What Are Some Common Prostate Problems
The most common prostate problem in men younger than age 50 is inflammation, called prostatitis. Prostate enlargement, or benign prostatic hyperplasia , is another common problem. Because the prostate continues to grow as a man ages, BPH is the most common prostate problem for men older than age 50. Older men are at risk for prostate cancer as well, but it is much less common than BPH.
What Is A Grade Group
In 2014, the International Society of Urological Pathology released supplementary guidance and a revised prostate cancer grading system, called the Grade Groups.
The Grade Group system is simpler, with just five grades, 1 through 5.
*Risk Groups are defined by the Grade Group of the cancer and other measures, including PSA, clinical tumor stage , PSA density, and number of positive biopsy cores.
Many hospitals report both the Gleason score and the Grade Group, but there may be hospitals that still report only the old Gleason system.
Psa Level Risk Analysis
- 15% of men with a PSA level less than 4 ng/ml go on to develop prostate cancer.
- 31% of men with PSA levels between 4 10 ng/ml have shown to develop prostate cancer.
- 50% 65% of men with psa scores over 10 ng/ml develop prostate cancer.
An important part of the your results is finding both the
1. Total amount of PSA in your blood.
2. Ratio of free vs bound PSA.
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Tests To Diagnose And Stage Prostate Cancer
Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.
If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.
The actual diagnosis of prostate cancer can only be made with a prostate biopsy .
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What Is The Psa Test
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a mans blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.
The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the use of the PSA test in conjunction with a digital rectal exam to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing to help doctors determine the nature of the problem.
In addition to prostate cancer, a number of benign conditions can cause a mans PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis and benign prostatic hyperplasia . There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
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What Does A Dre Involve
You might have a DRE at your GP surgery or at the hospital.
The doctor or nurse will ask you to lie on your side on an examination table, with your knees brought up towards your chest. They will slide a finger gently into your back passage. Theyll wear gloves and put some gel on their finger to make it more comfortable.
You may find the DRE slightly uncomfortable or embarrassing, but the test isnt usually painful and it doesnt take long.
Screening For Prostate Cancer
Prostate cancer is fairly common. Early detection of aggressive prostate cancer may allow timely treatment and can prevent the metastatic spread of cancer cells and death. Many men, especially those at high risk, choose to get screening for prostate cancer. It is important to discuss the risks and benefits of screening for prostate cancer with a urologist to make sure that screening is the right decision for you.
If you decide to get screening for prostate cancer, it is important to decide whether you should have a traditional PSA test or improved modern tests for prostate cancer such as 4Kscore test or PHI .
New York Urology Specialists, under the leadership of Dr. Alex Shteynshyuger, is the first practice in New York City and one of the first in the world to offer 4KScore and PHI test to their patients beginning in 2014.
If youre interested in testing for prostate cancer or prostate cancer screening, please contact New York Urology Specialists for an appointment.
If you have any questions, to schedule a consultation or if you need a second opinion, pleasecontact us or call:
We see patients from all parts of New York City , Long Island, Westchester and New Jersey as well as other parts of the USA. We also see from Canada, Japan, South America, Russia, Asia, Europe, Middle East, Africa, the Caribbean and other parts of the world.
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What Is A Digital Rectal Exam
The most common way for doctors to check on the health of your prostate is with a DRE. Its a fairly quick and simple procedure.
For the exam, youll bend at the waist while standing or lie on your side with your knees bent toward your chest.
Your doctor will lubricate a gloved finger and gently place it inside your rectum. Theyll press one hand on your prostate, and their other hand will feel your pelvic area. It should only take a few moments.
You may experience momentary discomfort. You may also feel the urge to urinate, especially if your prostate is enlarged or inflamed.
Your doctor will be able to tell you if your prostate seems to be a normal size and shape. In general, a DRE has no risks.
Use In Men Already Diagnosed With Prostate Cancer
The PSA test can also be useful if you have already been diagnosed with prostate cancer.
- In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
- The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
- PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .
