Additional Issues Of Clinical Importance
To improve the clinical value of tPSA and f/tPSA in the early detection of prostate cancer, several serum PSA derived indices have been described. They include PSA density, PSA velocity, and age-specific reference ranges.
PSA Density
PSA density requires the measurement of prostate volume by TRUS, and it is calculated by dividing the serum PSA value with the prostate volume . The use of PSA density to determine whether a patient requires prostatic biopsy is currently unclear and problematic.
PSA velocity
The rate of change in serum PSA over time is called PSA velocity . This parameter was first introduced in 1992, and its use is recommended in those cases with low serum PSA values . A PSA velocity greater than 0.35 ng/mL/year, as well as a 20% increase per year, is suggestive of prostatic cancer and should prompt a prostatic biopsy. When very high PSA velocities are found, prostatitis is more likely than prostate cancer.
PSA velocity must be interpreted with caution. To avoid spurious results due to inter-laboratory variations, an elevated PSA velocity should only be considered significant when repeat assays are performed by the same laboratory.
Age-specific PSA Reference Ranges
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What Happens If You Have A Likert Score Of 3 Or More
This result on its own doesnt mean that you definitely have prostate cancer. But its more likely that you do. Your doctor is likely to recommend for you to have a biopsy.
The MRI scan also helps doctors know where to take the biopsy from. You usually have tissue samples taken from the suspected area of cancer and also from the rest of the prostate. Doctors call these targeted biopsies and systematic biopsies. This is because not all cancers can be seen on an MRI scan.
Why The Test Is Performed
Reasons for a PSA test:
- This test may be done to screen for prostate cancer.
- It is also used to follow people after prostate cancer treatment to see if the cancer has come back.
- If a provider feels the prostate gland is not normal during physical exam.
MORE ABOUT SCREENING FOR PROSTATE CANCER
Measuring the PSA level can increase the chance of finding prostate cancer when it is very early. But there is debate over the value of the PSA test for detecting prostate cancer. No single answer fits all men.
For some men 55 through 69 years old, screening may help reduce the chance of death from prostate cancer. However, for many men, screening and treatment could potentially be harmful instead of beneficial.
Before having the test, talk to your provider about the pros and cons of having a PSA test. Ask about:
- Whether screening decreases your chance of dying from prostate cancer
- Whether there is any harm from prostate cancer screening, such as side-effects from testing or overtreatment of cancer when discovered
Men younger than age 55 have a higher chance of developing prostate cancer and should talk with their provider about PSA screening if they:
- Have a family history of prostate cancer
- Are African American
The PSA test result cannot diagnose prostate cancer. Only a prostate biopsy can diagnose this cancer.
A normal PSA level is considered to be 4.0 nanograms per milliliter of blood, but this varies by age:
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How Is Prostate Cancer Treated
Treatment options for prostate cancer include:
- Surgery to remove the prostate .
- High intensity focused ultrasound .
- Hormone treatment, also called androgen suppression therapy.
You may continue to have PSA level tests during and after prostate cancer treatment. These tests check that the treatment is working.
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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Other Factors That Influence Psa Levels
The PSA blood test alone cannot diagnose prostate cancer. It is possible, although rare, to have prostate cancer without raised PSA levels in the blood. A higher-than-normal PSA level doesnt automatically indicate prostate cancer either. A high PSA level is due to cancer in around one in three cases.
PSA levels can be raised by other factors, including:
- , also known as benign prostatic enlargement .
For this reason, the PSA blood test isnt used in isolation when checking for prostate cancer.
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New Blood Test Improves Prostate Cancer Screening
Researchers at Karolinska Institutet recently reported that magnetic resonance imaging could reduce overdiagnoses and thereby improve prostate cancer screening.
Now, the same research group has published a study in The Lancet Oncology, which shows that the addition of a novel blood test, the Stockholm3 test, can reduce the number of MRIs performed by a third while further preventing the detection of minor, low-risk tumours.
Image credit: Darko Stojanovic via pixabay.com, free licence
Overall, our studies show that we have identified the tools needed to be able to carry out effective and safe screening for prostate cancer. After many years of debate and research, it feels fantastic to be able to present knowledge that can improve healthcare for men, says Tobias Nordström, associate professor of urology at the Department of Clinical Sciences, Danderyd Hospital at Karolinska Institutet, who is responsible for the STHLM3MRI study.
Current screening methods PSA tests combined with traditional biopsies result in unnecessary biopsies and the detection of numerous minor, low-risk tumours . Consequently, no country except Lithuania has chosen to introduce a nationwide prostate cancer screening programme, as the benefits do not outweigh the disadvantages.
