiveness of any prostate abnormalities, whether it’s an enlarged prostate, prostatitis, or prostate cancer.
If your average PSA readings double in less than three years your doctor will most likely order a biopsy, to look in to the problem further and discuss possible prostate cancer treatment options.
The Ajcc Tnm Staging System
A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The most widely used staging system for prostate cancer is the AJCC TNM system, which was most recently updated in 2018.
The TNM system for prostate cancer is based on 5 key pieces of information:
- The extent of the main tumor *
- Whether the cancer has spread to nearby lymph nodes
- Whether the cancer has spread to other parts of the body
- The PSA level at the time of diagnosis
- The Grade Group , which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy .
*There are 2 types of T categories for prostate cancer:
- The clinical T category is your doctors best estimate of the extent of your disease, based on the results of the physical exam and prostate biopsy, and any imaging tests you have had.
- If you have surgery to remove your prostate, your doctors can also determine the pathologic T category . The pathologic T is likely to be more accurate than the clinical T, as it is done after all of your prostate has been examined in the lab.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to get the overall stage of the cancer.
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What Are The Stages Of Prostate Cancer
Your healthcare provider uses the Gleason score and Grade Groups to stage prostate cancer based on its projected aggressiveness. To get this information, the pathologist:
- Assigns a grade to each type of cell in your sample. Cells are graded on a scale of three to five . Samples that test in the one to two range are considered normal tissue.
- Adds together the two most common grades to get your Gleason score .
- Uses the Gleason score to place you into a Grade Group ranging from one to five. A Gleason score of six puts you in Grade Group 1 . A score of nine or higher puts you in Grade Group five . Samples with a higher portion of more aggressive cells receive a higher Grade Group.
What Does An Elevated Psa Level Mean If Ive Had Prostate Cancer In The Past
If youve ever had treatment for prostate cancer, youll have regular PSA screenings for the rest of your life. An increasing PSA level may mean the cancer has returned. Your care team may use other tests, including imaging scans and biopsies, to check for signs of cancer. If cancer returns, your team will discuss your treatment options with you.
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Problems With The Psa Test
There are reasons doctors donât agree on whether you need this test:
- Finding prostate cancer early doesnât always protect you. The PSA test often finds small, slow-growing tumors that arenât life-threatening. Treating them anyway, whether itâs with surgery or radiation, can expose you to harmful side effects and complications. Also, finding cancer early may not help if you have an aggressive tumor or if it spread to distant body parts before you found it.
- The results arenât always accurate. If you have a high level but you donât have cancer, the test results can create a lot of worry and lead to medical procedures you donât need. A negative result if you really do have cancer can prevent you from getting treatment you do need.
What Are Normal Psa Levels
Thereâs no such thing as a normal PSA for any man at any given age, but most men with prostate cancer have a higher than normal level. In general:
If your PSA results are in the borderline range , the % free PSA can be useful in helping distinguish between prostate cancer or benign prostatic hyperplasia . The pattern is the opposite of that seen with PSA in that a high % free PSAâabove 20%âpoints to BPH, while a %- free PSA less than 10% indicates a greater likelihood of cancer.
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Doctors Often Dont Discuss The Pros And Cons Of Screening With Patients
According to those USPSTF guidelines, men ages 55 to 69 and their doctors should discuss screening, taking into account the balance of benefits and harms on the basis of family history, race or ethnicity, comorbid medical conditions, patient values regarding risks and benefits, and other health needs.
But men may not be having that conversation, said Jemal. In fact, a study published in March 2018 in the Annals of Family Medicine found that many men did not receive shared decision-making discussions with their physicians.
This should not be the case, said Jemal. Men 50 to 69 should discuss the pros and cons of PSA screening with their doctors, he said, taking into account individual risk factors, like family history, obesity, and smoking. They have to ask and be informed about the balance of risk, benefit, and the uncertainty involved in PSA testing.
What Is The Cost Of The Psa Test
The PSA blood test is frequently covered by insurance, especially for men who are 50 years of age and older. PSA blood tests costs $20-$50. However, if it is obtained in the doctor’s office during a visit to the doctor there may be an additional charge of $25-$100 for the office visit. There are PSA blood tests available for home use. The home blood test comes with a lancet to prick your finger and squeeze out a sample of blood, a kit to collect the blood, a bandage, and an address or prepaid mailer to return to the laboratory. Not all of the advertised home blood tests are approved by the U.S. Food and Drug Administration . You can access the FDA web site to make sure you are using an approved test.
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What Is A Prostate Ultrasound And Biopsy And Why Would You Need One
The prostate is the part of your body that makes fluid for semen, which is the fluid that carries sperm. The gland surrounds part of your urethra, which is the tube that carries urine and sperm outside of the body. The prostate has muscles that move the sperm out of the body.
If you are having problems with your prostate, you might be having difficulties related to pushing urine or sperm out of your urethra and penis. Your healthcare provider may ask you to have a prostate ultrasound and biopsy to check for prostate cancer.
A prostate ultrasound probe is inserted into the rectum and uses sound waves to produce images inside the rectum to help image the prostate and guide the doctor in taking a biopsy of the prostate gland. Prostate ultrasound and biopsy are used to diagnose prostate cancer or to find the reason for other problems. A doctor may require this test if a patient has high levels of prostate-specific antigen found in a blood test, or has an abnormal prostate exam both suggesting that the patient may have a high risk for prostate cancer.
