What Happens If Your Psa Levels Are High
“If your PSA is elevated, your doctor will refer you to a urologist for follow-up screening,” says Dr. Miles. “Follow-up includes a digital rectal exam, where we feel the prostate for any abnormality.”
Healthy prostate tissue is firm, but still somewhat soft like the skin at the bottom corner of your palm. Prostate tissue that feels harder as hard as, say, your knuckle when it’s bent is considered suspicious and always followed up with a biopsy.
Even if your digital rectal exam is normal, some urologists may use a more sensitive blood test to check the levels of a few other proteins within the same family as PSA. This additional test can help safely delay or avoid the need for biopsy.
“If this blood test is also abnormal, it suggests the person is at higher risk and will need to biopsy,” explains Dr. Miles. “If the result is normal, it suggests they are at lower risk and we can simply monitor their PSA levels each year moving forward.”
If biopsy confirms prostate cancer, the next steps can range from monitoring the cancer to treating it depending on the severity.
“A low-grade, non-aggressive prostate cancer can sometimes simply be watched for quite some time called active surveillance before requiring treatment,” says Dr. Miles. “If the cancer is aggressive or has progressed to a later stage, your doctor will discuss treatment options with you.”
Should I Poop Before A Prostate Exam
You dont need to change any bathroom habits prior to your appointment. If you feel like you need to poop before your exam, then its fine to do so. But dont worry if you just dont have the urge. The prostate exam shouldnt make you feel like you need to go.
Theres no need to be embarrassed about fecal matter during your prostate exam. Your healthcare provider is experienced in performing this exam and will do everything to ensure your comfort during the process.
Screening For Prostate Cancer
While there is no known way to prevent prostate cancer, you should discuss the pros and cons of prostate-specific antigen screening with your doctor. PSA, a protein produced by cells in the prostate gland, may be elevated in men with prostate cancer. Men with a higher risk for prostate cancer should consider PSA testing at age 40, while all men should consider it once they reach 45.
Also Check: Everything To Know About Prostate Cancer
Weighing Your Options For Treatment
If you test positive for prostate cancer, you have some options as to what youd like to do about it. Until recently, nearly everyone opted for surgery or radiation, while some patients choose not to undergo treatment, instead opting for active surveillance, during which the cancers are left alone but regularly monitored to be certain that theyre not growing.
Certainly, screening can lead to earlier prostate cancer detection, and with earlier detection, youre eligible for multiple different treatments or active surveillance, said Sia Daneshmand, MD, director of urologic oncology at USC Urology of Keck Medicine of USC and associate professor of urology at Keck School of Medicine of USC. So we encourage patients who are candidates for screening to discuss it with their urologist and/or primary care physician so that we can determine whats the best course of treatment for them.
There also is a new option for those seeking prostate cancer treatment. Its called High-Intensity Focused Ultrasound , which uses ultrasound beams to non-surgically destroy prostate tumors.
Topics
What If My Test Results Are Abnormal
If the results of early detection tests like the PSA test or the digital rectal exam suggest that you might have prostate cancer, your doctor will conduct further testing. The PSA may be repeated, or you may be sent to a specialist for more tests such as a transrectal ultrasound and a prostate biopsy.
In a prostate biopsy, a tissue sample is taken from your prostate. Cancer can only be diagnosed with a tissue sample.
In addition to a PSA test, DRE , and a biopsy, research has yielded additional tests that can detect if cancer is present, and if so, how aggressive that cancer might be:
- The Prostate Health Index combines three blood tests that give a more accurate Phi Score, which gives accurate information based on a high PSA to better determine the probability of finding cancer during a biopsy.
You May Like: What Are The Sign Of Prostate Cancer
Mens Cancer Prevention & Care At Southwest General
Men should see their doctor regularly for recommended health screenings and testing. Our Southwest General Medical Group offers primary care and specialty care to help men protect and monitor their health. To learn more about our cancer care services or to schedule an appointment, visit our website.
When To Start Prostate Exams
The American Cancer Society recommends that men aged 50 start prostate cancer screenings. However, African American men and men with a family history of prostate cancer should start screening at age 45. In general, most experts recommend getting a prostate exam every three to five years.
Your doctor will check the prostate gland for any lumps or abnormalities during a prostate exam. It’s not painful, but some men may feel uncomfortable during the exam.
