Who Can Have The Psa Test
Although there is no screening programme, if you are aged over 50 you can ask your GP for the PSA test. Or you may be offered one as part of a general health check.
Before you have the test, your GP or nurse will talk through the benefits and disadvantages of having your PSA checked. If you are aged under 50 but at higher risk of prostate cancer, you can talk to your GP about having the PSA test.
How Can Psa Levels Be Lowered Naturally
There is no need to lower the PSA a high PSA level doesnt cause any harm. If you are worried about developing clinically significant prostate cancer , remember that there are no evidence-based strategies that are currently used to lower PSA. Unfortunately, this does not stop people offering dietary advice or other interventions that lack peer-reviewed evidence to support their use .
For patients that have been diagnosed with prostate cancer, there has been lots of research looking at interventions that could be classed as natural and that might improve their well-being and possibly delay their cancer progression. Exercise is one example. I do not make recommendations to my patients to try and lower their PSA levels. For patients worried about prostate cancer or that have been diagnosed with prostate cancer, I do try and promote a healthy lifestyle.
Mr Aidan Noon is extremely experienced in interpreting high PSA levels and providing professional guidance for the next steps. Click hereto learn more and to get in touch.
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
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Psa Testing During And After Treatment
During your treatment, the PSA level is measured periodically to assess the cancers response to treatment.
After your treatment, whether it is an operation, radiotherapy, or hormone therapy, your PSA level should decrease and stabilise. Consequently, if your blood tests repeatedly show that your PSA level has significantly increased, the results strongly suggest a recurrence of the disease and may call for additional treatments.
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Also take the time to visit each of our pages on this website, as well as our YouTube channel, in order to get familiar with the disease, our expert lectures and webinars, our section on available resources, the support that is offered to you, our events and ways to get involve to advance the cause.
Psa Transition Zone Density
Kalish introduced PSA density of the transition zone as a refinement to the original PSAD. This refinement is predicated on the following 2 assumptions:
That measuring transition zone volume with TRUS is more accurate than measuring the entire prostate volume because of the difficulty in measuring the true border of the apex in the longitudinal view
That most of the PSA entering the circulation arises from the transition zone
Zisman et al have offered a new index using the peripheral zone fraction of PSA to predict the presence of prostate cancer in men with PSA levels of 4-10 ng/mL. They point out that the PZ contributes little to tPSA. The PZ fraction can be calculated by using the following formula:
tPSA Ã /total prostate volume
PZ volume is measured by subtracting TZ volume from total prostate volume while neglecting the central zone.
Zisman et al compared the positive and negative predictive values using tPSA, PSAD, PSA-TZ, and PSA peripheral zone density . The efficacy rates of PSA and PSA-TZ were similar, at 60% PSA-PZ had a 70% efficacy rate, PSAD an 80% rate. The negative predictive values were superior to the positive predictive values, ranging from 78% to 83% for PSA, from 78% to 88% for PSAD, from 87% to 92% for PSA-TZ, and from 81% to 100% for PSA-PZ.
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Psa Expression And Processing
Under normal conditions, PSA is produced as a proenzyme by the secretory cells that line the prostate glands and secreted into the lumen, where the propeptide is removed to generate active PSA. The active PSA can then undergo proteolysis to generate inactive PSA, of which a small portion then enters the bloodstream and circulates in an unbound state . Alternatively, active PSA can diffuse directly into the circulation where it is rapidly bound by protease inhibitors, including alpha-1-antichymotrypsin and alpha-2-macroglobulin . Figure 1
Prostate-specific antigen isoforms in cells and blood. ACT: antichymotrypsin, hK-2: human glandular kallikrein, BPSA: benign prostate-specific antigen, iPSA: initial prostate-specific antigen, cPSA: complexed prostate-specific antigen.
In men with a normal prostate , the majority of free PSA in the serum reflects the mature protein that has been inactivated by internal proteolytic cleavage. In contrast, this cleaved fraction is relatively decreased in prostate cancer. Thus, the percentage of free or unbound PSA is lower in the serum of men with prostate cancer compared with those who have a normal prostate or BPH .
Screenings Can Lead To High Costs
The cost for a PSA test is fairly lowabout $40.
If your result is abnormal, the costs start adding up. Your doctor will usually refer you to a urologist for a biopsy. Costs may include:
- A consultation fee .
- An ultrasound fee .
- Additional professional fees .
- Biopsy fees .
If the biopsy causes problems, there are more costs. You might also have hospital costs.
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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.
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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Nz Case Control Cohorts
Details of the NZ prostate cancer patient cohort considered in this analysis are described in detail elsewhere. Patients were recruited between 2006 and 2013 with informed and signed consent . Patient factors, including self-reported ethnicity, current/former tobacco smoking status and alcohol consumption were recorded at recruitment. Drinking one or more alcoholic drinks per week equivalent to a can of beer, a small glass of wine or a single nip of spirits categorized men as alcohol consumers. At recruitment, patient heights and weights were measured at the study centre for body mass index estimation. Clinical and pathology records of patients were evaluated at the hospital databases to collect age, PSA level, Gleason score and disease stage at diagnosis. In this study, patient risk status was further stratified based on the disease prognostic stage grouping which followed the criteria defined by the 7th edition of the AJCC abbreviated as I, IIA,IIB,III and IV as mentioned previously.
Psa And Prostate Cancer Recurrence
Due to the sensitivity of serum PSA as a marker for prostate cancer, serial measurements are routinely obtained to detect early disease recurrence in men who have been treated for localized disease.
