Psa Test For Prostate Cancer
The prostate gland makes a protein called prostate specific antigen . This protein helps to nourish sperm. Normally, only tiny amounts of it enter the bloodstream.
Cancer cells in the prostate interfere with proper functioning and can cause large amounts of PSA to enter the bloodstream. Therefore, when high levels of PSA are detected in the bloodstream, this may indicate cancer.
Early prostate cancer often has no symptoms. However, high PSA levels can occur five to 10 years before the onset of prostate cancer symptoms. In such circumstances, the PSA test can help to indicate the presence of cancer at an early stage.
Other tests are needed to confirm a diagnosis because an abnormal PSA test can be due to non-cancerous causes. Equally, it is possible for a man to have a normal PSA level when cancer is present.
American Cancer Society Recommendations For Prostate Cancer Early Detection
The American Cancer Society recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information. The discussion about screening should take place at:
- Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative diagnosed with prostate cancer at an early age .
- Age 40 for men at even higher risk .
After this discussion, men who want to be screened should get the prostate-specific antigen blood test. The digital rectal exam may also be done as a part of screening.
If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the mans general health preferences and values.
If no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test:
- Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years.
- Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.
What Is The Chance Of A Diagnosis Of Prostate Cancer
Around 17,000 new cases of prostate cancer are diagnosed each year in Australia. It affects mostly men in older age groups and is rare in men under 50 years of age.
The chance of developing prostate cancer is significantly higher in men who have a close relative with prostate cancer the risks are higher if the relative was diagnosed before the age of 60.
If you have a family history of prostate cancer, talk to your doctor.
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Early Cancer Detection Can Save Lives And Cut Treatment Costs But When Should You Start Having Prostate Exams And Do You Need To Have Them At All
When it comes to screening for prostate cancer, some men may be confused or apprehensive about beginning to get annual exams.
As prostate cancer affects one out of every six men, the American Cancer Society and other leading medical organizations recommend older men discuss having annual prostate cancer screenings with their primary care doctor to help detect the disease early. Early detection of the disease helps cure it in 90 percent of cases.
Generally, it is recommended that men with an average risk of prostate cancer start being screened with a digital rectal exam and PSA blood-level exam when they hit the age of 50. African-American men and men who have a father, brother or son who were diagnosed with prostate cancer when they were younger than 65 are at higher risk and should start screenings at age 40. Men who have had more than one of these close relatives diagnosed before age 65 are at even higher risk.
There Are Risks To Getting Prostate Cancer Tests And Treatments
If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.
Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.
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What Age Should Men Be Screened For Prostate Cancer
The Prostate Cancer Foundation recommends that Black men or men with a family history of cancer be screened at the age of 40 otherwise, the organization advises getting screened at 45. The American Cancer Society recommends that men at “average risk” be screened at the age of 50, while “men at high risk of developing prostate cancer” like Black men and men who have a first-degree relative, like a father or brother, who were diagnosed with prostate cancer before the age of 65, be screened at 45. Men at “even higher risk” should be screened at 40.
In 2018, the U.S. Preventive Services Task Force issued a recommendation advising men to start talking about screenings with their doctors at the age of 55.
A Cancer Prevention Plan For Men
Finding cancer early improves your chances of successful treatment and long-term survival.
Look for:
- lumps, sores or ulcers that don’t heal
- unusual changes in your testicles changes in shape, consistency or lumpiness
- coughs that don’t go away or show blood, a hoarseness that persists
- weight loss that can’t be explained
- moles that have changed shape, size or colour, or bleed, or an inflamed skin sore that hasn’t healed
- blood in a bowel motion
- persistent changes in toilet habits
- urinary problems or changes.
These symptoms are often related to more common, less serious health problems. However, if you notice any unusual changes, or these symptoms persist, visit your doctor.
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Dealing With A Growing Prostate
Some men notice no symptoms of prostate growth. For the many who do, though, treatments can ease the peeing process.
Lifestyle changes: Cut down on, or cut out, alcohol and coffee, and drink less fluid in the evening. Both strategies can lessen the number of trips to the toilet. Also, talk to your doctor about your current medications. Some drugs may worsen your symptoms.
Medications: The FDA has approved several medications for benign prostate growth, which help by slowing growth, shrinking the prostate, or relaxing the muscles that make urination easier. Some men may benefit from a combination of drugs.