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When Is It Time To Stop Being Checked For Prostate Cancer
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Image: Thinkstock Its essential to be fully informed about the potential risks of PSA testing, which includecomplications from biopsies and teratments. |
The answer depends on your current health and your level of concern about cancer.
Routine PSA testing to check for prostate cancer is no longer recommended for most men. But despite what the experts suggest, many men continue to opt for annual PSA tests. This includes a surprisingly large number of men in their 70s. In a recent study in the journal Cancer, more than half of a group of men 75 and older had PSA tests and biopsies.
These men have placed their hope in the value of early diagnosis and treatment, yet stand to gain less from PSA testing than younger men. Across all ages, routine PSA screening leads to life-saving treatment for cancer in about one in every 1,000 men screened.
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Force guidelines: These independent experts on preventive medicine do not recommend PSA screening for prostate cancer in men at any age, due to a lack of definitive evidence that the benefits of PSA testing are greater than the risks. |
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When Is The Test Done
Doctors don’t use the CEA test to make a first-time diagnosis of cancer. This test isn’t an accurate way to screen for it because many other diseases can cause the levels of this protein to rise. And some people with cancer don’t have high CEA levels.
This test can help your doctor plan and monitor your treatment once you know you have cancer. You might get the test:
- After your diagnosis to help your doctor find the right treatment
- During treatment to see how well chemotherapy, radiation, surgery, or other therapies have worked
- After treatment to help find out whether the cancer has come back
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Kscore: A Better Mousetrap
4KScore provides the key to what was missing with the PSA test alone. It allows us to separate men who are at high risk for high-risk, aggressive prostate cancer from those who may never experience symptoms of prostate cancer.
#4KScore is a simple blood test. 4KScore is actually a combination of PSA test with a hK2 and a few other related tests .
4KScore can be used in combination with PHI to gain a better understanding of the risks associated with prostate cancer.
In our practice, we recommend the 4KScore test to all our patients who are at risk for prostate cancer. New York Urology Specialists is the first practice in the New York Metro area to offer 4KScore tests to our patients.
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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Biochemical And Overall Survival Outcomes And Predictive Factors
Actuarial 5 years OS and BRFS for the entire cohort was respectively 93 % and 95 %, with a median follow-up of 44 months . On univariate analysis, neutrophil count , cardiac history , age and CAPRA were associated with OS . Lymphocytes, NLR and comorbidities other than cardiac history were not associated with mortality. On multivariate analysis, neutrophil count , age and CAPRA were independent predictors of OS .
Fig. 1
Kaplan Meier OS curve with lower and upper limits of the 95 % confidence intervals showing a 5-year OS of 93 % in patients with localized prostate cancer treated with radical radiotherapy or brachytherapy
Fig. 2
Kaplan Meier BRFS curve with lower and upper limits of the 95 % confidence intervals showing a 5-year BFRS of 95 % in patients with localized prostate cancer treated with radical radiotherapy
On univariate analysis, only CAPRA was associated with BRFS . On multivariate analysis, both age and CAPRA were associated with BRFS .
Table 3 Univariate and multivariate analysis of factors associated with BRFS
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Understanding Your Biopsy Results
A specialist doctor called pathologist looks at the prostate samples under a microspore. The results usually take about 2 to 4 weeks.
You might have a negative biopsy. This means that no cancer cells were found. Your doctor might recommend another biopsy even if the first was negative. They’ll discuss this with you. This is because in some cases biopsies can miss cancer.
A positive biopsy means that they have found cancer cells. A pathologist then grades each sample of prostate cancer cells based on how quickly they are likely to grow or how aggressive the cells look. You may hear this being called the Gleason score or Grade Group.
Doctors now use the Gleason score and other information to divide prostate cancer into 5 groups. This is called the Cambridge Prognostic Group .
It can be difficult to understand what the Gleason score, Grade Group and CPG mean in your situation. We have more information about this, and you can ask your doctor and specialist nurse if you have any questions.
Can A Blood Test Determine If You Have Prostate Cancer
When it comes to prostate cancer, screenings play a key role in saving lives. Earlier detection when there are no symptoms leads to earlier treatment and better outcomes. And the good news is that many prostate cancer screenings can be done with a simple blood test. But thats just the start.
Learn more about how the PSA is the first step in the prostate cancer journey.
