Best Way To Test For Prostate Cancer

Psa Screening Risks And Benefits

Avoid prostate biopsies with new cancer screening

In recent years, PSAscreening has come under fire because of concerns that it has led to overdiagnosis and overtreatment. At Fred Hutchinson Cancer Center, we believe there are several good reasons to continue PSA screening.

A protein made by the prostate gland and found in the blood. Prostate-specific antigen blood levels may be higher than normal in men who have prostate cancer, benign prostatic hyperplasia , or infection or inflammation of the prostate gland.

PSAscreening has yielded a dramatic transformation in how prostate cancer patients present Ã¢ meaning, the status of their disease when they first get the diagnosis. More men begin care with early-stage and potentially curable disease.

PSAscreening has likely saved many lives, but it also uncovers many cases of prostate cancer that may not need to be treated. The main harm in screening is not the PSA test itself but the possibility that the results may lead to overtreatment of low-risk cancers in older men.

What Is The Best Test For Prostate Cancer

In the past, digital rectal exam in combination with PSA was the recommended tests for prostate cancer.

In 2016, while PSA can still be used as a test for prostate cancer, newer tests that provide better information became available. As of 2016, Dr. Alex Shteynshlyuger recommends that men with symptoms suggestive of prostate cancer consider more specific tests that include the 4KScore test that includes genetic profile and PHI test.

How Are Prostate Problems Diagnosed

To diagnose prostate problems, the health care provider will perform a digital rectal exam . The health care provider will also ask the patient

when the problem began and how often it occurs
what symptoms are present
whether he has a history of recurrent urinary tract infections
what medications he takes, both prescription and those bought over the counter
the amount of fluid he typically drinks each day
whether he consumes caffeine and alcohol
about his general medical history, including any major illnesses or surgeries

Answers to these questions will help the health care provider identify the problem or determine what medical tests are needed. Diagnosing BPH may require a series of medical exams and tests.

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What Tests Find Causes For Blood In The Urine

Your urologist will likely examine your upper urinary tract using a scan with dye that gives images from your kidneys to your bladder. This can check for stones, tumors or other abnormalities.

He or she will check the lower urinary tract with a scope that looks at the bladder, prostate and urethra. Your doctor also may perform other tests, such as a test for prostate cancer, as needed.

Sometimes doctors find that hematuria shows up in routine testing. A sample taken during an annual physical may find blood that isnt visible. When this happens, your doctor will send the sample to a lab to check for red blood cells.

Dr. Abouassaly stresses the importance of getting in to see your physician if you see even a trace of blood in your urine.

Cancers can bleed just one time and not again, he says. If you have doubts, a quick visit to your primary care provider can sort it out.

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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.

Recent Advances Can Help Men With A Worrisome Psa Result Avoid Immediate Biopsy

Prostate-specific antigen blood testing receives high marks as an effective way to monitor disease activity in men diagnosed with prostate cancer. Yet, as a screening tool for prostate cancer, PSA testing is problematic.

PSA naturally tends to increase as men get older, but levels that get too high may suggest prostate cancer. A PSA level of less than 4 nanograms per milliliter is often reassuring, unless there has been a sudden jump from a much lower number. Many doctors consider a total PSA level higher than 10 ng/mL as the threshold for getting a biopsy to check for cancer.

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Recurrent Prostate Cancer Treatment

For most patients, initial prostate cancer treatment includes either radiation therapy or surgery. If a patients prostate cancer returns, the other treatment option may be used. In addition, doctors may recommend the use of systemic therapies , like hormone therapy and possibly chemotherapy.

In some cases, patients can have what is known as biochemical recurrence. These patients have elevated PSA levels that indicate the disease has returned, but imaging exams do not show any cancer. Patients with biochemical recurrence are given intermittent hormone therapy and are monitored closely for further changes.

What Is A Prostate Exam

A prostate exam is a screening method used to look for early signs of prostate cancer. In general, a prostate exam includes a PSA blood test and a digital rectal exam .

During the digital rectal exam portion, your healthcare provider carefully inserts their gloved finger into your rectum. This allows them to feel the edges and surface of your prostate gland to detect any potential abnormalities.

Medium Risk Localised Prostate Cancer

PSA blood test easiet way to detect prostate cancer

You usually have treatment straight away. You might have:

radiotherapy, usually with hormone therapy

You might have active surveillance if you dont want treatment straight away. This is an option if surgery or radiotherapy would be suitable treatments for you in the future. If they wouldnt be possible for you, you might have watchful waiting instead.

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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.

Clinical Trials

When To Startand Stopscreening

The doctors and researchers who recommend screening argue that cases of prostate cancer found very early can be cured more quickly, with less chance of relapse or spread. Those who recommend against routine screening point to the slow-moving nature of prostate cancer and the side effects of surgical and medical treatment, which can be considerable.

The introduction of PSA screening in the US led to an initial increase in the number of prostate cancer cases diagnosed each year, even though many of these new cases were non-aggressive or low-risk prostate cancer. The issue was not that screening was harmful, it was that many of these low-risk cancers did not necessarily need immediate treatment. It seems strange to say that a patient might be better off leaving cancer untreated, but in some cases, it can be true. For a few years, the United States Preventative Services Task Force recommended against PSA screening. We are now seeing more cases of advanced prostate cancer diagnosed in recent years. This may be a long-tail effect of that USPSTF recommendation. It has now been changed to note that for men aged 55 to 69 years, the decision to undergo PSA screening is an individual one and should be discussed with your doctor. USPSTF continues to recommend against screening for men aged 70 and over.