Surgery: For men who donât benefit from medications, there are many types of surgery to offer relief. Some are minimally invasive, others are more involved. The most common, called TURP , removes the prostate tissue thatâs compressing the urethra. TURP may result in retrograde ejaculation, a condition in which semen enters the bladder rather than exiting the urethra. It is harmless, but can lead to male infertility.
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When Should I Have A Prostate Check
Generally, if you aged 50 years or older and have any urinary symptoms, you should let your doctor know. They will discuss with you whether or not you should have a prostate check.
Symptoms include:
- poor flow of urine
- trouble stopping peeing
- dribbling after you are done peeing
- needing to pee more often, at night or urgently
- trouble starting peeing
- incontinence
- pain when peeing
- blood in your pee.
If you have no symptoms, it is recommended that you get checked if you:
- you are a man aged 5070 years old but dont have any family history
- you are a man aged 4070 years old and your father or brother has had prostate cancer
- you are a man aged more than 70 years old and you have family history of prostate cancer or you have had an abnormal PSA test previously, and you have a life expectancy of more than 10 years.
Having a prostate check is your decision. The tests for prostate cancer can be uncomfortable but they may reduce your chance of being harmed or dying from prostate cancer.
If your test results suggest you are at risk of cancer, you will need to decide whether to have further testing and possibly treatment. In making this decision, you will need to consider whether your quality of life will be better living with a slow growing cancer than having treatments, which may cause you more harm than the cancer ever will.
Your doctor can help you weigh up the benefits and risks of being tested, by taking into consideration factors such as your age and family history.
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Two Main Screening Tests
There are two tests commonly used to screen for prostate cancer:
- The Digital Rectal Exam : A doctor or nurse inserts a gloved, lubricated finger into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities.
- The Prostate Specific Antigen Test: This exam measures the level of PSA in the blood. The levels of PSA in the blood are often higher in men who have prostate cancer. The PSA level may also be high in other conditions that affect the prostate.Usually, the higher the bloods PSA level is, the more likely it is that a prostate problem is present. But other factors, such as age and race, also can raise PSA levels. PSA levels also can be impacted by certain medical procedures, some medications, an enlarged prostate or a prostate infection.
Since your PSA level may be high for other reasons, your doctor will need to interpret the test results.
If the results of the PSA and/or DRE suggest that you might have prostate cancer, your doctor will need to do a prostate biopsy to find out. This means a sample of your prostate tissue will be removed with a needle and sent to a lab, where a specialist will determine if it contains cancer cells.
Causes Of Prostate Cancer
The causes of prostate cancer are largely unknown. But certain things can increase your risk of developing the condition.
The chances of developing prostate cancer increase as you get older. Most cases develop in men aged 50 or older.
For reasons not yet understood, prostate cancer is more common in black men and less common in Asian men.
Men whose father or brother were affected by prostate cancer are at slightly increased risk themselves.
Recent research also suggests that obesity increases the risk of prostate cancer.
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When To Get Checked For Prostate Cancer
Establish a routine. As you enter middle age, be proactive and ask your doctor for their recommendations on establishing a prostate cancer screening schedule that makes sense for you, given your risk factors and your family history. Exactly when you begin screening depends on a lot of factors, based on incidence rates among different populations. These are questions to consider in setting up a proactive prostate cancer screening regimen that works for you:
- Do you have a family history of prostate, ovarian, breast, colon, or pancreatic cancers among your male and female relatives?
- Do you have African ancestry?
- How old are you?
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When Do You Need A Prostate Exam
PSA is continuously present in the bloodstream for most men, and an increase in its number may be attributed to causes other than cancer. However, men who have an increased risk of prostate cancer should undergo a regular prostate exam.
Age, family history, and race are all possible factors that can increase your risk. Likewise, your doctor may also recommend that you undergo testing if you are experiencing discomfort or pain while urinating.
Symptoms which may indicate that you have a prostate issue include the following:
- Inconsistent flow of urine
How Often Is a Prostate Exam Necessary?
Your frequency of testing may be due to several factors, including your age and present health condition:
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What To Expect During The Digital Rectal Exam
This examination can be done while you are either standing or lying down. This may depend on the examination room and any other health conditions that you have.
