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.
What Happens During The Test
Your doctor will start by giving you a digital rectal exam . They will insert a lubricated, gloved finger in your rectum and gently push on your prostate gland. This helps move the PCA3 into your urethra so it can be expelled in your urine. Following the DRE, youll be asked to provide a urine sample. The urine sample will be sent to a lab for testing and the results will then be sent to your doctor when they are available.
The PCA3 test results are more accurate when preceded by a DRE.
When Is A Psa Test Needed
If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.
Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.
- You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
- Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
- If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
04/2014
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Does A High Psa Level Mean I Have Prostate Cancer
There is no set rule about what constitutes an abnormal PSA reading on a blood test. Since prostate cancer is not the only source of PSA, an elevated PSA may reflect an enlarged or inflamed benign prostate gland. High PSA levels are often the result of benign prostate hyperplasia, enlargement of the prostate that occurs in most men as they age. When interpreting the test results, doctors take a number of factors into consideration, including the patients age and ethnicity as well as rate of rise of PSA.
It is hard to detect the difference between PSA made by normal prostate tissue and PSA made by prostate cancer cells, says , a medical oncologist at Dana-Farber Cancer Institute. We know that as the PSA rises and gets higher and higher, the odds that that PSA is coming from a cancer than a normal prostate increases.
Still, most men considered tohave an elevated PSA do not have a detectable prostate cancer. About 25 percentof those who undergo a prostate biopsyin which a small section of the prostateis removed and examined for signs of cancerare found to have prostate cancer.
What Is The Prostate Health Index Test
Prostate Health Index is a test that predicts the risk of having prostate cancer. It is used instead of the PSA test for prostate cancer detection and prostate cancer screening. PHI provides more useful information than PSA alone and is more specific for prostate cancer. When the Prostate Health Index test is elevated, there is a greater likelihood of having prostate cancer than when a PSA test is elevated.
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Facts About Prostate Specific Antigen Tests
According to the American Cancer Society, 1 in 8 men will be diagnosed with prostate cancer during his lifetime, and prostate cancer is the second leading cause of cancer death in American men. Here are five things you should know about prostate cancer and prostate specific antigen tests.
1. Prostate cancer is silent for many men.
In most men, prostate cancer displays few early symptoms. Urinary symptoms, such as decreased force of urinary stream or nocturia , are common in aging men but, in general, these are not associated with prostate cancer. Symptoms such as bone pain, blood in urine or weight loss can be found if prostate cancer has spread.
2. Some men are at a greater risk for developing prostate cancer.
All men can develop prostate cancer. However, there are some risk factors that increase your likelihood. Older men are at increased risk. African American men and men with one or more close relatives who have had prostate cancer also are at increased risk. Your risk also will be higher if you have a close relative diagnosed with prostate cancer prior to age 55.
3. PSA tests do not diagnose prostate cancer.
There is no universally accepted threshold value above which total PSA is considered abnormal, as PSA values change depending on your age and race.
4. There are some downsides with a PSA test.
5. There are established screening guidelines for men of average risk of prostate cancer.
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Factors That Might Affect Psa Levels
One reason its hard to use a set cutoff point with the PSA test when looking for prostate cancer is that a number of factors other than cancer can also affect PSA levels.
Factors that might raise PSA levels include:
- An enlarged prostate: Conditions such as benign prostatic hyperplasia, a non-cancerous enlargement of the prostate that affects many men as they grow older, can raise PSA levels.
- Older age: PSA levels normally go up slowly as you get older, even if you have no prostate abnormality.
- Prostatitis: This is an infection or inflammation of the prostate gland, which can raise PSA levels.
- Ejaculation: Thiscan make the PSA go up for a short time. This is why some doctors suggest that men abstain from ejaculation for a day or two before testing.
- Riding a bicycle: Some studies have suggested that cycling may raise PSA levels for a short time , although not all studies have found this.
- Certain urologic procedures: Some procedures done in a doctors office that affect the prostate, such as a prostate biopsy or cystoscopy, can raise PSA levels for a short time. Some studies have suggested that a digital rectal exam might raise PSA levels slightly, although other studies have not found this. Still, if both a PSA test and a DRE are being done during a doctor visit, some doctors advise having the blood drawn for the PSA before having the DRE, just in case.
- Certain medicines: Taking male hormones like testosterone may cause a rise in PSA.
Some things might lower PSA levels :
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The New Recommendations For Prostate Cancer Screenings Are A Bad Deal
Vinay PrasadApril 11, 2017
That popping sound you may have heard on Tuesday was made by urologists opening the champagne bottles they had chilled in anticipation of the United States Preventive Services Task Force upgrading its recommendation about PSA screening for prostate cancer from a D to a C .
Much like a teacher changing a dissatisfied students grade from a D to a C and only after much complaining the new guidelines should hardly be construed as a ringing endorsement. PSA screening remains a difficult decision for healthy men and their doctors.
The test measures the amount of a protein called prostate-specific antigen in the bloodstream. A PSA level above 4.0 nanograms per milliliter of blood has been used as the traditional cutoff to suggest the possibility of prostate cancer . Screening means testing healthy individuals to see if they might have hidden cancer.