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Use In Men Already Diagnosed With Prostate Cancer

The PSA test can also be useful if you have already been diagnosed with prostate cancer.

In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .

The Future Of Prostate Cancer Testing

Prostate Cancer Diagnosis: The Prostate Biopsy

An initial 2020 study with 72 participants found that a new blood test can diagnose prostate cancer, and identify its stage, with 99 percent accuracy.

This new test detects changes in the immune system which are identified in the blood of the patient. Alterations in the white blood cells are the primary signal for prostate cancer. Computer analysis of the blood sample can detect small changes which can indicate cancer.

Further research is needed into this method, before it becomes a recommended test. The next step is a larger study with more participants. If larger clinical studies verify the initial findings we may see this test come into use in the future.

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New Prostate Cancer Blood Test

If you have an abnormal PSA score, your doctor may recommend another newertest that gives a better sense of yourprostate cancer risk. The prostate health index is one such test that is a more accurateblood test and measures your risk for having prostate cancer. Its approvedby the FDA for men who have PSA scores between 4 and 10.

What are the benefits of the PHI test?

Fewer unnecessary biopsies: Some men who have elevated PSA scores are unsure about getting an invasive biopsy. This tool can be used to better determine whether your risk is high enough to warrant a biopsy.
More accurate: This test is better at detecting prostate cancer. It can also detect whether you have a more aggressive type of cancer. This information can guide doctors to a more targeted treatment plan for you.

If you score low on the PHI test, your doctor may recommend monitoring youover time to see if your levels rise enough to cause concern.

How Soon Will Prostate Test Results Be Available

Results for simple medical tests such as some urodynamic tests, cystoscopy, and abdominal ultrasound are often available soon after the test. The results of other medical tests such as PSA blood test and prostate tissue biopsy may take several days to come back. A health care provider will talk with the patient about the results and possible treatments for the problem.

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Prostate Cancer Symptoms And Treatment

After a prostate cancer diagnosis, choosing an appropriate treatment path can be incredibly confusing and stressful for you and your loved ones.

Sometime after being diagnosed with prostate cancer you and your doctor will start to discuss your medical management options. Knowing your tumor aggressiveness is critical for understanding if you are safe to pursue active surveillance or if you should pursue one or multiple forms of treatment. Each of the below treatments has pros and cons, so make sure to talk with your doctor, family, and friends to gather as much information as possible to create a plan that is best for you.

What Is Done If A Screening Test Shows An Elevated Psa Level

Prostate Cancer Screening and Biopsy with Urologist Dr. Scott Davidson

If someone who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to have an elevated PSA level, the doctor may recommend another PSA test to confirm the original finding. If the PSA level is still high, the doctor may recommend that the person continue with PSA tests and digital rectal exams at regular intervals to watch for any changes over time .

If the PSA level continues to rise or a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. These may include imaging tests, such as magnetic resonance imaging or high-resolution micro-ultrasound.

Alternatively, the doctor may recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. The biopsy needle may be inserted through the wall of the rectum or through the perineum . A pathologist then examines the collected tissue under a microscope. Although both biopsy techniques are guided by ultrasound imaging so the doctor can view the prostate during the biopsy procedure, ultrasound cannot be used alone to diagnose prostate cancer. An MRI-guided biopsy may be performed for patients with suspicious areas seen on MRI.

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Further Tests For Prostate Cancer

If results of the PSA test or the DRE are abnormal, a urologist will likely recommend a biopsy, where small samples of tissue are removed from the prostate and examined.

If cancer is diagnosed, other tests may be used to check the progression of the cancer, including:

magnetic resonance imaging scan of the prostate – often done before a biopsy
bone scan – to check whether or not cancer cells have spread to the bones
computed tomography scan – a specialised x-ray
pelvic lymph node dissection – a nearby lymph node is removed and examined to check whether or not cancer cells have entered the lymphatic system .

What Active Surveillance Means

For many men, prostate cancer never affects their lives, said Christopher L. Runz, DO, attending urologist at University of Maryland Shore Regional Health. Active surveillance means we actively watch the cancer and make sure it stays low-grade, which means the cancer may potentially never spread.

Active surveillance requires regular prostate specific antigen screenings and MRIs, with occasional biopsies. Men who are older and have a shorter life expectancy become candidates for active surveillance when they have a Gleason score of 7 .

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What Is The First Test For Detecting Prostate Problems

The first test for detecting prostate problems is a blood test to measure prostate-specific antigen , a protein made only by the prostate gland. This test is often included in routine physical exams for men older than age 50. Because African American men have higher rates of getting, and dying from, prostate cancer than men of other racial or ethnic groups in the United States, medical organizations recommend a PSA blood test be given starting at age 40 for African American men. Medical organizations also recommend a PSA blood test be given starting at age 40 for men with a family history of prostate cancer. Some medical organizations even recommend a PSA blood test be given to all men starting at age 40.

If urination problems are present or if a PSA blood test indicates a problem, additional tests may be ordered. These tests may require a patient to change his diet or fluid intake or to stop taking medications. If the tests involve inserting instruments into the urethra or rectum, antibiotics may be given before and after the test to prevent infection.

Positron Emission Tomography Scan

PSA Screening for Prostate Cancer â Science

A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.

However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.

Other newer tracers, such as Ga 68 PSMA-11, 18F-DCFPyl , and Ga 68 gozetotide , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.

These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body. PSMA PET scans can also be used to help determine if the cancer can be treated with a radiopharmaceutical that targets PSMA.

Doctors are still learning about the best ways to use these newer types of PET scans, and some of them might not be available yet in all imaging centers.

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