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Best Way To Screen For Prostate Cancer

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Prostate Specific Antigen Test

Avoid prostate biopsies with new cancer screening

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.

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.

04/2014

Possible Harm From Screening

False positive test results: This occurs when a man has an abnormal PSA test but does not have prostate cancer. False positive test results often lead to unnecessary tests, like a biopsy of the prostate. They may cause men to worry about their health. Older men are more likely to have false positive test results.

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Both Tests Are Better Than One

Using these tests together is better than using either test alone. PSA testing together with a DRE may help find a dangerous cancer early when it is easier to treat.

Follow-up tests

If a problem is found, more tests will be done to find out whether you have prostate cancer or another health problem. Further tests can include:

  • a follow-up PSA test
  • a transrectal ultrasound a test that uses sound waves to make a picture of the rectum and nearby organs, including the prostate
  • a biopsy of the prostate tissue samples of the prostate are looked at under a microscope

American Cancer Society Recommendations For Prostate Cancer Early Detection

How Prostate Cancer Is Diagnosed

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.

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Benefits Of Early Detection And Treatment

The goal of screening for prostate cancer is to identify high-risk, localized prostate cancer that can be successfully treated, thereby preventing the morbidity and mortality associated with advanced or metastatic prostate cancer.

Adequate evidence from randomized clinical trials shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened.3, 4 Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened.3 Current results from screening trials show no reductions in all-cause mortality from screening. There is inadequate evidence to assess whether the benefits for African American men and men with a family history of prostate cancer aged 55 to 69 years are different than the benefits for the average-risk population. There is also inadequate evidence to assess whether there are benefits to starting screening in these high-risk groups before age 55 years.

Adequate evidence from RCTs is consistent with no benefit of PSA-based screening for prostate cancer on prostate cancer mortality in men 70 years and older.

Current Evidence For Prostate Cancer Screening

Localized prostate cancer is asymptomatic. By the time symptoms become present, the disease is generally too advanced for cure. Indeed, one of the most common presentations of prostate cancer before the advent of screening was paralysis, related to spinal cord metastasis. Therefore, the concept of screening is particularly appealing for prostate cancer, as it provides an opportunity to identify the disease at a curable stage. This called for a test that could detect prostate cancer earlier, and led to the discoveries of the blood test prostate-specific antigen , first isolated and defined in the 1970s.24 Several screening studies in the late 80s-early 90s showed that the PSA-test could identify more prostate cancers at an organ-confined, clinically localized stage as compared to evaluations for palpable tumors by digital rectal examination, which set the stage for a widespread adoption of PSA-testing, particularly in the U.S. This resulted in a rapid surge in prostate cancer incidence.510

The age-specific prostate cancer mortality in the U.S. is down by 50% from peak rates due to PSA screening and improvements in treatment, but recently this trend has been flattening due to recommendations against PSA screening in previous years, mainly the 2012 United States Preventive Services Task Force guideline.10,22 Studies now document an increase in metastatic prostate cancer.2326

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Need For This Guidance

New Zealand men currently receive conflicting advice about prostate cancer testing and treatment. Some men may benefit from early diagnosis and treatment, but have limited opportunity to access appropriate health services.

Unlike other cancers, prostate cancer often grows slowly. With routine prostate specific antigen testing, many men can be diagnosed with a cancer that is not going to progress during their lifetime. Such a diagnosis may increase mens exposure to unnecessary treatment-related harms.

On the other hand, some men will still develop aggressive and potentially life-threatening prostate cancer. These men may benefit from prompt diagnosis and treatment.

Psa Test: The Current Prostate Screening Standard

What it’s like to go for a rectal screening for prostate cancer

Before recommending when you should be screened for prostate cancer, yourdoctor will consider many factors, such as:

  • Family history, particularly whether any of your family members have had prostate cancer
  • Race, as African-American men have a higher risk of developing prostate cancer

If your doctor determines you should undergo screening, he or she will mostlikely recommend the PSA test. For more than 30 years, the PSA test hasbeen the gold standard in prostate cancer screening. This simple blood testmeasures how much prostate-specific antigen is in your blood.

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Living With Prostate Cancer

As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.

Nevertheless, it can affect your life. As well as the possible side effects of treatment, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.

You may find it beneficial to talk about the condition with your family, friends, a GP and other people with prostate cancer.

Financial support is also available if prostate cancer reduces your ability to work.

Prostate Cancer Screening Patient Version

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Screening is looking for cancer before a person has any symptoms. This can help findcancer at an early stage. When abnormaltissue or cancer is found early, it maybe easier to treat. By the time symptoms appear, cancer may have begunto spread.

Scientists are trying to better understand whichpeople are more likely to get certain types of cancer. They also study the thingswe do and the things around us to see if they cause cancer. Thisinformation helps doctors recommend who should be screened for cancer, whichscreening tests should be used, and how often the tests should be done.

