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.
Localized Prostate Cancer: Psa Tests For Prostate Cancer Screening
The PSA test for prostate cancer screening has pros and cons: It can prevent 3 out of 1,000 men from dying of prostate cancer. But it also leads to an unnecessary prostate cancer in up to 60 out of 1,000 men who often have unnecessary cancer treatment as a result. The decision about whether or not to have the test is a personal decision.
The aim of doing PSA tests is to discover prostate cancer before it causes any symptoms. Early and treatment can improve the chances of recovery and lower the risk of the cancer spreading to other parts of the body .
But this screening also has clear disadvantages: It finds many small tumors that aren’t a medical concern. This is because, in most men, prostate cancer grows so slowly that it doesn’t cause any problems for the rest of their lives. Men who have prostate cancer that is detected by screening are subjected to the burdens and side effects of the and treatment. The diagnosis of a medical condition that would never have caused any symptoms or problems is called overdiagnosis.
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.
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Linked Articles In This Bmj Rapid Recommendation Cluster
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Tikkinen KAO, Dahm P, Lytvyn L, et al. Prostate cancer screening with prostate-specific antigen test: a clinical practice guideline. BMJ 2018:362:k3581. doi:10.1136/bmj.k3581
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Summary of the results from the Rapid Recommendation process
Ilic D, Djulbegovic M, Jung JH, et al. Prostate cancer screening with prostate-specific antigen test: a systematic review and meta-analysis. BMJ 2018:362:k3519. doi:10.1136/bmj.k3519
Systematic review and meta-analysis of all available randomised trials that assessed PSA based screening for prostate cancer
Vernooij RWM, Lytvyn L, Pardo-Hernandez H, et al. Values and preferences of men for undergoing prostate-specific antigen screening for prostate cancer: a systematic review. BMJ Open 2018 0:e025470. doi:10.1136/bmjopen-2018-025470
Systematic review of the values and preference of men considering PSA screening
Expanded version of the results with multilayered recommendations, evidence summaries, and decision aids for use on all devices
Clinical And Survival Characteristics In Psa
Through the survival analysis, it was found that the overall and prostate cancer-specific survival was high in the Chinese cohort in comparison to it is in the western countries where PSA-based mass screening have been widely used for decades. In order to figure out whether PSA-based mass screening is contribute to mortality reduction in prostate cancer, we further compared the clinical and survival characteristics between PSA-based mass screening and clinically diagnosed prostate cancer patients.
Based on PSA-based mass screening, 383 men were diagnosed as having prostate cancer. Of these, 358 men had prostatic adenocarcinoma. 259 of them had biopsies and were diagnosed immediately and 99 men refused biopsies at first and were diagnosed years later when their PSA levels were very high. Therefore, in this study, to reduce discrepancies, these 99 men were subcategorized into another group as PSA screened with later diagnosis, whereas the other 259 patients were subcategorized as PSA screened patients. Clinical characteristics and survival were compared in three groups: 259 PSA screened patients, 99 PSA screened patients with later diagnosis, and 626 clinically diagnosed prostatic adenocarcinoma patients.
Clinical characteristics
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New Prostate Cancer Blood Test
If you have an abnormal PSA score, your doctor may recommend another newertest that gives a better sense of yourprostate cancer risk. The prostate health index is one such test that is a more accurateblood test and measures your risk for having prostate cancer. Its approvedby the FDA for men who have PSA scores between 4 and 10.
What are the benefits of the PHI test?
- Fewer unnecessary biopsies: Some men who have elevated PSA scores are unsure about getting an invasive biopsy. This tool can be used to better determine whether your risk is high enough to warrant a biopsy.
- More accurate: This test is better at detecting prostate cancer. It can also detect whether you have a more aggressive type of cancer. This information can guide doctors to a more targeted treatment plan for you.
If you score low on the PHI test, your doctor may recommend monitoring youover time to see if your levels rise enough to cause concern.
How Is The Psa Test Used In Men Who Have Been Treated For Prostate Cancer
The PSA test is used to monitor men after surgery or radiation therapy for prostate cancer to see if their cancer has recurred . If a mans PSA level begins to rise after prostate cancer treatment, it may be the first sign of a recurrence. Such a biochemical relapse typically appears months or years before the recurrence causes symptoms.