These are some types of prostate exams:
- Digital Rectal Exams : During a DRE, the doctor physically examines the rectum to feel for any abnormalities in the prostate. This exam can help detect prostate cancer in its early stages
- Prostate-Specific Antigen Tests : A PSA test measures the level of PSA, a protein produced by the prostate present in the blood. A high PSA level may be a sign of prostate cancer
If any of the above tests is abnormal, further testing may include:
- Biopsies: A needle is used to sample tissues for cancer cells. This is typically done as an MRI-guided biopsy.
- Screening Tests: Screening tests can sometimes have incorrect or unclear test results, making it essential to speak with your doctor about the risks and benefits of this test. Men should talk to their doctor about how often they should get a prostate exam, depending on their health status.
Don’t Miss: How To Remove The Prostate
Table 3 Harm Outcomes
| Quality of evidence supporting association* | |||
| False positive tests | Proportion of men with PSA > 3.0 ng/mL and no cancer on subsequent biopsy 18 | Moderate to High | |
| 12% | Cumulative risk of at least 1 false-positive test after 3 rounds of testing every four years 18 | ||
| 13% | Cumulative risk of at least 1 false-positive test after 4 rounds of annual testing 19 | ||
| 5.5% | Risk for undergoing at least 1 biopsy due to a false-positive test 18 | ||
| Overdiagnosis | 66% | Cases overdiagnosed as a fraction of screen-detected cases age 55-67 years, four year screening interval)33 | Moderate |
| Cases overdiagnosed as a fraction of screen-detected cases 26 | |||
| Lead time | 5.4-6.9 years | Average time by which screening advances diagnosis among cases who would have been diagnosed during their lifetimes in the absence of screening 26 | Moderate |
| 20-50% 18 24-45% 28 | |||
| Composite medical complications | 68/10,000 | ||
| Loeb et al. and Nam et al.28,29 | High |
The core age group, 136,689 screening tests were performed . Of these tests, 16.6% were positive, and 85.9% of the men with positive tests underwent prostate biopsy.
*The quality of evidence means how much confidence we have in the reported quantitative estimate. It does not mean the methodological quality of the study although the latter is one factor that affects confidence in the estimate.
When Should Men Get A Prostate Exam
According to the American Cancer Society, men and people who were assigned male at birth should have their first prostate exam by age 50. If you have a family history of prostate cancer, you should consider having your first prostate exam at age 45.
Additionally, Black men are at a higher risk for being diagnosed with prostate cancer. For this reason, healthcare providers often recommend that Black men have their first prostate exam around age 45.
You May Like: Dog Prostate Cancer Life Expectancy
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.
Potential Harms Of Screening And Treatment
Potential Harms of Screening and Diagnosis
In addition to the ERSPC and PLCO trials, the USPSTF examined the results of a good-quality cohort study embedded within the ProtecT trial , a fair-quality cohort study conducted in the US Department of Veterans Affairs health system, as well as a report on complications of prostate biopsy from the ERSPC Rotterdam site to understand the potential harms of screening and diagnosis.3
In the large RCTs, one-fourth to one-third of men offered PSA-based screening had at least 1 positive screening test result. In the PLCO trial, 13% of men had undergone at least 1 biopsy. In the ERSPC trial, nearly 28 biopsies were performed for every 100 men randomized to screening.3 In the ProbE trial, 7.3% of men reported moderate or greater pain, 5.5% reported moderate to severe fever, and 26.6% reported troublesome hematospermia within the 35 days after biopsy.28 Complications from transrectal prostate biopsy resulted in 1.3% of men in the UK cohort, 1.6% of men in the VA cohort, and 0.5% of men in the Rotterdam cohort requiring hospitalization.30-32 In these studies, two-thirds to three-fourths of biopsies demonstrated that the PSA screening test was a false positive.3
Potential Harms of Treatment
In several studies, men older than 70 years had a significantly increased risk of medical complications and perioperative mortality after radical prostatectomy compared with younger men.3
Recommended Reading: Pi Rads 4 Lesion Prostate
Does Screening Reduce Pc Mortality
The European Randomized Study of Screening for Prostate Cancer is the worlds largest randomized controlled trial on PSA-screening including 162,388 men aged 5569 years in 8 European countries . The 13-year follow-up report showed that PSA-screening every 24 years reduces PC mortality by 21%. The reduction in PCa mortality was even larger44% at 14 yearsin the Göteborg trial where 20,000 men ages 5064 were randomized to biennial PSA-screening or a control group . The U.S. Prostate Lung Colorectal and Ovarian cancer screening trial randomized 76,685 men aged 5574 years but did not show any difference in PCa mortality between the screening and control arm . The reason for this was high pre-screening rates in both arms and a high contamination rate in the control arm i.e., the two arms were subjected to almost the same amount of screening . However, with these discrepancies accounted for, both the ERSPC and PLCO trials provide compatible evidence that PSA screening reduces PC mortality . There is also compelling evidence from observational data. In the U.S., where the PSA test was introduced as a screening tool in the early 90s, the age-adjusted death rate from PCa dropped 51% between 1993 to 2014 .