If standing, you will be asked to stand facing the examination bed, with feet apart, body bent forward, and your arms or elbows on the bed. Feel free to ask your healthcare provider to give you a heads up before each part of your exam.
Your healthcare provider will coat their gloved finger in lubricant. They will insert their finger into your rectum at a downwards angle. You may feel a little pressure or slight discomfort, but it shouldn’t hurt. It is important to relax and take deep breaths and let your healthcare provider know immediately if you feel any pain.
It may take a few seconds for your external sphincter muscle to relax, and your provider may ask you to bear down as if you are having a bowel movement. They will move their finger in a circular motion in order to identify the lobes of your prostate gland.
A normal prostate is usually around 2-4 cm long and has a triangular shape, with a firm and rubbery texture.
During this exam, the healthcare provider checks for:
- Lumps on or around the prostate
- Swelling
How Is Prostate Cancer Treated
For many men with prostate cancer, treatment is not immediately necessary.
If the cancer is at an early stage and not causing symptoms, your doctor may suggest either âwatchful waitingâ or âactive surveillanceâ.
The best option depends on your age and overall health. Both options involve carefully monitoring your condition.
Some cases of prostate cancer can be cured if treated in the early stages.
Treatments include:
- radiotherapy either on its own or alongside hormone therapy
Some cases are only diagnosed at a later stage, when the cancer has spread.
If the cancer spreads to other parts of the body and cannot be cured, treatment is focused on prolonging life and relieving symptoms.
All treatment options carry the risk of significant side effects, including erectile dysfunction and urinary symptoms, such as needing to use the toilet more urgently or more often.
For this reason, some men choose to delay treatment until thereâs a risk the cancer might spread.
Newer treatments, such as high-intensity focused ultrasound and cryotherapy, aim to reduce these side effects.
Some hospitals may offer them as an alternative to surgery, radiotherapy or hormone therapy.
But the long-term effectiveness of these treatments is not known yet.
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Finding Prostate Cancer Early
There is no national screening program for the early detection of prostate cancer. Doctors have different opinions about whether all men without symptoms of prostate cancer should be tested.
There is concern that testing healthy men will cause unnecessary harm and lead to treatments that may not offer long-term benefits. Treatment for prostate cancer can leave men with side effects such as erectile dysfunction and continence issues, which can affect their quality of life.
Testing may identify fast-growing or aggressive cancers that have the potential to spread to other parts of the body and would benefit from treatment. It may also detect very slow-growing cancers that are unlikely to be harmful.
Weigh up all the risks and benefits before deciding whether to be tested for prostate cancer, particularly if you dont have symptoms. Talking to your doctor can help.
What Are The 5 Early Warning Signs Of Prostate Cancer
Some early prostate cancer signs include:
- Burning or pain during urination.
- Difficulty urinating, or trouble starting and stopping while urinating.
- More frequent urges to urinate at night.
- Loss of bladder control.
- Blood in urine
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Dr. Behfar Ehdaie, a urologic surgeon specializing in prostate cancer at Memorial Sloan Kettering Cancer Center in New York, said that these varying guidelines are due to the different risk factors that each person faces. Things like family history, environmental factors, race and more can all come into play when it comes to assessing prostate cancer risk.
“There are specific patient level factors that have to go into that decision, including family history, comorbidities, and life expectancy,” said Ehdaie, who said that people who are not expected to live more than another decade may not be advised to get screened. “And of course, the patient’s own preferences are taken into account, their goals, what they want to achieve.”
When Should You Get Tested
Prostate Cancer UK recommend PSA blood testing from age 45 and up for men who are at higher risk, and from 50 upward for men at normal levels of risk
Dr Rodgers said: Risk of prostate cancer is increased for people of African Carribean ethnicity and those with a family history of prostate cancer.
If you develop symptoms that suggest prostate enlargement, or your symptoms change over time then you should be discussing this with your doctor.
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Whats The Best Treatment For Prostate Symptoms
Treatments for prostate cancer include surgery to remove the prostate, radiation therapy, and ablation therapies, as well as active surveillance. Some treatments are better for some men and some prostates than others. There are side effects for each, so it really requires an informed discussion to help each man make an educated decision.
One thing we do at Yale is use an MRI of the prostate to evaluate the location of the prostate cancer for surgical planning. Ive found it to be quite helpful. Its not done everywhere.