However, a single elevated PSA measurement in someone who has a history of prostate cancer does not always mean that the cancer has come back. Someone who has been treated for prostate cancer should discuss an elevated PSA level with their doctor. The doctor may recommend repeating the PSA test or performing other tests to check for evidence of a recurrence. The doctor may look for a trend of rising PSA level over time rather than a single elevated PSA level.
A rising trend in PSA level over time in combination with other findings, such as an abnormal result on imaging tests, may lead the doctor to recommend further cancer treatment.
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What Do The Results Mean
There is no specific normal or abnormal level for PSA in blood. In general, the higher your PSA level, the more likely it is that you have cancer. But it’s possible to have a high PSA without prostate cancer, or a low PSA with prostate cancer.
If you had a PSA test for a prostate cancer screening or because you have prostate symptoms:
- High PSA levels can mean you have prostate cancer or a prostate condition that’s not cancer, such as an infection or an enlarged prostate. If your PSA levels are higher than normal, your provider may talk with you about having more tests to diagnose the cause. These tests may include:
- Another PSA test, more commonly if you don’t have any symptoms. PSA levels can go up and down, so it helpful to see if your PSA levels change over time.
- A digital rectal exam . For this test, your provider inserts a gloved, lubricated finger into your rectum to feel your prostate for lumps or anything unusual.
- A urine test. A sample of your urine is tested for infection.
- A prostate biopsy. A biopsy is minor surgery. A doctor removes samples of tissue from your prostate so it can be studied under a microscope to look for cancer cells. A biopsy is the only way to diagnose cancer. It may be recommended if your provider thinks you may have prostate cancer.
If you have questions about your results, talk with your provider.
Learn more about laboratory tests, reference ranges, and understanding results.
What Happens If My Psa Level Is Elevated
If you have a high PSA level, you will need ongoing PSA tests and DREs so your provider can look for any changes. If the PSA level continues to increase or if your healthcare provider finds a lump during a DRE, you may need other tests, including:
- Transrectal ultrasound and prostate biopsies.
- Iso PSA or 4Kscore® .
A biopsy can tell you definitively if you have prostate cancer. The biopsy results also affect your treatment. For example, if the biopsy shows a lot of cancer cells, you might need more aggressive treatment.
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Biases In The Evaluation Of Biomarker Performance
An error common throughout the history of prostate cancer screening might be described as a self-fulfilling prophecy: If you don’t look for it, you won’t find it. In the late 1980s, without preliminary validation studies to ascertain test performance, a cut-off level of 4.0 ng/mL was widely adopted, and virtually no patients with levels less than that underwent biopsy. As a result, for almost 2 decades prostate cancer was generally thought to be almost nonexistent at PSA levels under 4.0 ng/mL. As we later found, this was incorrect and PSA results, like those of other markers, are not dichotomous.20 Because of the failure to verify the true prostate-cancer status of men with low PSA concentrations and the subsequent exclusion of these men from formal evaluations of the operating characteristics of the test, many of the earlier reports on the test’s sensitivity and specificity were upwardly biased.21
Why Might Your Doctor Offer Psa Screening For You
Your doctor may discuss PSA screening if you are in your 50s or 60s. If you’re at high risk, your doctor may discuss screening sooner. Some things may put you at high risk for prostate cancer, such as being African American, having a family history of prostate cancer, or carrying gene changes thought to increase the risk for prostate cancer. If you don’t already know your prostate cancer risk, you can ask your doctor.
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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.
What Matters Most To You
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have a PSA test
Reasons not to have a PSA test
I want to find prostate cancer early.
I want to avoid the side effects of prostate cancer treatment.
I want to be tested so I can have peace of mind.
I’m not worried that I might get prostate cancer.
I want to know if I have prostate cancer.
I don’t want to know if I have prostate cancer, because it may never affect my health.
I think having a PSA test is worth the risk of having a false alarm if it could find prostate cancer early.
I want to avoid worry from a false alarm and more testing.
