What Secondary Tests Are Available To Me
Various secondary testing methods are at your disposal should you need more information before engaging in shared decision-making with your physician about further prostate cancer screening. It could also be helpful if your PSA test or rectal exam results place you in a “gray area” of risk for prostate cancer.
- PSA free-to-total-ratio, or prostate health index : can help improve the accuracy of the standard PSA test by discerning whether your risk of having prostate cancer is as low as 10% or as high as 50%.
- PSA velocity: If you’ve had previous PSA tests, your physician will look at them to determine how quickly your PSA levels have changed over time. A steep PSA level increase over a short period often correlates with a prostate cancer diagnosis, Ruckle says.
- Urine tests: One of which detects PCA3, a noncoding RNA gene that is only in your prostate. Too many copies of PCA3 in the urine indicate a greater chance of having prostate cancer.
- MRI of the prostate to image for biopsy targets.
Based on any of these results, the doctor will recommend a prostate biopsy if they suspect cancer.
What Are The Limitations Of The Psa Test
The level of PSA is a continuous parameter the higher the value, the higher the probability of having prostate cancer. On the other hand, men may have prostate cancer despite low levels of PSA. In a U.S. prevention study, 6.6% of the men whose PSA level was less than 0.5 ng/mL had prostate cancer. Thus, although age and ethnicity-based normal reference ranges exist, they have limitations. Furthermore, PSA does not allow one to predict the likelihood of clinically significant prostate cancer being present, thus subjecting men to potentially unnecessary biopsy and treatment and the morbidity associated with these.
What Does An Ultrasound
During an ultrasound-guided prostate biopsy, physicians insert a thin, flexible tube with a tiny camera into the rectum to reach the prostate. They then carefully guide a very small, hollow needle into the prostate to take some samples of the organs tissue. Next, a pathologist examines the collected tissue under a microscope to search for any cancerous cells.
Before starting the procedure, physicians will ensure you do not have an infection and do not take blood thinners. The procedure takes only around 10 minutes, during which the patient has local anesthesia. Ruckle says the chance to find a curable prostate cancer and have the opportunity to prevent it from harming you far outweighs the transient, mild discomfort and risks of the biopsy experience.
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What Is Psa Velocity And Psa Doubling Time
Change in PSA levels over time can be used to assess both cancer risk and aggressiveness of the particular tumor. Most urologists use these PSA metrics to help drive patient counseling and care. PSA velocity is defined as the rate of change in PSA over time. PSA doubling time is the time it takes the PSA value to increase by 100% . Although these two measures do not appear to be useful in determining who is at risk for prostate cancer, they do appear to be useful in monitoring some individuals with prostate cancer.
Is The Psa Test Recommended For Prostate Cancer Screening
Until about 2008, some doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50. Some organizations recommended that men who are at higher risk of prostate cancer, including African-American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45. However, as more was learned about both the benefits and harms of prostate cancer screening, a number of organizations began to caution against routine population screening. Most organizations recommend that men who are considering PSA screening first discuss the risks and benefits with their doctors.
Currently, Medicare provides coverage for an annual PSA test for all Medicare-eligible men age 50 and older. Many private insurers cover PSA screening as well.
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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.
What Causes Prostate Cancer
Experts arent sure why some cells in the prostate gland become cancerous . Genetics appear to play a role. For example:
- Youre two to three times more likely to get prostate cancer if your father, brother or son has the disease.
- Inherited mutated breast cancer genes and other gene mutations contribute to a small number of prostate cancers.
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What Does Psa Mean
PSA, or prostate-specific antigen, is a protein produced by the prostate and found mostly in semen, with very small amounts released into the bloodstream. When theres a problem with the prostatesuch as the development and growth of prostate cancermore PSA is released. Sometimes, a mans prostate releases slightly high PSA for other reasons. Rising PSA eventually reaches a level where it can be easily detected by a blood test.
For more information on rising PSA, download or order your free copy of the Prostate Cancer Patient Guide.
Prostate Specific Antigen Test
A blood test called a prostate specific antigen test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.
As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.
PSA levels also can be affected by
- Certain medical procedures.
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Following Psa Levels During And After Prostate Cancer Treatment
A mans prostate-specific antigen blood level is often a good indicator of how effective treatment is or has been. Generally speaking, your PSA level should get very low after treatment. But PSA results arent always reliable, and sometimes doctors arent sure what they mean.
Before starting treatment, you might want to ask your doctor what he or she expects your PSA level to be during and after treatment, and what levels might cause concern. Its important to know that the PSA level is only one part of the overall picture. Other factors can also play a role in determining if cancer is still there, if it is growing, or if it has come back.
