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
What Happens If My Biopsies Comes Back Negative
Just because your biopsies are negative, does not mean that you do not have cancer in your prostate. You need to be seen on a regular basis for digital rectal examination and PSA testing. If there is significant change in your PSA, we may suggest repeat biopsies. The average risk of finding cancer in a repeat biopsy following a benign diagnosis is about 18%.
The Initial Causes Psa Levels And Prostate Cancer Chart
One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.
Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.
If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.
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Normal Psa Levels Chart By Numbers And Age
Dr.Megan Ralf
A Medical laboratory Scientist who devoted his life to medical and laboratory sciences, writes his everyday expertise dealing with various pathological conditions through laboratory diagnosis of different body fluids, also participating in many workshops for first aids, infection control, and urgent care. Also Dr Megan Ralf coaching many medical teams.
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High Psa Levels From A Urinary Tract Infection
“Any infection near the prostate gland, including a urinary tract infection, can irritate and inflame prostate cells and cause PSA to go up,” says Milner.
If youve been diagnosed with a urinary tract infection, be sure to wait until after the infection has cleared up before you get a PSA test. In men, most urinary tract infections are caused by bacteria and respond well to antibiotics.
Having BPH increases your risk for a urinary tract infection.
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Absolute Benefits And Harms
The main infographic explains the recommendation and provides an overview of the absolute benefits and harms of screening at a 10 year time horizon for consistency and easier communication. However, the individual trials varied in their duration of follow-up from 10 to 20 years , and we used the relative estimates of effect, pooled in the linked systematic review, at the longest available follow-up time.1 For the 10 year time horizon, we used as baseline risk in the non-screening arm of the CAP trial. It provided the most contemporary estimates of risks from a large sample of men representative of a general practice setting.2
Death and cancer diagnosis
PSA screening may increase the detection of prostate cancer at 10 years), particularly of localised cancer ). But the data show no difference in prostate cancer mortality. Overall confidence in these estimates across these outcomes was low because of risk of bias as well as the inconsistency of findings across studies.
-
When focusing on studies at lower risk of biasâERSPC trialsâthe panel was confident that over a 10 year period:
-
PSA screening probably has little or no effect on death
-
All-cause mortality )
-
Prostate cancer mortality )
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Prostate cancer mortality is similar at longer periods of up to 18 years of follow-up 1
PSA screening probably increases diagnosis of prostate cancer
Detection of any prostate cancer )
Detection of localised cancer )
The panel was also confident that:
Quality of life
Practical Issues And Other Considerations
Figure 3 outlines the key practical issues. PSA testing can be performed on any normal blood sample, but prostate biopsies and their follow-up have important implications for daily life.
Lower urinary tract symptoms are common complaints in adult men that can have a major impact on quality of life. Benign prostatic enlargement is the major cause. Evidence to date indicates that men with these complaints are not at increased risk of prostate cancer.4
For men who chose to undergo PSA testing, the optimal frequency of screening remains unknown. Figure 2 summarises the frequency used in the different trials, yet the accompanying systematic review did not find any significant subgroup effect of the effect of screening based on these different frequencies.1 Given that the ERSPC data are likely at lower risk of bias, PSA screening every four yearsârather than, say, every year or only once in a lifetimeâmay be the optimal interval.
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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.
When Should I Get A Psa Test
The guidelines below are adapted from the NCCN Clinical Practice Guidelines In Oncology for Prostate Cancer Early Detection. Please use these guidelines to have a discussion with your physician about your personal risk and make a plan for screening.
- If you are between ages 45 and 75:
- Discuss the risks and benefits of prostate cancer screening with your doctor, have a baseline PSA, and consider a baseline DRE
- If your PSA is below 1 ng/mL and your DRE is normal, repeat testing every 2-4 years
- If your PSA is between 1 and 3 ng/mL and your DRE is normal, repeat testing every 1-2 years
- If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
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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.
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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If Screening Test Results Arent Normal
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.
Understanding Psa Levels & The Psa Test
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.
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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.
What Can Lower The Psa Test Results
Medications commonly taken to treat benign enlargement of the prostate such as finasteride , dutasteride , and a combination of dutasteride and tamsulosin can decrease the PSA by about 50% within 6-12 months of starting use.
Another medication used to treat fungal infections, ketoconazole, can also lower PSA levels.
Lastly, herbal supplements such as saw palmetto and those containing phytoestrogens, which are plant-derived chemicals with estrogen-like effects, can also lower the PSA level. It is important to tell your health care provider all the medications, both prescription and nonprescription, as well as any herbal preparations or health supplements that you are taking.
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Fewer Incidence Of Cancer Moderate
©BMJ Publishing Group Limited.
Disclaimer: This infographic is not a validated clinical decision aid. This information is provided without any representations, conditions or warranties that it is accurate or up to date. BMJ and its licensors assume no responsibility for any aspect of treatment administered with the aid of this information. Any reliance placed on this information is strictly at the user’s own risk. For the full disclaimer wording see BMJ’s terms and conditions:
Prostatitis: A Common Problem In Men Under 50
“The PSA test is a good screening tool for prostate cancer, but it is not very specific,” says Erik P. Castle, MD, a urologist and researcher at the Mayo Clinic in Phoenix, Arizona. “Common causes of inflammation in the gland, called prostatitis, can cause high PSA levels.”
Prostatitis is the most common prostate problem for men younger than 50.
Prostatitis caused by bacteria can be treated with antibiotics. Another, more common type of prostatitis, called nonbacterial prostatitis, can be harder to treat and may last a long time.
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How Is Prostate Cancer Treated
Treatment options for prostate cancer include:
- Surgery to remove the prostate .
- High intensity focused ultrasound .
- Cryotherapy .
- Hormone treatment, also called androgen suppression therapy.
- Chemotherapy.
You may continue to have PSA level tests during and after prostate cancer treatment. These tests check that the treatment is working.
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. And other potential biomarkers of prostate cancer are being investigated. None of these tests has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include
Selected References
Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. New England Journal of Medicine 2004 350:22392246.
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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.
Should You Know Your Psa Level
Instead of a national screening programme, there is an informed choice programme, called prostate cancer risk management, for healthy men aged 50 or over who ask their GP about PSA testing. It aims to give men good information on the pros and cons of a PSA test.
If you’re aged 50 or over and decide to have your PSA levels tested after talking to a GP, they can arrange for it to be carried out free on the NHS.
If results show you have a raised level of PSA, the GP may suggest further tests.
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How To Get A Psa Test
Consult with your general practitioner or urologist about receiving a PSA test in their offices. PSA tests are typically covered without co-pay or deductible by Medicare once a year for men 50 years and older. Many states now have laws which require private health insurers to cover the costs for PSA testing. However, additional PSA test costs may need to be covered by the patient.
For those without insurance, or for those with insurance that does not cover PSA testing, free tools are available through advocacy groups, such as ZERO.
Companies such as imawaretm also offer in-home PSA testing kits and telemedicine appointments to discuss your PSA test results with a licensed physician. All imaware test kits are easy to use. After registering the test kit online, results will populate in the secure patient portal within 5-7 business days. You can submit your receipt of this test to insurance for potential reimbursement.
At-Home testing is now at a point where results can be provided accurately and quickly within 5 business days, with real physicians providing telemedicine support through the entire testing process
Dr. Diamandis Lunenfeld-Tanenbaum Research Institute, Sinai Health System
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