How Is Psa Testing Used For Pretreatment Staging Of Prostate Cancer
Once prostate cancer is diagnosed by the presence of cancer cells on prostate biopsy and assigned a cancer grade , PSA is used in combination with the grade of the prostate cancer to determine further medical studies needed for cancer staging. Staging determines if the cancer is localized or metastatic . Staging therefore drives the best management and appropriate treatment for the cancer. As mentioned earlier, serum PSA levels correlate with the risk of prostate cancer extension outside of the prostate including seminal vesicle invasion as well as metastasis to the pelvic lymph nodes.
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Psa And Total Testosterone Levels In Men With Prostate Cancer
Prostate-specific antigen is a protein produced by the prostate. Because PSA levels are often elevated in men with prostate cancer, health care providers use PSA blood measurements to screen for and monitor prostate cancer. For example, if a man is found to have high levels of PSA in his blood, a prostate biopsy may be recommended to determine if prostate cancer is present.
Additionally, there is a higher incidence of prostate cancer among men with low testosterone. Since low testosterone and prostate cancer may occur at the time same time, medical professionals might choose to measure prostate cancer patients serum total testosterone levels, even though medical guidelines currently do not include serum testosterone testing as a necessary/required part of prostate cancer assessment.
Given the independent associations of PSA and testosterone levels with prostate cancer, a team of researchers sought to better understand the potential relationship between these two measures in prostate cancer patients. To do so, they collected and analyzed the PSA and serum total testosterone levels of 646 prostate cancer patients in a retrospective study. The mean age of the men included in the study was 61 years.
Regarding PSA levels, the patients were divided into three groups: < 2 ng/mL, 24 ng/mL, > 4 ng/mL. Of the 646 participants, 8% had PSA levels of < 2 ng/mL, 17% had between 24 ng/mL, and 76% had > 4 ng/mL.
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Other Tests For Prostate Cancer
Early diagnosis and regular screening can aid in both the diagnosis and decision on treatment when it comes to prostate cancers.
However, none of these tests are conclusive on their own. When performed in addition to a PSA test, a digital rectal exam and biopsy can provide more information about specific cancer.
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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.
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. âBPH means more cells, so that means more cells making PSA,â 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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What Is A Psa Test How To Understand Your Levels
Perhaps one of the most feared cancers for men, prostate cancer can be deadly if detected too late. It causes about 26,000 deaths per year and affects one out of every seven men. Helping detect cases of prostate cancer, the PSA blood test is a crucial tool for early diagnosis.
The first step in prostate cancer early detection is the prostate-specific antigen test or PSA test.
What Is A Psa Test
PSA is a protein that is made by all prostate cells, whether they are normal or cancerous. A PSA test measures the level of PSA in a mans blood and generally reflects the volume of prostate tissue in the body.
Since prostate cancer can increase the level of PSA in the blood as it is progressing, a high PSA is associated with higher risk of having the disease. Therefore, many doctors have used the test to help determine whether a man is harboring the disease. Since the test was developed, several professional organizations have recommended that men over age 50 undergo PSA testing, often in addition to a digital rectal exam, to aid in early detection of the disease.
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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.
Are Psa Tests Regularly Done
The UK government has not introduced a prostate cancer screening programme and therefore, no men are currently called in to have their PSA levels measured. Patients with new urinary symptoms like decreased urinary flow, for example, may be advised to have a PSA test once the implications of the test have been discussed. Unfortunately, the PSA test is not always accurate and can lead to further investigations in some men who do not actually have prostate cancer .
Some men, who have no urinary symptoms, may want to undergo a PSA test. This can be because they have become anxious about the possibility that they have prostate cancer and want to get checked out. A PSA test can be performed provided that the patient has had a proper discussion about the pros and cons of the test. NHS England has produced a guidance leaflet for men aged over 50 who are considering a test and have no urinary symptoms.
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Psa And Prostate Cancer: What Do My Numbers Mean
The prostateis a walnut-sized gland that sits below the bladder in men. It is responsible for creating semen, the milky liquid that carries sperm out of the body when a man ejaculates.
A PSA test is a blood test used to screen for prostate cancers. PSA is a protein produced in the prostate by both cancerous and noncancerous tissue. Elevated PSA levels can indicate the presence of cancer, but high PSA levels can also be a result of non-cancerous conditions like benign prostatic hyperplasia , or an infection. PSA levels also rise naturally as you age.
