Pros And Cons Of The Psa Test
- it may reassure you if the test result is normal
- it can find early signs of cancer, meaning you can get treated early
- PSA testing may reduce your risk of dying if you do have cancer
- it can miss cancer and provide false reassurance
- it may lead to unnecessary worry and medical tests when there’s no cancer
- it cannot tell the difference between slow-growing and fast-growing cancers
- it may make you worry by finding a slow-growing cancer that may never cause any problems
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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.
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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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.
- Prostate MRI.
- 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.
What Is The Accuracy Of The Psa Test
One of the limitations of the PSA test is that PSA is not specific to prostate cancer and that it can be affected by several common conditions such as benign enlargement of the prostate, inflammation, and infection of the prostate. Furthermore, there is some variability in PSA results when using different testing equipment. One study showed that 25% men who had an initial PSA result between 4 ng/mL and 10 ng/mL had a normal test result when it was repeated.
Limitations of PSA testing include a high false-positive rate . In fact, only about 25% of men who have an elevated PSA between 4 ng/mL and 10 ng/mL will have prostate cancer identified on prostate biopsy and 75% will not. If one uses a lower cutoff of 3.1 ng/mL, PSA had a sensitivity of 32% and specificity of 87% for identifying prostate cancer.
Another concern in addition to the low specificity in detecting the presence of prostate cancer is the inability of the test to discriminate between a more aggressive, high-risk, prostate cancer from one that is less likely to cause harm, or a low-risk prostate cancer. This is thought to lead to overtreatment in up to 50% of men with prostate cancer.
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What Factors Can Falsely Elevate Your Psa Level
There are other factors that can affect the PSA level besides prostate cancer. The following conditions can lead to increased PSA levels:
Benign prostate hyperplasia , a condition that commonly develops as those assigned male at birth age and causes the prostate to grow in size
Inflammation or infection of the prostate, like prostatitis or a urinary tract infection
Hormone medications, like testosterone
Ejaculation, which can raise the PSA level for a short period of time
Riding a bike, or anything that puts pressure on the area near the prostate
Trauma to an area near the prostate
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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I Have High Psa Levels: How Do I Find Out If I Have Prostate Cancer
Prostate cancer is the most common form of cancer in men. The first test most doctors use to screen for prostate cancer is the PSA test. A high PSA level can indicate the presence of cancer. But other factors besides cancer can cause an elevated PSA level. If your PSA level is rising, learn more about your options for finding out if you have prostate cancer.
Whats The Next Step If My Psa Level Is Elevated
If you have a high PSA test result, you have a few options. Your decision can take into account your personal risk for prostate cancer and your comfort level with the additional testing options. Some options are:
Repeating the PSA test after a month: This might be a good option if you think your PSA may be falsely elevated.
A prostate biopsy: This is a procedure that collects a small tissue sample to check for prostate cancer.
Imaging studies: These are like an ultrasound or MRI. They can provide additional information. If these tests show an abnormal prostate, a prostate biopsy will likely be recommended.
Rest assured, you dont have to make this decision alone. Your regular provider or a specialist can help you make the right one for you.
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How Fusion Guided Biopsy Works
First, a patient will have a prostate MRI. The MRI will image the prostate and any abnormalities in much greater detail than the ultrasound used for traditional biopsies. This allows the radiologist to better distinguish between abnormal and regular tissue.
Next, the patient will have an ultrasound-guided biopsy. A special machine attaches to the ultrasound probe and overlays the MRI image onto the ultrasound image. So when the doctor moves the ultrasound probe, the detailed MRI image moves with it in real time.
The doctor then biopsies the prostate with fine needles, using the MRI image to guide the needles directly to the areas with tumors or abnormal tissue. Because the MRI images are so detailed, doctors can more precisely target exactly where they need to biopsy. This means that far fewer clinically significant tumors are missed. This strategy also helps reduce the number of biopsies a patient might need by giving the doctor better information the first time.
Can Kidney Stones Affect Your Psa Count
Typically, no. While kidney infections or UTIs can cause an elevated PSA count, kidney stones generally do not. Kidney stones are formed in the kidneys and pass through the bladder and urethra. PSA is produced in the prostate. If you had a kidney stone that got caught in your urethra at the prostate, and caused further inflammation of the prostate, it could result in a spike in your PSA level.
