What Other Screening Tests Are Used To Detect Prostate Cancer
Because a biopsy is an invasive procedure, your doctor may first use one or more of the following methods to screen for prostate cancer:
Medical history
When your doctor takes a detailed medical history, they may ask you about your symptoms, underlying health conditions and whether you consume alcohol or tobacco in any form. Your doctor may also ask you whether any of your close family members such as a father, uncle or brother were diagnosed with prostate cancer at a young age . You may also be asked other questions such as whether you have experienced weight loss or a change in sex drive.
Digital rectal examination
A thorough physical examination will also allow your doctor to assess your general health by looking for any signs of disease.
Your doctor may order a digital rectal examination . During a DRE, your doctor will insert a gloved, lubricated finger into your rectum and try to feel for any lumps, irregularities or hard areas on the prostate that could suggest cancer. This examination will also provide clues as to whether the cancer is in one or both sides of the prostate and whether it has spread to the nearby structures.
Prostate-specific antigen blood test
Your doctor may order blood tests to look for blood counts or inflammatory markers . One blood test may measure the levels of a type of protein called PSA, which is made by both normal and cancerous cells in the prostate.
Further Testing For Advanced Cancer
If there’s a significant chance the cancer has spread from your prostate to other parts of the body, further tests may be recommended.
These include:
- an MRI scan, CT scan or PET scan these scans build a detailed picture of the inside of your body
- an isotope bone scan, which can tell if the cancer has spread to your bones a small amount of radiation dye is injected into the vein and then collects in parts of the bone where there are any abnormalities
What Is Free Psa
The routine PSA test measures total PSA in your blood. But there are two types of PSA. Bound PSA is attached to a protein. Free PSA is not. The free PSA test breaks the results down and provides your doctor with a ratio. Men with prostate cancer tend to have lower levels of free PSA than men who dont have prostate cancer.
Its a simple blood test, but theres no consensus among doctors on the ideal ratio of free to bound PSA. The free PSA test is valuable in that it gathers more information, which can help in the biopsy decision.
On its own, the free PSA test cant confirm or rule out a prostate cancer diagnosis.
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Genetic Testing For Some Men With Prostate Cancer
Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.
What Is The Prostate Health Index Test
Prostate Health Index is a test that predicts the risk of having prostate cancer. It is used instead of the PSA test for prostate cancer detection and prostate cancer screening. PHI provides more useful information than PSA alone and is more specific for prostate cancer. When the Prostate Health Index test is elevated, there is a greater likelihood of having prostate cancer than when a PSA test is elevated.
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Biopsy: What The Diagnosis Means
The pathologist has just looked under the microscope at 12 tissue samples from your prostate. Whats in there? First, there are normal cells. Pathologists can tell that theyre normal, because they are round and uniform, with well-defined edges and clear centers. As cancer progresses, the cells become more oblong then more irregular. The edges get blurred, and eventually, the outside shapes start to get weird so do the insides. What once looked like pebbles drawn with a fine-tip pen, as the cancer gets more aggressive, ends up looking like ragged clumps of algae drawn with a fat crayon.
But wait theres more! A sample of prostate cells might also include atypical cells, which are a big question mark. Theyre not normal, but the pathologist cant definitely report that theyre cancerous, either. Theyre just suspicious.
Note: This is one reason why you may want to get a second opinion on your biopsy slides from a pathologist who is an expert in prostate cancer. Having your slides sent to another pathologist is a lot cheaper than having a repeat biopsy just to get more conclusive information.
Gleasons original system had more than 25 different possible combinations. This was simplified into a new system, called Grade Groups, originally proposed in 2013 by Jonathan Epstein at Johns Hopkins. The World Health Organization accepted Epsteins system in 2016. Heres what you need to know:
Grade Group 4: Gleason score 8, and Grade Group 5: Gleason scores 9-10.