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Strengths And Limitations Of This Study
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This is the first randomised trial to directly compare serum prostate-specific antigen testing and prostate MRI for prostate cancer screening purposes.
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Participants in each arm did not undergo the reciprocal test at the time of randomisation.
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Limitations of the current study include the conduct of the trial at a single centre and the higher drop-out rate seen in the PSA arm.
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The study was terminated prematurely due to accrual challenges and difficulties accessing MRI resources and PSA follow-up data due to resource limitations and patient reluctance during the COVID-19 pandemic as a result, the study was underpowered.
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Nevertheless, this randomised trial confirms the utility and public acceptance of the use of MRI in this setting.
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 55 to 69 . This rating has now been certified official by the task force.
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Should I Get Screened For Prostate Cancer
This video helps men understand their prostate cancer screening options.
In 2018, the U.S. Preventive Services Task Force made the following recommendations about prostate cancer screening
- Men who are 55 to 69 years old should make individual decisions about being screened for prostate cancer with a prostate specific antigen test.
- Before making a decision, men should talk to their doctor about the benefits and harms of screening for prostate cancer, including the benefits and harms of other tests and treatment.
- Men who are 70 years old and older should not be screened for prostate cancer routinely.
This recommendation applies to men who
- Are at average risk for prostate cancer.
- Are at increased risk for prostate cancer.
Results Of The Cap Randomized Clinical Trial2
This cluster-randomised trial of 419â582 British men was published in March 2018. After a median follow-up of 10 years, there was no significant difference in prostate cancer-specific mortality in men receiving care by general practices randomised to a single PSA screening intervention compared with men receiving care by practices randomised to standard practice without screening. The detection of low risk prostate cancer cases was higher in the PSA screening group. Although the trial had limitations, such as low adherence to PSA testing in the intervention arm and a follow-up of only 10 years, its findings do not support the use of single PSA testing for population based screening.
The Rapid Recommendations executive felt this new studyâtaken together with extended follow-up data from existing trialsârequired a new appraisal of the body of evidence for patients and clinicians.
Although the results of this study suggest screening is not worthwhile, several guidelines advocate offering screening in some cases. The study was much larger than previous studies, and existing trials had published more extended follow-up results, and the BMJ Rapid Recommendations team felt these merited a new appraisal of the body of evidence. This guideline aims to promptly and transparently translate potentially practice-changing evidence to usable recommendations for clinicians and patients, based on the GRADE framework and following standards for trustworthy guidelines.
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The Role Of Psa In Staging
Prostate cancer causes cells to become malignant and multiply uncontrollably. This can lead to overproduction of PSA, and higher levels of PSA in the bloodstream.
However, some men who have prostate cancer do not exhibit elevated PSA levels. And certain noncancerous conditions, like a prostate infection or benign enlargement, can also cause high PSA levels.
PSA levels are just one factor used in determining the stage of prostate cancer. Another diagnostic tool is called the Gleason scale. This rates the extent of abnormality in your prostate cells after biopsy.
At a certain point in prostate cancers late-stage progression, Gleason and PSA become less useful. When a tumor is large enough, doctors no longer need these numbers to predict its growth or malignancy.
Unanswered Questions And Future Research
While MRI has proven to be a useful clinical tool for prostate cancer risk stratification, the feasibility and cost-effectiveness of widespread population-based prostate MRI is a challenge in many clinical landscapes. A recent microsimulation model assessed the cost-effectiveness of PSA with MRI and MRI-guided biopsy for prostate cancer detection. MRI-based prostate cancer screening resulted in more years of life gained and quality-adjusted life-years by 3 and 3.5 years per 1000 men invited for screening, respectively. In the integrated cost-effectiveness analysis, MRI-based screening was associated with a cost of just over 11000 per QALY gained compared with PSA-screening, suggesting MRI-based screening is cost-effective. In their analysis, compliance rates were assumed to be the same for both PSA-based and MRI-based screening. However, as demonstrated in this study, greater public acceptance of MRI-based screening may further increase the benefit of integrating MRI into prostate cancer screening practices. Indeed, imaging-based cancer screening approaches for breast , lung and colon have been considered.
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