Elevated PSA levels do not necessarily mean that you have prostate cancer. PSA tests arent always accurate: many men who have prostate cancer have normal PSA levels. Alternatively, some men have high PSAs but dont have cancer. Or they have a slow growing form of cancer that would never have had symptoms or caused them any harm.
What Is Prostate Intraepithelial Neoplasia Or Atypical Or Suspicious Cells On Biopsy
In about 10% of prostate needle biopsy reports, the pathologist will tell us that the final diagnosis is neither benign nor malignant. They describe this condition as
- High Grade Intraepithelial Neoplasia
- Biopsy should be repeated soon
- 25% risk of cancer on repeat biopsy
- Low Grade Intraepithelial Neoplasia
- Repeat biopsy is not indicated unless there is a rise in PSA
- Atypia
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What Factors Can Impact Psa Level
Several conditions can lead to an elevated PSA level, not just prostate cancer.
As men grow older, many are affected by prostatitis, an inflammation of the prostate, or benign prostatic hyperplasia , a non-cancerous enlargement of the prostate which causes PSA levels to rise. Ejaculation, male hormone medications, and some urologic procedures can also lead to an elevated reading.
Additionally, PSA levels tend to slowly rise with age, even if there is no abnormality within the prostate.
There are several factors that may cause a lowered PSA level as well. Patients who are overweight, frequently take aspirin, or use certain cholesterol-lowering drugs may see misleadingly low changes in their PSA levels.
Similarly, medication for the urinary symptoms of BPH, such as finasteride or dutasteride, may cause misleadingly low PSA levels.
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.
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Risk Factors For Prostate Cancer
Some risk factors have been linked to prostate cancer. A risk factor is something that can raise your chance of developing a disease. Having one or more risk factors doesnt mean that you will get prostate cancer. It just means that your risk of the disease is greater.
- Age. Men who are 50 or older have a higher risk of prostate cancer.
- Race. African-American men have the highest risk of prostate cancerâthe disease tends to start at younger ages and grows faster than in men of other races. After African-American men, prostate cancer is most common among white men, followed by Hispanic and Native American men. Asian-American men have the lowest rates of prostate cancer.
- Family history. Men whose fathers or brothers have had prostate cancer have a 2 to 3 times higher risk of prostate cancer than men who do not have a family history of the disease. A man who has 3 immediate family members with prostate cancer has about 10 times the risk of a man who does not have a family history of prostate cancer. The younger a mans relatives are when they have prostate cancer, the greater his risk for developing the disease. Prostate cancer risk also appears to be slightly higher for men from families with a history of breast cancer.
- Diet. The risk of prostate cancer may be higher for men who eat high-fat diets.
What Is Considered An Elevated Prostate
Researchers havent settled on a single normal PSA level. Previously, a level of 4.0 ng/mL or higher would lead to more testing, usually a prostate biopsy. During the biopsy, a healthcare provider removes a small sample of prostate tissue to check it for cancer.
However, healthcare providers now consider other issues together with the PSA level to decide whether to perform a biopsy. Your age, general health, family history and health history factor into the decision.
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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.
My Psa Is Elevated What Happens Next
Men who have undergone a prostate-specific antigen test that resulted in a high PSA number may have questions: What could an elevated PSA indicate? and, What can I do next for my health?
Herbert Ruckle, MD, FACS, chair of Loma Linda University Healths Urology Department, answers your top questions about receiving and interpreting an elevated PSA result and what to expect thereafter. It is important for men to know their PSA number and understand what it means, so they can engage in shared decision making with their doctor and decide what is best for their care moving forward, he says.
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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.
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.
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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
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 If My Biopsy Results Are Negative
A negative biopsy does not definitively exclude the presence of cancer. After a negative result, you will have a PSA test every three to six months. If the PSA remains elevated, the physician will recommend a second biopsy.
The closer you follow the patients with negative biopsies, the less likely you are to miss a clinically significant cancer.Dr. Herb Ruckle
For a second biopsy, MRI imaging is typically performed. An MRI-guided prostate biopsy uses advanced, more accurate imaging to take a biopsy and detect a cancer missed in the first ultrasound-guided biopsy. If this second biopsy comes back as negative, the physician will continue to keep a close eye on your PSA levels with the variety of tests, and you may need to undergo additional biopsies. The closer you follow the patients with negative biopsies, the less likely you are to miss a clinically significant cancer, Ruckle says.
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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