The New Recommendations For Prostate Cancer Screenings Are A Bad Deal
Vinay PrasadApril 11, 2017
That popping sound you may have heard on Tuesday was made by urologists opening the champagne bottles they had chilled in anticipation of the United States Preventive Services Task Force upgrading its recommendation about PSA screening for prostate cancer from a D to a C .
Much like a teacher changing a dissatisfied students grade from a D to a C and only after much complaining the new guidelines should hardly be construed as a ringing endorsement. PSA screening remains a difficult decision for healthy men and their doctors.
The test measures the amount of a protein called prostate-specific antigen in the bloodstream. A PSA level above 4.0 nanograms per milliliter of blood has been used as the traditional cutoff to suggest the possibility of prostate cancer . Screening means testing healthy individuals to see if they might have hidden cancer.
The data on which the USPSTF based its new recommendation for PSA screening is similar to the data it used for its prior recommendation in 2012. No study has shown that the test saves lives or improves the quality of life. It does not reduce mortality or extend survival in any randomized trial to date, nor when all studies are combined together. Let me say that again: There is no proof that PSA screening extends your life, improves the years you have, or reduces your risk of dying.
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Early Detection Saves Lives
Prostate cancer is the most common cancer affecting Australian men .
Prostate cancer is the growth of abnormal cells in the prostate gland. This gland is only found in males and is about the size of a walnut.
The causes of prostate cancer are not understood and there is currently no clear prevention strategy.
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No Evidence Of Cancer In The Samples
A biopsy result that does not show prostate cancer in the samples taken cannot guarantee there is not cancer elsewhere in your prostate gland. In this case, you might be advised to:
- Go back to your GP and continue to have your PSA checked.
- Have a repeat prostate biopsy if your PSA changes in the future, even if your biopsy showed no abnormal cells.
- Have a repeat biopsy sooner rather than later because your biopsy showed abnormal cells.
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What Is Done If A Screening Test Shows An Elevated Psa Level
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.
Getting A Prostate Biopsy
For some men, getting a prostate biopsy might be the best option, especially if the initial PSA level is high. A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. This test is the only way to know for sure if a man has prostate cancer. If prostate cancer is found on a biopsy, this test can also help tell how likely it is that the cancer will grow and spread quickly.
For more details on the prostate biopsy and how it is done, see Tests to Diagnose and Stage Prostate Cancer.
For more information about the possible results of a prostate biopsy, see the Prostate Pathology section of our website.
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Preparing For Your Transperineal Biopsy
You usually have this test in the outpatient department under local anaesthetic. Sometimes, you may have it in the operating theatre under a general anaesthetic. This is when you are asleep and dont feel anything.
Your doctor will ask you to sign a consent form once you have all the information about the test.
You take antibiotics to stop an infection from developing after the biopsy. You take them before the biopsy and for a few days afterwards. Your doctor will explain when you need to take the antibiotics and for how long. This is usually for a couple of days afterwards.
You usually have a tube into your bladder to drain urine if you have a general anaesthetic. Your nurse removes the catheter on the day of surgery or the morning after.
Repeating The Psa Test
A mans blood PSA level can vary over time , so some doctors recommend repeating the test after a month or so if the initial PSA result is abnormal. This is most likely to be a reasonable option if the PSA level is on the lower end of the borderline range . For higher PSA levels, doctors are more likely to recommend getting other tests, or going straight to a prostate biopsy.
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What If A Screening Test Indicates The Possibility Of Prostate Cancer
If prostate cancer is suspected, a biopsy will be recommended. During this procedure, a physician inserts a hollow needle through the wall of the rectum to collect prostate tissue samples, which can be evaluated under a microscope for evidence of cancer.
Moffitt Cancer Center offers prostate cancer screening without referrals. To request an appointment with a specialist in our Urologic Oncology Program, call or complete a new patient registration form online.
Biopsy During Surgery To Treat Prostate Cancer
If there is more than a very small chance that the cancer might have spread , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy .
The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.