The data on which the USPSTF based its new recommendation for PSA screening is similar to the data it used for its prior recommendation in 2012. No study has shown that the test saves lives or improves the quality of life. It does not reduce mortality or extend survival in any randomized trial to date, nor when all studies are combined together. Let me say that again: There is no proof that PSA screening extends your life, improves the years you have, or reduces your risk of dying.
Early Detection Saves Lives
Prostate cancer is the most common cancer affecting Australian men .
Prostate cancer is the growth of abnormal cells in the prostate gland. This gland is only found in males and is about the size of a walnut.
The causes of prostate cancer are not understood and there is currently no clear prevention strategy.
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What Is A Prostate
A prostate-specific antigen test measures the level of PSA in your blood. The prostate is a small gland that is part of a man’s reproductive system. It is located below the bladder and makes a fluid that is part of semen. PSA is a substance made by the prostate. Men normally have low PSA levels in their blood. A high PSA level may be a sign of prostate cancer, the most common non-skin cancer affecting American men. But high PSA levels can also mean noncancerous prostate conditions, such as infection or benign prostatic hyperplasia, a noncancerous enlargement of the prostate.
Other names: total PSA, free PSA
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.
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Who Should Have Regular Screening Tests For High Psa
The PSA test was first developed to observe prostate changes in men who had a history of prostate cancer. Then it became more widely used in the general population as a way to detect and prevent prostate cancer before symptoms developed. But routine screening can find prostate cancers that grow slowly and do not need treatment. Talk to your healthcare provider to see if you should have regular PSA tests.
Lymph Node Biopsy As A Separate Procedure
A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.
Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.
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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.
Factors That Affect Psa Levels
It is important to note that PSA levels can rise naturally with age, and that a number of benign conditions can also affect PSA levels, such as prostatitis , benign prostatic hyperplasia , urinary tract infection , or even injury to the prostate.
Other factors such as sexual activity right before testing, certain exercises, or even diet can impact the PSA levels as well. It is essential to consult a doctor regarding the meaning and next steps of your PSA testing results.
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Psa Transition Zone Density
Kalish introduced PSA density of the transition zone as a refinement to the original PSAD. This refinement is predicated on the following 2 assumptions:
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That measuring transition zone volume with TRUS is more accurate than measuring the entire prostate volume because of the difficulty in measuring the true border of the apex in the longitudinal view
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That most of the PSA entering the circulation arises from the transition zone
Zisman et al have offered a new index using the peripheral zone fraction of PSA to predict the presence of prostate cancer in men with PSA levels of 4-10 ng/mL. They point out that the PZ contributes little to tPSA. The PZ fraction can be calculated by using the following formula:
tPSA Ã /total prostate volume
PZ volume is measured by subtracting TZ volume from total prostate volume while neglecting the central zone.
Zisman et al compared the positive and negative predictive values using tPSA, PSAD, PSA-TZ, and PSA peripheral zone density . The efficacy rates of PSA and PSA-TZ were similar, at 60% PSA-PZ had a 70% efficacy rate, PSAD an 80% rate. The negative predictive values were superior to the positive predictive values, ranging from 78% to 83% for PSA, from 78% to 88% for PSAD, from 87% to 92% for PSA-TZ, and from 81% to 100% for PSA-PZ.
Serum Insulinlike Growth Factor
Insulinlike growth factor -1, its binding protein , and its receptor have been implicated in the development of prostate cancer. PSA cleaves IGF-1 from its binding protein, allowing this potent growth factor to act on prostate epithelial cells.
Plasma concentrations of IGF-1 have been associated with an increased risk of prostate cancer. In the Physiciansâ Health Study, 152 cases of prostate cancer were matched with 152 controls from the population of 14,916 physicians. Serum samples assayed for IGF-1 at the outset of the study found a positive association with the subsequent development of prostate cancer. Men in the highest quartile for IGF-1 had a relative risk of 2.4 as compared with men in the lowest quartile.
The predominant IGF-1 binding protein, IGFBP-3, has growth-inhibiting properties that diminish the effect of IGF-1. After correcting for IGFBP-3 levels, the risk of developing prostate cancer was 4.5 times greater for the highest quartile than for the lowest quartile.
The clinical usefulness of this assay has yet to be demonstrated, because alternative explanations for these findings may exist. Prostate size and a large overlap in actual values limit the utility of the test but do provide additional information regarding the biology of prostate cancer.
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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.
In Men Over : Bph May Be The Cause Of High Psa
Benign prostatic hyperplasia is an enlargement of the prostate gland, but its not prostate cancer. “BPH means more cells, so that means more cells making PSA,” explains Dr. Castle.
BPH is the most common prostate problem in men over age 50. It may not need to be treated unless its causing frequent or difficult urination.
Your primary care doctor may be able to tell the difference between BPH and prostate cancer by doing a digital rectal exam, but commonly this will require evaluation by a urologist and further testing, such as a biopsy or imaging studies.
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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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