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What Does My Prostate Do
It is a small gland that is part of the male reproductive system. It’s supposed to be about the shape and size of a walnut.
It rests below your bladder and in front of your rectum. It surrounds part of the urethra, the tube in your penis that carries pee from your bladder.
The prostate helps make some of the fluid in semen, which carries sperm from your testicles when you ejaculate.
What Happens During A Digital Rectal Exam
Your health care provider will insert a gloved finger into the rectum and feel the prostate for hard, lumpy, or abnormal areas. The test takes only a few minutes to complete.
You may feel slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate.
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What Is The Psa Screening Controversy
The goal of measuring PSA in men with no symptoms of cancer as a screening test for prostate cancer is to reduce the mortality caused by this cancer. Although the advent of prostate cancer screening is associated with decreased prostate cancer deaths, concerns exist regarding risks of overtreatment and the associated risks of such treatments.
A substantial number of the cancers detected by PSA screening are early stage and low-risk, and these patients will likely never die from this disease. PSA screening, due to its low specificity, does not allow differentiating between low-risk and high-risk prostate cancer. Hence PSA systematic screening is inevitably associated with over-diagnosis and potentially overtreatment. Therefore, not only do these patients not benefit from early detection but they also carry the burden of a cancer diagnosis. In addition, a subset of these patients may suffer the side effects of an unnecessary treatment.
Another trial conducted in the United States recently concluded that there is no evidence of an improvement in death rate from prostate cancer with annual PSA screening compared with usual medical care. After 13 years of follow-up, the cumulative mortality rates from prostate cancer in the intervention and control groups were 3.7 and 3.4 deaths per 10,000 person-years, respectively, meaning that there was no significant difference between the two groups.
Why Genetic Testing For Prostate Cancer
Studies have revealed several inheritable genes which are associated with prostate cancer. Getting whole-genome sequencing through a company like Nebula Genomics can help you discover how high your risk of developing prostate cancer is. Some of the gene mutations associated with prostate cancer are on the MLPH, BRCA1 and BRCA2, CHEK2, and TP53 genes.
About 10% of men are at risk of being diagnosed with prostate cancer. However, men with family members who have prostate cancer are 20% likely to develop it. If the family member is in the immediate family, such as a father or a brother, the risk increases to about 50%. Genes that are suspected to be linked with prostate cancer have a 50% chance of being passed on to the next generation.
Genetic testing for prostate cancer has other benefits aside from early diagnosis. After genome sequencing, if a person is found to carry gene variants that are associated with prostate cancer, it can help other family members decide to get tested too. Genetic counselors can help review the results of genetic testing once performed.
Genetic testing helps you determine if your prostate cancer is hereditary or not and then helps the specialists make more informed decisions on treatment.
Genetic research is also helping with the nearly 600 clinical trials designed to help create better treatments.
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Psa In Other Biologic Fluids And Tissues
Concentration of PSA in human body fluids
| Fluid | |
|---|---|
| female serum | 0.01 – 0.53 |
It is now clear that the term prostate-specific antigen is a misnomer: it is an antigen but is not specific to the prostate. Although present in large amounts in prostatic tissue and semen, it has been detected in other body fluids and tissues.
In women, PSA is found in female ejaculate at concentrations roughly equal to that found in male semen. Other than semen and female ejaculate, the greatest concentrations of PSA in biological fluids are detected in breast milk and amniotic fluid. Low concentrations of PSA have been identified in the urethral glands, endometrium, normal breast tissue and salivary gland tissue. PSA also is found in the serum of women with breast, lung, or uterine cancer and in some patients with renal cancer.
Tissue samples can be stained for the presence of PSA in order to determine the origin of malignant cells that have metastasized.
Normal Psa Levels By Age Chart
We mentioned earlier in this article that PSA levels increase with age due to age related growth of the prostate gland. A doctor will therefore take into account an age-adjusted PSA level when discussing your prostate health:
|
Age Range |
|
|
0 to 6.5 |
Although there are normal PSA levels by age range, it is still important to screen routinely to ensure these normal levels are not rising.