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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 .
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What Are The Side Effects Of A Biopsy
Having a biopsy can cause side effects. These will affect each man differently, and you may not get all of the possible side effects.
Pain or discomfort
Some men find the biopsy painful, but others have only slight discomfort. Your nurse or doctor may suggest taking mild pain-relieving drugs, such as paracetamol, to help with any pain.
If you have any pain or discomfort that doesnt go away, talk to your nurse or doctor.
Short-term bleeding
Its normal to see a small amount of blood in your urine or bowel movements for about two weeks. You may also notice blood in your semen for a couple of months it might look red or dark brown. This is normal and should get better by itself. If it takes longer to clear up, or gets worse, you should see a doctor straight away.
A small number of men who have a TRUS biopsy may have more serious bleeding in their urine or from their back passage . This can also happen if you have a transperineal biopsy but it isn’t very common. If you have severe bleeding or are passing lots of blood clots, this is not normal. Contact your doctor or nurse at the hospital straight away, or go to the accident and emergency department at the hospital.
Infection
Some men get an infection after their biopsy. This is more likely after a TRUS biopsy than after a transperineal biopsy. It’s very important to take any antibiotics youre given, as prescribed, to help prevent this. But you might still get an infection even if you take antibiotics.
- a high temperature
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Factors That Might Affect Psa Levels
One reason its hard to use a set cutoff point with the PSA test when looking for prostate cancer is that a number of factors other than cancer can also affect PSA levels.
Factors that might raise PSA levels include:
- An enlarged prostate: Conditions such as benign prostatic hyperplasia, a non-cancerous enlargement of the prostate that affects many men as they grow older, can raise PSA levels.
- Older age: PSA levels normally go up slowly as you get older, even if you have no prostate abnormality.
- Prostatitis: This is an infection or inflammation of the prostate gland, which can raise PSA levels.
- Ejaculation: Thiscan make the PSA go up for a short time. This is why some doctors suggest that men abstain from ejaculation for a day or two before testing.
- Riding a bicycle: Some studies have suggested that cycling may raise PSA levels for a short time , although not all studies have found this.
- Certain urologic procedures: Some procedures done in a doctors office that affect the prostate, such as a prostate biopsy or cystoscopy, can raise PSA levels for a short time. Some studies have suggested that a digital rectal exam might raise PSA levels slightly, although other studies have not found this. Still, if both a PSA test and a DRE are being done during a doctor visit, some doctors advise having the blood drawn for the PSA before having the DRE, just in case.
- Certain medicines: Taking male hormones like testosterone may cause a rise in PSA.
Some things might lower PSA levels :
Whats The Purpose Of A Transrectal Ultrasound
A transrectal ultrasound is a procedure that produces an image of the prostate. Its usually ordered after an abnormal PSA and DRE. For the test, a small probe is inserted into the rectum. The probe then uses sound waves to produce a picture on a computer screen.
The test is uncomfortable, but not painful. It can be done in your doctors office or on an outpatient basis in about 10 minutes. It can help estimate the size of the prostate and spot abnormalities that may indicate cancer. However, a TRUS cant confirm the diagnosis of prostate cancer.
A TRUS can also be used to guide a biopsy.
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What Is The Psa Test
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in the blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.
The blood level of PSA is often elevated in people with prostate cancer, and the PSA test was originally approved by the FDA in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the PSA test to be used in conjunction with a digital rectal exam to aid in the detection of prostate cancer in men 50 years and older. Until about 2008, many doctors and professional organizations had encouraged yearly PSA screening for prostate cancer beginning at age 50.
PSA testing is also often used by health care providers for individuals who report prostate symptoms to help determine the nature of the problem.
In addition to prostate cancer, several benign conditions can cause a persons PSA level to rise, particularly prostatitis and benign prostatic hyperplasia . There is no evidence that either condition leads to prostate cancer, but someone can have one or both of these conditions and develop prostate cancer as well.