Understanding the PSA
For more than 20 years, there has been a blood test to monitor men for high levels of a protein called a prostate-specific antigen, or PSA, that is often associated with prostate cancer. Unfortunately, this test is not perfect many harmless conditions can cause heightened levels of this protein, leading to unnecessary tests and procedures that carry their own risk.
The uncertainty over the value of the PSA test led the U.S. Preventive Services Task Force in 2012 to recommend it only be given to people at high risk of prostate cancer. Other groups, including the American Urological Association, opposed this decision at the time.
But that recommendation has been softened. Instead of advising against this test for most men, the task force now suggests that men aged 55 to 69 should talk to their doctor about its risks and potential benefits.
Dr. Vipul Patel, a urologist and robotic surgeon at the AdventHealth, calls that a step in the positive direction.
If youre over 50 years old, get PSA screening and get a rectal prostate exam, he says.
What the PSA Can Reveal
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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.
Screening For Prostate Cancer: What Do You Need To Know About Digital Rectal Examination
The digital rectal examination is a clinical examination during which the attending physician makes a series of gestures to feel the patients prostate at the level of his rectum. This touch is risk-free for the patient and only lasts a maximum of two minutes. During the digital rectal examination, the doctor checks the consistency, texture and volume of the surface of the prostate. He can therefore detect abnormalities such as an enlarged prostate, abnormally hard or presenting nodules. In order to deepen this examination, the doctor will refer the patient to a urologist for more precision. However, it should be kept in mind that the presence of an abnormality in the prostate is not synonymous with the existence of a prostate cancer. A complementary examination makes it possible to establish a diagnosis with certainty.
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Cholesterol And Psa Levels
A few studies in men found that, after beginning statin therapy to lower LDL cholesterol levels, PSA levels decreased by between 4 and 40%. One study suggested that for every 10% decrease in cholesterol brought about by statins, PSA levels dropped by about 1.6 ng/mL. This relationship appears to be most noted in white men, but not black men. In white men, increased serum prostate serum antigen was associated with increased total cholesterol levels and LDL cholesterol levels. However, studies have not established a relationship between PSA and HDL cholesterol or triglyceride levels.
What Tests Can Find Prostate Problems
Some tests are routine, others need an appointment
The gland has two or more lobes-or sections-enclosed by an outer layer of tissue. Located in front of the rectum and just below the bladder, where urine is stored, the prostate surrounds the urethra, which is the canal through which urine passes out of the body.
The most common prostate problem in men under 50 is inflammation or infection, which is called prostatitis. Prostate enlargement is another common problem.
Because the prostate normally continues to grow as a man matures, prostate enlargement, also called benign prostatic hyperplasia or BPH, is the most common prostate problem for men over 50. Older men are at risk for prostate cancer as well, but it is much less common than BPH.
Sometimes, different prostate problems have similar symptoms. For example, one man with prostatitis and another with BPH may both have a frequent, urgent need to urinate. Other men with BPH may have different symptoms. For example, one man may have trouble beginning a stream of urine, while another may have to get up to go to the bathroom frequently at night. A man in the early stages of prostate cancer may have no symptoms at all. This confusing array of symptoms makes a thorough medical examination and testing very important. Diagnosing the problem may require a series of tests.
Talking with your doctor or nurse
Procedures
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What Can The Test Do
CEA is a type of protein in the body. Babies in the womb have high levels of it. After birth, levels drop way down. Healthy adults have a very low level, but some types of cancer can cause it to rise.
Your doctor can use CEA as a âmarkerâ to learn more about your cancer.
The test can often help predict whether the cancer is growing or spreading to other parts of your body. It can also help tell how well your treatment has worked and predict your outlook.
Your doctor might give you a CEA test if you’re diagnosed with one of these cancers:
Kscore Test For Prostate Cancer Screening: Early Detection Of Prostate Cancer
Screening for prostate cancer detects prostate cancer early, which allows for timely treatment. Screening with PSA test has a number of limitations as elevated PSA can occur in the absence of prostate cancer.
Many men undergo biopsy with attended inconvenience, risks, and costs which do not have prostate cancer because with PSA test, there is a degree of uncertainty of who has prostate cancer and who does not.
What we need is a better test for predicting who has prostate cancer. Then we need to know who among the men with prostate cancer is at risk of having an aggressive disease. We know that many men with prostate cancer have a very slow-growing disease that may not cause any problems for many years. Some have a disease that is on fire. We need to tell which is which.
An ideal test would be easy to administer, inexpensive, and will tell us with a great degree of certainty if a man has prostate cancer. Just as important, a good test will also tell us with a great degree of certainty that someone does not have prostate cancer.
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