Its also important to know that PSA levels can sometimes fluctuate a bit on their own, even during or after treatment, so they may not always be a sign of what is actually happening with your cancer. Understandably, many men being treated for prostate cancer are very concerned about even very small changes in their PSA levels. The PSA level is an important tool to monitor the cancer, but not every rise in PSA means that the cancer is growing and requires treatment right away. To help limit unnecessary anxiety, be sure you understand what change in your PSA level might concern your doctor.
How Is The Psa Test Used In Men Who Have Been Treated For Prostate Cancer
The PSA test is often used to monitor patients who have a history of prostate cancer to see if their cancer has recurred . If a mans PSA level begins to rise after prostate cancer treatment, it may be the first sign of a recurrence. Such a biochemical relapse typically appears months or years before other clinical signs and symptoms of prostate cancer recurrence.
However, a single elevated PSA measurement in a patient who has a history of prostate cancer does not always mean that the cancer has come back. A man who has been treated for prostate cancer should discuss an elevated PSA level with his doctor. The doctor may recommend repeating the PSA test or performing other tests to check for evidence of a recurrence. The doctor may look for a trend of rising PSA level over time rather than a single elevated PSA level.
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During Treatment For Advanced Prostate Cancer
When treatments such as hormone therapy, chemotherapy, or immunotherapy are used for more advanced prostate cancer, the PSA level can help show how well the treatment is working or when it might be time to try a different treatment.
Treatments should lower the PSA level , although in some cases they may just help keep it from rising further, or even just slow the rise. Of course, other factors, such as whether youre having symptoms from your cancer and whether imaging tests show it is growing, are also important when deciding if it might be time to change treatments.
If the cancer has spread outside the prostate, the actual PSA level is often not as important as whether it changes, and how quickly it changes. The PSA level itself does not predict whether or not a man will have symptoms or how long he will live. Many men have very high PSA levels and feel just fine. Other men with low PSA levels can have symptoms.
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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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.
References
Ejaculation Is A Potential Cause Of Mildly Elevated Psa
“Ejaculation can cause a mild elevation of your PSA level, and so can having a digital rectal exam,” says Milner. “These types of PSA elevations are usually not enough to make a significant difference unless your PSA is borderline. PSA should return to normal in two to three days.”
To avoid this type of elevation, doctors will usually draw blood for a person’s PSA level before doing a rectal exam. Ask your doctor if you should avoid ejaculation for a few days before a PSA test.
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What Is The Prognosis For People Who Have Prostatitis
Antibiotics can cure acute bacterial prostatitis. These medications also ease chronic bacterial prostatitis symptoms in approximately 30% to 60% of men. Up to 80% of men with chronic pelvic pain syndrome feel better after receiving appropriate treatments for their symptoms using the UPOINT system. Men with asymptomatic inflammatory prostatitis dont need treatment.
What’s A Raised Psa Level
The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood .
If you’re aged 50 to 69, raised PSA is 3ng/ml or higher.
A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of another condition that’s not cancer, such as:
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Are Prostate Problems Always A Sign Of Prostate Cancer
Not all growths in the prostate are cancerous, and not all prostate problems indicate cancer. Other conditions that cause similar prostate cancer symptoms include:
- Benign prostatic hyperplasia : At some point, almost every man will develop benign prostatic hyperplasia . This condition enlarges the prostate gland but doesnt increase cancer risk. The swollen gland squeezes the urethra and blocks the flow of semen and urine. Medications, and sometimes surgery, can help.
- Prostatitis: Men younger than 50 are more prone to prostatitis, inflammation and swelling of the prostate gland. Bacterial infections are often the cause. Treatments include antibiotics or other medications.
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What Is A Psadi
The PSADI is the relative prostaticconcentration of the PSA �see C.M.P.� and it is still used as an indicator of thepossibility of prostate cancer although its usefulness is limited in the absence of otherdata. The C.M.P., which includes the PSADI, is the best exam for detecting what iselevating the PSA at present.
Mri/ultrasound Fusion Guided Biopsy: Working Together For Your Health
At UVA Health, we are proud to offer a new prostate cancer detection option: MRI/ultrasound fusion guided biopsy. Through a unique partnership between the UVA Radiology and Urology departments, we are able to use MRI imaging to help guide a biopsy in real time. This makes the biopsy much more accurate. It also reduces the risk of false negative or false positive results, and decreases the odds that you may have to repeat a biopsy.
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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.