Monitoring PSA after treatment of localized prostate cancer leads to the identification of men with a PSA-only recurrence. In this situation, increases in serum PSA over the baseline after initial treatment are not accompanied by symptoms or signs of locally recurrent or metastatic disease. Many of these men are relatively young and otherwise healthy. Thus, intense interest has been focused upon their treatment, with attention on both survival and the impact of therapy on quality of life.
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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.
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.
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Prostatitis: A Common Problem In Men Under 50
“The PSA test is a good screening tool for prostate cancer, but it is not very specific,” says Erik P. Castle, MD, a urologist and researcher at the Mayo Clinic in Phoenix, Arizona. “Common causes of inflammation in the gland, called prostatitis, can cause high PSA levels.”
Prostatitis is the most common prostate problem for men younger than 50.
Prostatitis caused by bacteria can be treated with antibiotics. Another, more common type of prostatitis, called nonbacterial prostatitis, can be harder to treat and may last a long time.
Us Case Control Cohorts
The US cohort is part of the NCI-Maryland Prostate Cancer CaseControl Study and has been described previously. Recruitment was carried out between 2005 and 2015 under the ethics approval by the Institutional Review Boards at the NCI and the University of Maryland . Of the 976 cases that were recruited into the study, 489 were African Americans and 487 were European Americans . For the study herein, other patient clinical information collected from pathology reports and medical records of 202 of these US-AA and 232 US-EA cases were also available for analysis. Disease prognostic stage grouping, and risk classification followed the criteria as mentioned before for NZ cases. 486 US-AA and 548 US-EA healthy controls within the age range 47 to 92 were also recruited for the controls arm of the study. All cases and controls self-reported to be either US-AA or US-EA at an interview and signed an informed consent to participate in the study. The interview also evaluated lifestyle factors that included tobacco-smoking habits and alcohol consumption. Alcohol consumers were considered as those consuming more than 12 alcoholic beverages per year, such as beer, wine, wine coolers or liquor. At recruitment, participants were asked their current heights and weights for BMI estimation.
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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.
Discuss Prostate Cancer Testing With Your Doctor
Medical authorities do not recommend that all men should be tested for prostate cancer. In fact, most authorities suggest that men should make their own choice about whether or not to have a PSA test. If you decide to be tested, it is recommended that it should be done every two years from 50 to 69 years of age, and only if your health is such that you expect to live for at least another seven years.
Men at high risk of prostate cancer, such as men with a family history of prostate cancer , or men who have previously had an elevated test result, can start two-yearly testing from age 45. Your doctor can help you decide whether this is necessary.
While there is now some evidence that regular testing may prevent prostate cancer deaths, there are concerns that many men may be diagnosed and treated unnecessarily as a result of being screened, with a high cost to their health and quality of life .
However, the option of active surveillance, where a low-risk cancer is watched closely instead of being treated, helps to lower these risks. Active surveillance is now used quite commonly in Australia for men with low-risk prostate cancer.
If you are unsure whether or not to be tested after considering the benefits and uncertainties of testing and your own risk of prostate cancer, discuss it with your doctor.
In Australia, if you choose to be tested for prostate cancer the tests are covered by Medicare.
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Average Psa Test Doubling Time
Another red flag. This calculation denotes the time it takes your PSA values to double.
Therefore it may signify the aggressiveness of any prostate abnormalities, whether it’s an enlarged prostate, prostatitis, or prostate cancer.
If your average PSA readings double in less than three years your doctor will most likely order a biopsy, to look in to the problem further and discuss possible prostate cancer treatment options.
Who Should Get A Psa Test
Until recently, doctors were encouraging patients to get a PSA test done every year after the age of 50 or at the age of 40 or 45 if they are African American or have a brother or father who has been diagnosed with prostate cancer. However, after other researchers compared the risks and benefits of PSA screenings, many medical professionals stopped suggesting routine PSA tests. To date, it is suggested to talk to your doctor about when you should get a PSA test with consideration given to your age and medical history.
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How Should The Psa Test Be Used For The Early Detection Of Prostate Cancer
Ultimately, the decision to use PSA for the early detection of prostate cancer should be individualized. Men should be informed of the known risks and the potential benefits of early screening. Not all men are appropriate candidates for screening efforts. For instance, screening in men with less than a 10-year life expectancy, either due to age or other illness, is discouraged as there will be most likely no benefit for them.
If prostate cancer is detected on prostate biopsy, all treatment options should be discussed. The benefits and risks of the many treatment options should be reviewed and discussed with men found to have prostate cancer. The AUA recommends that this discussion include active surveillance in men with low-risk prostate cancer. The goal of active surveillance is to allow men to maintain their quality of life when the disease is slow-growing or inactive but still allow them to be cured of prostate cancer when the disease appears to become more aggressive or is fast-growing. Other novel biomarkers, such as PCA3 , may assist the clinician in these decisions.
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The Test Is Often Not Needed
Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:
- An enlarged prostate gland.
- Recent sexual activity.
- A recent, long bike ride.
Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.
Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.
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What Research Has Been Done To Study Prostate Cancer Screening
Several randomized clinical trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and DRE were evaluated for their ability to decrease a mans chances of dying from prostate cancer.
The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but the same rate of deaths from the disease . Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment.
A second large trial, the European Randomized Study of Screening for Prostate Cancer , compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer .