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
Is There A National Screening Programme For Prostate Cancer
Screening is a way to try to find cancer early in people who do not have any symptoms. In the UK, there are screening programmes for breast, bowel, and cervical cancer.
There is no UK national screening programme for prostate cancer. The PSA test on its own is not accurate enough to be used in a screening programme to diagnose early prostate cancer. It may falsely diagnose prostate cancer and may also miss some cancers.
Some studies show that lives may be saved by PSA screening because it may lead to prostate cancer being diagnosed at an early stage. But they also show that screening may lead to:
- more invasive tests, such as a prostate biopsy, which can cause complications
- more treatment of slow growing prostate cancers that would never have caused serious harm.
Treatment side effects include:
- or difficulty getting an erection.
For a screening programme to be effective, the benefits need to outweigh the disadvantages.
Advising Men Without Symptoms Of Prostate Disease Who Ask About The Psa Test
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This publication is available at https://www.gov.uk/government/publications/prostate-specific-antigen-testing-explanation-and-implementation/advising-well-men-about-the-psa-test-for-prostate-cancer-information-for-gps
This prostate cancer risk management programme information helps GPs give clear and balanced information to asymptomatic men who ask about prostate specific antigen testing. The PSA test is available free to any man aged 50 and over who requests it.
GPs should use their clinical judgement to manage asymptomatic men and those aged under 50 who they consider to be at increased risk of prostate cancer.
GPs should follow National Institute for Health and Care Excellence guideline NG12 for the management of men who have symptoms of prostate disease.
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Psa Tests Arent Great For Diagnosing Prostate Cancer Here Are Some Better Options In The Works
4 days ago at 7:19 PM
The PSA test is an imperfect way to screen men for prostate cancer. But until recently, it was seen as the best option available.
The test measures the amount of prostate specific antigen, or PSA, in the blood. This protein is produced in the prostate and tends to spike in men with cancer.
The trouble is, there are other things besides prostate cancer that can boost PSA, says Dr. Stacy Loeb, a urologist at NYU Langone Medical Center in New York City. Experts have come to realize that the test caused many men with elevated PSA levels to endure cancer scares and painful biopsies for no good reason.
Now, doctors have new tools to help them detect and manage the often-perplexing disease.
We havent had the perfect tests to guide our decisions, Loeb says. But were making progress. If youre coming into this now, youre in a way better situation than you would have been five or 10 years ago.
The new generation of screening tests including the Prostate Health Index and the 4Kscore can help some men avoid unnecessary biopsies. Both tests use total PSA as just one of many inputs to give a clearer picture of prostate health.
If I had a PSA of 6, I would definitely want the PHI test, he says. If the test suggests I didnt have cancer, I would feel great about the world.
A prostate biopsy is not a lot of fun, he says. This helps men make an informed decision.
Doctors still dont know how to put the tests to best possible use, he says.
How Is Prostate Cancer Detected
There is no single test to detect prostate cancer. The two most common tests are the prostate specific antigen blood test and the digital rectal examination .
The PSA test measures the level of PSA in your blood. It does not specifically test for cancer. Virtually all PSA is produced by the prostate gland. The normal range depends on your age. A PSA above the typical range may indicate the possibility of prostate cancer. However, two-thirds of cases of elevated PSA are due to noncancerous conditions such as prostatitis and BPH.
A DRE is generally conducted by a urologist to feel the prostate. While DRE is no longer recommended as a routine test for men who do not have symptoms of prostate cancer, it may be used to check for any changes in the prostate before doing a biopsy.
If either of these tests suggest an abnormality, other tests are necessary to confirm a diagnosis of prostate cancer, usually a magnetic resonance imaging scan and transrectal ultrasound biopsy.
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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.
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.
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Further Tests For Prostate Cancer
If results of the PSA test or the DRE are abnormal, a urologist will likely recommend a biopsy, where small samples of tissue are removed from the prostate and examined.
If cancer is diagnosed, other tests may be used to check the progression of the cancer, including:
- magnetic resonance imaging scan of the prostate – often done before a biopsy
- bone scan – to check whether or not cancer cells have spread to the bones
- computed tomography scan – a specialised x-ray
- pelvic lymph node dissection – a nearby lymph node is removed and examined to check whether or not cancer cells have entered the lymphatic system .