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Preparing For A Prostate Exam
Theres nothing special that you need to do to prepare for a prostate exam. Tell your doctor if you have anal fissures or hemorrhoids, as a DRE may aggravate these conditions.
If you decide to get a prostate cancer screening, your doctor will likely order a blood test, so inform the person drawing your blood if youre prone to dizziness.
Your doctor may ask you to sign a consent form before performing a cancer screening.
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
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How Psa Results Are Used For Diagnosis
In the past, many doctors wanted men with elevated PSA and/or an abnormal digital rectal examination to undergo a prostate biopsy. Today, this is not a course of action recommended by the American Urological Association. In such cases, multiparametric prostate MRI is now recommended as the best front-line test to detector rule outprostate cancer.
If a mpMRI shows a suspicious finding, a MRI-guided biopsy is the most accurate way to perform a biopsy of the prostate. If this is not possible, an MRI can be used with an ultrasound-guided biopsy. This is referred to as a fusion biopsy, and is more accurate than an ultrasound biopsy alone.
What If A Screening Test Shows An Elevated Psa Level
If a man 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 man continue with PSA tests and DREs at regular intervals to watch for any changes over time.
If a mans PSA level continues to rise or if a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. A urine test may be recommended to check for a urinary tract infection. The doctor may also recommend imaging tests, such as a transrectal ultrasound, x-rays, or cystoscopy.
If prostate cancer is suspected, the doctor will 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. Most often, the needles are inserted through the wall of the rectum . A pathologist then examines the collected tissue under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to diagnose prostate cancer.
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What Is Psa And Why Is It Important To Monitor
Prostate-specific antigens s are naturally occurring. Cells within the prostate gland produce PSA, which is typically found in semen, but may be present in trace amounts in the blood as well.
The blood test is one of two exams used in the early screening of prostate cancer. Approved by the FDA in 1986, the test was intended to monitor the progression of the disease among those who were already diagnosed, according to the National Cancer Institute .
Right now Medicare covers yearly PSA screenings for men 50 and older who are Medicare-eligible. Many private insurers likewise cover the test. Patient advocacy groups, such as ZERO The End of Prostate Cancer, offer support in accessing PSA testing and finding free testing in your community.
While age and genetics both affect PSA levels, lifestyle factors actually play the largest role. Thats why simple changes to health, diet, and exercise routines can naturally bring down PSA levels.
It’s Important To Know Your Free Psa Level
The PSA molecule circulates throughout the body in two formseither bound to other proteins or unbound. The free PSA measures the unbound molecule and is often used by urologists as another helpful indicator for prostate cancer. The lower the percent of free PSA, the higher the risk of having prostate cancer. Patients with free PSA of less than 10 percent can have up to a 56 percent risk of harboring a focus of cancer in their prostates.
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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 Does Having A High Psa Level Mean
Your body fights off foreign substances like viruses or other diseases with proteins called antigens. Antigens are produced throughout the body and can indicate if there is a problem with a specific region. For example, men produce prostate-specific antigen which can signal potential problems with prostate or urinary tract health if levels are too high.
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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.
What If My Biopsy Results Are Positive
Following a positive biopsy result, the next step is to determine the cancers staging the extent to which cancer has developed by growing and possibly spreading. You will undergo a bone scan, an MRI of the pelvis, or a CT scan. In the near future, PET scanning specifically for prostate cancer will be widely available. Ruckle says you and your physician should customize your prostate cancer care based on your desires, fears, age, current health status, motivation, and lifestyle.
There is a wide spectrum of treatments, Ruckle says. It is really important that patients understand that it is not a one-size-fits-all treatment by any means. Different prostate cancer treatments bear various side effects from close observation with deferred treatment if necessary, focal therapy to radiation therapies to robotic surgical removal.
We have a lot of resources and options to help men get through this and not have it adversely affect their life or their lifestyle, Ruckle says.
Learn more about prostate cancer screening and treatment options online. Loma Linda University Health is committed to your health and safety. Visit MyChart to schedule a telehealth visit or in-person appointment, or call .
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What Are Symptoms Of Bph
The following are the most common symptoms of benign prostatic hyperplasia. However, each individual may experience symptoms differently. Symptoms may include:
Leaking or dribbling of urine
More frequent urination, especially at night
Urgency to urinate
A hesitant, interrupted, weak stream of urine
These problems may lead to one or more of the following:
Inability to pass urine at all
The symptoms of benign prostatic hyperplasia may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.