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What Happens After The Test
After you have a PCA3 test, your doctor will discuss the results with you and suggest next steps. If the test results show a high score, its likely the doctor will recommend that you have a biopsy.
If youre diagnosed with prostate cancer, especially if its discovered in an early stage, your long-term outlook is very good. After discussing with their doctors, many men choose not to have treatment for their prostate cancer. Instead they adopt watchful waiting, in which their prostate tests are monitored closely for signs that the cancer may be progressing.
What Is A Normal Psa Test Result
There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.
However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer . In addition, various factors can cause a mans PSA level to fluctuate. For example, a mans PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugsincluding finasteride and dutasteride , which are used to treat BPHlower a mans PSA level. PSA level may also vary somewhat across testing laboratories.
Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of White men. Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group.
In general, however, the higher a mans PSA level, the more likely it is that he has prostate cancer. Moreover, a continuous rise in a mans PSA level over time may also be a sign of prostate cancer.
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What Is The 4k Biomarker
The 4kscore test measures free and total PSA, human kallikrein 2 , and intact PSA and considers age, digital rectal exam results, and prior biopsy status. The test result reports the percent likelihood of finding high-grade prostate cancer on a prostate biopsy result. This test is not approved by the FDA, rather it is regulated as a laboratory-developed test. No cutoff threshold has been established for this test. Currently, the NCCN recommendations are that this test can be considered in patients prior to biopsy and for those with a prior negative prostate biopsy who are thought to be at higher risk for a high grade prostate cancer.
Improving Sensitivity Of Psa Testing
Prostate-specific antigen testing with a cutoff of 4.0 ng/mL has a sensitivity of 67.5-80%, which implies that 20-30% of cancers are missed when only the PSA level is obtained. Sensitivity can be improved by lowering the cutoff or by monitoring PSA values so that a rise in PSA level of more than 20-25% per year or an increase of 0.75 ng/mL in 1 year would trigger performance of a biopsy regardless of the PSA value.
The specificity of PSA at levels higher than 4.0 ng/mL is 60-70%. Specificity can be improved by using age-adjusted values, PSA velocity , and the ratio of free PSA to total PSA . Another method is to adjust the PSA according to the size of the prostate or volume determinations of the transitional zone, which produces most of the PSA, and the peripheral zone, which produces less PSA but a majority of prostate cancers.
In the European Randomized Study of Screening for Prostate Cancer, Schroder et al studied a strategy for the early detection of prostate cancer that excluded digital rectal examination results and used a PSA cutoff of 3.0 ng/mL as the only indication for a biopsy. This protocol was compared with one in which a PSA level of 4.0 ng/mL or higher or the presence of a positive DRE or transrectal ultrasound was the indication for a biopsy. In a follow-up study, Schroder et al confirmed a substantial reduction in mortality from prostate cancer as a result of PSA testing.
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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.
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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How Is The Psa Count Measured
PSA is measured by a simple blood test that does not require fasting or special preparation. Since the amount of PSA in the blood is very low, detection of it requires a very sensitive type of technology . The PSA protein can exist in the blood by itself or be bound with other substances . PSA is mostly bound to three substances: alpha-2-macroglobulin, alpha 1-antichymotrypsin , and albumin. Total PSA is the sum of the free and the bound forms. The total PSA is what is measured with the standard PSA test. More recently, a precursor of PSA, proenzyme PSA , has been identified, which may be helpful in determining prostate cancer risk in men with a PSA under 10 and a normal digital rectal examination. The prostate health index is a new approved test that measures the total PSA, free PSA, and proenzyme PSA. The National Comprehensive Cancer Network guidelines include use of PHI as a secondary test option for men making decisions about an initial or repeat biopsy. The 4K score test is another test that incorporates PSA. The 4K score uses a prediction model based on clinical variables and laboratory measurements of total PSA, free PSA, intact PSA, and a related protein known as hK2 .