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Prostate Cancer Grading and Gleason Scores Verywell 1 hours ago Because the two most common types of cancer cells are identified in the prostate, the Gleason score is a combination of these two cell types. For example, if the most common cell type is a 3 and the second most common type is a 4, then the Gleason score is reported as a 7 or sometimes as a. 2021. 12. 5. ·Because the two most common types of cancer cells are identified in the prostate, the Gleason score is a combination of these two cell types. For example, if the most common cell type is a 3 and the. 2022. 8. 3. ·Usually, the grade of the cancer is evaluated separately from the stage. For prostate cancer, cell morphology is graded based on the Gleason grading system. Of note, this system of describing tumors as “well-“, “moderately-“, and “poorly-” differentiated based on Gleason score of 24, 56, and 710,. This can be very confusing and lead to overtreatment. A simple solution is new Gleason 1-5 grading scale as described by the pathologist, Dr. Epstein. The significance is that they now classify Gleason 3+3 is a Grade Group 1 or pre-cancerous, and Gleason 3+4 a GG2 or low risk. Gleason 4+3 is now a GG 3 and an intermediate risk.
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When Should I Have My Psa Levels Tested
The first thing to do is talk to your doctor about the pros and cons of prostate cancer screening before you decide whether to be tested. Donât get tested until you have that talk. Opinions differ about when you should do that.
The American Cancer Society says to get tested at age:
- 40 or 45 if youâre at high risk
- 50 if youâre at average risk
The American Urological Association suggests:
- Under 40: No screening
- 40 to 54: No screening if youâre at average risk. If youâre at a high risk, you and your doctor can decide.
- 55 to 69: Screening if your doctor suggests
- Over 70 or less than a 10-15 year life expectancy: No screening
The U.S. Preventive Services Task Force says:
- 55 to 69: Men with prostate cancer risks may need testing.
If your doctor thinks you might have prostate cancer based on either a PSA level or a rectal exam, a biopsy is the next step. This is a test where the doctor takes a small amount of tissue from your prostate and sends it to a lab for tests. Itâs the only way to be sure you have cancer.
During Watchful Waiting Or Active Surveillance
If you choose observation or active surveillance, your PSA level will be monitored closely to help decide if the cancer is growing and if treatment should be considered.
Your doctor will watch your PSA level and how quickly it is rising. Not all doctors agree on exactly what PSA level might require further action . Again, talk to your doctor so you understand what change in your PSA might be considered cause for concern.
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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.
Psa Test For Prostate Cancer
The prostate gland makes a protein called prostate specific antigen . This protein helps to nourish sperm. Normally, only tiny amounts of it enter the bloodstream.
Cancer cells in the prostate interfere with proper functioning and can cause large amounts of PSA to enter the bloodstream. Therefore, when high levels of PSA are detected in the bloodstream, this may indicate cancer.
Early prostate cancer often has no symptoms. However, high PSA levels can occur five to 10 years before the onset of prostate cancer symptoms. In such circumstances, the PSA test can help to indicate the presence of cancer at an early stage.
Other tests are needed to confirm a diagnosis because an abnormal PSA test can be due to non-cancerous causes. Equally, it is possible for a man to have a normal PSA level when cancer is present.
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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 Is A Normal Psa Test Result
There is no specific normal or abnormal level of PSA in the blood. In the past, PSA levels of 4.0 ng/mL and lower were considered normal. However, some individuals with PSA levels below 4.0 ng/mL have prostate cancer and many with higher PSA levels between 4 and 10 ng/mL do not have prostate cancer .
In addition, various factors can cause someones PSA level to fluctuate. For example, the PSA level tends to increase with age, prostate gland size, and inflammation or infection. A recent prostate biopsy will also increase the PSA level, as can ejaculation or vigorous exercise in the 2 days before testing. Conversely, some drugsincluding finasteride and dutasteride, which are used to treat BPHlower the PSA level.
In general, however, the higher a mans PSA level, the more likely it is that he has prostate cancer.
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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.
If I Have Elevated Psa Levels What Should I Ask My Healthcare Provider
If you have any symptoms of prostate cancer, or if it runs in your family, ask your provider:
- Should I have regular tests to check my PSA level?
- What can I do to lower my risk for prostate cancer?
- What other tests or monitoring do I need?
- What are my treatment options if I get prostate cancer?
- What other signs or symptoms should I look out for?
A note from Cleveland Clinic
An elevated PSA level can be a sign of prostate cancer, but it doesnt always mean you have cancer. Your healthcare provider will watch you and do more tests to arrive at a diagnosis. Prostate cancer is often slow-growing and may never become life-threatening. If you have symptoms of prostate problems, such as difficulty urinating, don’t hesitate to let your provider know.
Last reviewed by a Cleveland Clinic medical professional on 04/06/2021.
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Information For Well Men Aged 50 And Over
You can refer to the infographic above and direct patients to the information sheet for well men aged 50 and over for a summary of the potential benefits and risks of PSA testing.
The information sheet for well men includes the above infographic, which explains the PSA test. It also includes a list of the potential advantages and disadvantages of the PSA test for men to consider when making a decision.
The Office for Health Improvement and Disparities created this information on behalf of the NHS.