Prostate Cancer Screening Ages 40 To 54
The PSA test is a blood test that measures how much of a particular protein is in your blood. Its been the standardfor prostate cancer screening for 30 years.
Your doctor will consider many factors before suggesting when to startprostate cancer screening. But hell probably start by recommending the PSAtest.
While the general guidelines recommend starting at age 55, you may need PSAscreening between the ages of 40 and 54 if you:
- Have at least one first-degree relative who has had prostate cancer
- Have at least two extended family members who have had prostate cancer
- Are African-American, an ethnicity that has a higher risk of developing more aggressive cancers
Also Check: Rapid Rise In Psa May Signal Prostatitis
How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. And other potential biomarkers of prostate cancer are being investigated. None of these tests has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include
Selected References
Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. New England Journal of Medicine 2004 350:22392246.
What To Do If You Are Worried About Prostate Cancer
Talk to your GP if you’re worried about prostate cancer. Or if you have urinary symptoms such as difficulty passing urine. The symptoms don’t mean that you have prostate cancer, but it is important to get them checked.
-
Adult screening programme Prostate cancerUK National Screening Committee, Last accessed March 20222
-
Screening for prostate cancer. External review against programme appraisal criteria for the UK National Screening CommitteeUK National Screening Committee, October 2020
-
Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow upC Parker and others
Read Also: When Your Prostate Is Removed What Happens
A Prostate Cancer Gene 3 Rna Test May Be Used For Certain Patients
If a man had a high PSA level and a biopsy of the prostate did not show cancer and the PSA level remains high after the biopsy, a prostate cancer gene 3 RNA test may be done. This test measures the amount of PCA3 RNA in the urine after a DRE. If the PCA3 RNA level is higher than normal, another biopsy may help diagnose prostate cancer.
> > > All Natural Technique Fixes Enlarged Prostate Watch Here< <
Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.
An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.
Don’t Miss: Mri Prostate With And Without Contrast
Benefits Of Psa Screening
The benefits of PSA screening merit careful consideration while developing an approach to prostate cancer screening. It is also important to emphasize that the benefits of PSA based screening for prostate cancer may not be representative of prostate cancer screening in general. While there are several potential tests that could be applied in screening for prostate cancer, almost all currently available data pertain to the use of PSA with or without DRE. As a primary screening test, there is no evidence that DRE is beneficial, but DRE in men referred for an elevated PSA may be a useful secondary test.
Prostate cancer specific mortality was the primary endpoint for both the ERSPC and the PLCO trials. However, one cannot ignore the benefits of earlier detection through screening in decreasing the risk of metastatic disease.54 The incidence of metastatic disease at presentation has declined by approximately three-fourths in the US since the advent of PSA screening. Further, in data from the ERSPC, the cumulative risk of metastatic disease at 9 to 11 years of follow-up was 31% to 33% lower in the screened arm compared to the control arm.7,18 The Goteborg arm of the trial demonstrated a 56% reduction in risk of metastatic disease.17 Most of this reduction in metastatic disease was seen in cancers detected at the time of diagnosis in the screened arm and not following diagnosis. This reduction is more pronounced with longer follow-up.
There Is No Standard Or Routine Screening Test For Prostate Cancer
Although there are no standard or routine screening tests for prostate cancer, the following tests are being used or studied to screen for it:
Digital rectal exam
Digital rectal exam is an exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel the prostate for lumps or anything else that seems unusual.
Prostate-specific antigen test
A prostate-specific antigen test is a test that measures the level of PSA in the blood. PSA is a substance made mostly by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. The level of PSA may also be high in men who have an infection or inflammation of the prostate or benign prostatic hyperplasia .
A PSA test or a DRE may be able to detect prostate cancer at an early stage, but it is not clear whether early detection and treatment decrease the risk of dying from prostate cancer.
Studies are being done to find ways to make PSA testing more accurate for early cancer detection.
Also Check: Prostate Proton Therapy Side Effects