How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:
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Isup 2014 Grading Of Prostate Cancer
It is now recommended that the aggregated ISUP grade should be reported for each individually labelled biopsy site.49 If multiple cores of one biopsy site contain carcinoma, it is optional to report the grade for each core. Further, a global Gleason score is generally reported taking into account the grade patterns of the carcinoma foci encountered in all cores. Although it may seem counterintuitive, three recent studies showed that the global Gleason score outperformed the worst Gleason score with regard to pathological features in corresponding prostatectomy specimens.50, 51, 52
Grading of prostatectomy specimens follows slightly different rules compared to biopsy grading: if no clearly spatially separate carcinoma foci with disparate grade are detected a global ISUP grade is reported. If a predominant Gleason grade 3 carcinoma is identified with a minor grade 4, the minor component is not accounted for in the ISUP grade, but recorded as a minor component. If Gleason grades 3 and 4 are the two dominant patterns and a grade 5 component comprises less than 5% of the carcinoma area, most would not include the grade 5 in the ISUP grade, but report it as minor grade 5 component. If, however, the grade 5 component represented the third most common pattern, while exceeding 5% of the carcinoma area, many pathologists would include the grade 5 component in the ISUP grade.
Screening Tests For Prostate Cancer
Screening is testing to find cancer in people before they have symptoms. Its not clear, however, if the benefits of prostate cancer screening outweigh the risks for most men. Still, after discussing the pros and cons of screening with their doctors, some men might reasonably choose to be screened.
The screening tests discussed here are used to look for possible signs of prostate cancer. But these tests cant tell for sure if you have cancer. If the result of one of these tests is abnormal, you will probably need a prostate biopsy to know for sure if you have cancer.
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Fast Psa Rise Implies Bad Prostate Cancer
Prostate Cancer Death Linked to Speedy Rise in PSA Count
Among the 660 men who chose radical prostatectomy — surgical removal of the prostate — there were 89 deaths within a median 5.4 years. Prostate cancer caused 29 of these deaths. In 44% of these prostate-cancer deaths, the only sign of high-risk disease was a PSA rise of at least 2 ng/mL in the year before treatment.
Among the 288 men who chose external-beam radiation treatment, there were 75 deaths within a median four years. Prostate cancer caused 32 of these deaths. In 28% of these prostate cancer deaths, the only sign of high-risk disease was a PSA rise of at least 2 ng/mL in the year before treatment.
Other clues that a man is at increased risk of dying from prostate cancer are tumors with a score of 7 or more on the Gleason tumor aggressiveness score clinical disease that has advanced to the T2b stage and a PSA level of greater than 10 ng/mL.
What Are Prostate Cancer Treatment Side Effects
Some prostate cancer treatments can affect the bladder, erectile nerves and sphincter muscle, which controls urination. Potential problems include:
- Incontinence: Some men experience urinary incontinence. You may leak urine when you cough or laugh, or you may feel an urgent need to use the bathroom even when your bladder isnt full. This problem can improve over the first six to 12 months without treatment.
- Erectile dysfunction : Surgery, radiation and other treatments can damage the erectile nerves and affect your ability to get or maintain an erection. Some men regain erectile function within a year or two . In the meantime, medications like sildenafil or tadalafil can help by increasing blood flow to the penis.
- Infertility: Treatments can affect your ability to produce or ejaculate sperm, resulting in male infertility. If you think you might want children in the future, you can preserve sperm in a sperm bank before you start treatments. After treatments, you may undergo sperm extraction. This procedure involves removing sperm directly from testicular tissue and implanting it into a womans uterus.
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Stages Of Prostate Cancer
Any T, any N, M1
Any Grade Group
The cancer might or might not be growing into tissues near the prostate and might or might not have spread to nearby lymph nodes . It has spread to other parts of the body, such as distant lymph nodes, bones, or other organs . The Grade Group can be any value, and the PSA can be any value.
Prostate cancer staging can be complex. If you have any questions about your stage, please ask someone on your cancer care team to explain it to you in a way you understand.
While the stage of a prostate cancer can help give an idea of how serious the cancer is likely to be, doctors are now looking for other ways to tell how likely a prostate cancer is to grow and spread, which might also help determine a mans best treatment options.
Is The Psa Test Recommended For Prostate Cancer Screening
Until about 2008, some doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50. Some organizations recommended that men who are at higher risk of prostate cancer, including African-American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45. However, as more was learned about both the benefits and harms of prostate cancer screening, a number of organizations began to caution against routine population screening. Most organizations recommend that men who are considering PSA screening first discuss the risks and benefits with their doctors.
Currently, Medicare provides coverage for an annual PSA test for all Medicare-eligible men age 50 and older. Many private insurers cover PSA screening as well.
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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.
Repeating The Psa Test
A mans blood PSA level can vary over time , so some doctors recommend repeating the test after a month or so if the initial PSA result is abnormal. This is most likely to be a reasonable option if the PSA level is on the lower end of the borderline range . For higher PSA levels, doctors are more likely to recommend getting other tests, or going straight to a prostate biopsy.
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How Should You Prepare For A Prostate Ultrasound And Biopsy
Preparation for a prostate ultrasound and biopsy is simple. You shouldnt take any blood-thinning medications such as warfarin , clopidogrel , aspirin or ibuprofen before a prostate biopsy because blood thinner increase the risk of bleeding. If you are already taking blood thinners, your doctor will discuss with you how many days prior to the biopsy they should be held.
Most healthcare providers dont ask you to follow any type of special diet before a biopsy. However, they suggest eating lightly before the procedure and drinking only clear liquids. Check with your providers office to see if you need to do anything additional to prepare for the test.