It is important to remember that your doctor does not necessarilythink you have cancer if he or she suggests a screening test. Screeningtests are given when you have no cancer symptoms. Screening tests may be repeated on a regular basis.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.

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A Note On Suspicious Results

A suspicious result indicates that the biopsy sample contained some abnormalities but no cancer was found. There are a couple of potential explanations for a suspicious prostate biopsy result, including:

  • Prostatic intraepithelial neoplasia refers to changes within prostate cells that are abnormal, but not indicative of cancer. This condition is low-grade or high-grade, depending on how abnormal the cells are. Low-grade PIN is very common and isnt associated with prostate cancer. High-grade PIN, however, is associated with a higher risk of prostate cancer. If you have high-grade PIN after a prostate biopsy, your doctor may recommend that biomarker tests be performed on the sample to learn more about the cells. Alternatively, another prostate biopsy may be suggested.
  • Atypical small acinar proliferation indicates that the biopsy sample contains some cells that appear to be cancerous, but not enough to confirm the diagnosis. In most cases, this finding suggests that another prostate biopsy is needed.
  • Proliferative inflammatory atrophy describes a prostate biopsy that reveals inflammation in the prostate and abnormally small prostate cells. While these cells arent cancerous, having PIA may be associated with an increased risk of developing prostate cancer.

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Benefits Of Psa Screening

Pull your finger out, doc, rectal exams aren

A summary of the data described in this section can be found in Appendix 2 , with detailed tables available in the systematic review.13

The literature search for the systematic review identified six randomized controlled trials .1621 Because three of the trials1618 were considered to have a high risk of bias, evidence from these trials was not considered for this guideline. None of the excluded studies showed benefit from prostate cancer screening. Findings from all sites of the European Randomized Study of Screening for Prostate Cancer ,19 a multi-country study, were considered together when we formulated the recommendations.

A small absolute reduction in prostate cancer mortality was reported in the ERSPC study.19 The investigators found that the risk of death from prostate cancer was reduced in the screening group , with a pretrial PSA testing rate of 20%.13,19 However, there was evidence of heterogeneity between study centres, with some finding that screening reduced prostate cancer mortality while others did not.

There was no demonstrable effect of PSA screening on all-cause mortality in the PLCO or ERSPC studies .13,15,19,21

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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.
  • A urine test that more accurately detects the possibility of prostate cancer by examining the expression of PCA3 a gene specific to prostate cancer. The PCA3 score is used to determine the need for repeated biopsies. Research has continued for years to look into whether PCA3 can replace or serves as a substitute for the PSA test.
  • A simple, non-invasive urine test to assess your risk of having clinically significant high-grade prostate cancer. The ExoDx Prostate Test does not require a digital rectal exam and provides an individualized risk score that can help determine to whether to proceed or defer a prostate biopsy.
  • Tests To Diagnose And Stage Prostate Cancer

    Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.

    If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.

    The actual diagnosis of prostate cancer can only be made with a prostate biopsy .

    On this page

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    Thinking About Taking Part In A Clinical Trial

    Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.

    If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.

    Screening Tests Have Risks

    Prostate Cancer Screening and Biopsy with Urologist Dr. Scott Davidson

    Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying fromcancer.

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    Lymph Node Biopsy As A Separate Procedure

    A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.

    Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.

    How Is Prostate Cancer Diagnosed

    A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope.

    A biopsy is a procedure that can be used to diagnose prostate cancer. A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope to see if there are cancer cells.

    A Gleason score is determined when the biopsy tissue is looked at under the microscope. If there is a cancer, the score indicates how likely it is to spread. The score ranges from 2 to 10. The lower the score, the less likely it is that the cancer will spread.

    A biopsy is the main tool for diagnosing prostate cancer, but a doctor can use other tools to help make sure the biopsy is made in the right place. For example, doctors may use transrectal ultrasound or magnetic resonance imaging to help guide the biopsy. With transrectal ultrasound, a probe the size of a finger is inserted into the rectum and high-energy sound waves are bounced off the prostate to create a picture of the prostate called a sonogram. MRI uses magnets and radio waves to produce images on a computer. MRI does not use any radiation.

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    How Is Prostate Cancer Detected

    There is no single test to detect prostate cancer. The two most common tests are the prostate specific antigen blood test and the digital rectal examination .

    The PSA test measures the level of PSA in your blood. It does not specifically test for cancer. Virtually all PSA is produced by the prostate gland. The normal range depends on your age. A PSA above the typical range may indicate the possibility of prostate cancer. However, two-thirds of cases of elevated PSA are due to noncancerous conditions such as prostatitis and BPH.

    A DRE is generally conducted by a urologist to feel the prostate. While DRE is no longer recommended as a routine test for men who do not have symptoms of prostate cancer, it may be used to check for any changes in the prostate before doing a biopsy.

    If either of these tests suggest an abnormality, other tests are necessary to confirm a diagnosis of prostate cancer, usually a magnetic resonance imaging scan and transrectal ultrasound biopsy.

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