Pilot Study To Examining The Feasibility Of Mri Prostate Cancer Screening
In contrast to previously described approaches, the use of mpMRI in an otherwise unselected population is relatively untested. We recently conducted a pilot study assessing the feasibility of mpMRI as an initial prostate cancer screening test . Following a newspaper based call for volunteers, 319 men agreed to participate in this study. Of these, 120 were eligible, 50 were enrolled due to limitations in funding, and 47 completed the study protocol. Serum PSA testing, mpMRI, digital rectal examination, and systematic prostate biopsies were performed on all men. Prostate cancer was identified in 18 of 47 men . MpMRI significantly outperformed PSA in the prediction of prostate cancer. In multivariable analyses including age, digital rectal examination findings, PSA and MRI score, mpMRI was the only significant predictor for the presence of prostate cancer . These findings were even stronger when we sought to predict only clinically significant prostate cancer .
Which Patients Might Benefit
When is MRI recommended for men with prostate cancer?
Men who are most commonly referred to our center have had a prostate biopsy that reveals cancer, but some other aspect of the diagnostic workup raises questions about the extent or aggressiveness of the cancer. For instance, maybe the PSA level or biopsy indicates that cancer is aggressive, but nothing can be felt on a digital rectal exam. In this type of situation, an MRI can help to resolve the issue.
So youre trying to provide some additional information that might affect a treatment decision?
Exactly.
What are some other situations where MRI is helpful?
One of the more useful applications of MRI is in locating cancer that has not shown up on a biopsy. This can be very helpful to a man who has not yet been diagnosed with prostate cancer despite having an elevated PSA and continued biopsies that come back as being negative, meaning there is no evidence of cancer. The urologist thinks that cancer is present, but cant find it based upon the biopsy results. Often men are referred to us after they have several negative biopsies. We can use MRI to advise the urologist where to target the biopsy needle, so that the doctor samples the area where we have the highest degree of suspicion that cancer exists.
How do you answer critics who have not kept up with developments in this field and remember MRI of the prostate as being no better than a coin flip, and who believe that this may be a total waste of time and energy?
When Will I Know The Results Of The Colonoscopy
Usually, your doctor will speak with you after the procedure to explain what was done. The doctor will tell you if you did have polyps and if any tissue was removed. They will also go over when you are able to start taking your medications again if you had to stop taking something before the colonoscopy.
Also, usually you will get a formal report either mailed to you or sent to you and your primary care provider in your electronic medical record. Your healthcare team will let you know if any follow-up is needed based on the results of your colonoscopy.
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A Colonoscopy Is Painless
Yes, the tube goes exactly where you think it does. But you wont feel a thing.
Colonoscopies employ monitored anesthesia. Youll be given medicine through an IV that will keep you comfortable, virtually pain-free and unaware of the procedure.
A nurse anesthetist will administer the medicine and watch you intentlymonitoring your heart, breathing and blood pressurefor the duration of the procedure, so the doctors can focus on the colonoscopy.
The only soreness you might feel after would be associated with your IV site, but that typically doesnt hurt, Dr. Parekh says.
You might pass gas with some startling force for a couple of hours after the procedure. This is normal and not painful.
What If My Test Results Are Abnormal
If the results of early detection tests like the PSA screening 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.
Recent research has yielded additional tests that in addition to the PSA and subsequent DRE and Biopsy that can give a doctor more information on to determine the probability of both finding cancer during a biopsy and determining how aggressive that cancer is likely to be. Read more on those tests.
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Who Is At Risk For Colorectal Cancer
In the United States, colorectal cancer is most common in adults aged 65 to 74. Rates of new colorectal cancer cases are decreasing among adults aged 50 years or older due to an increase in screening and to changes in some risk factors . However, incidence is increasing among younger adults for reasons that are not known.
An analysis of US population-based cancer registry data from NCIs Surveillance, Epidemiology, and End Results program for 2000 to 2014 shows that, each year over this period, the incidence of colorectal cancer increased 2.7% among 20- to 39-year-olds and 1.7% among 40- to 49-year-olds while decreasing 0.5% among 50- to 59-year-olds, 3.3% among 60- to 69-year-olds, and 3.8% among 70- to 79-year-olds .
Although the percentage increases were higher in the younger age groups than the older age groups, fewer colorectal cancers were still diagnosed in younger people than older people .
The major risk factors for colorectal cancer are older age and having certain inherited conditions , but several other factors have also been associated with increased risk, including a family history of the disease, excessive alcohol use, obesity, being physically inactive, cigarette smoking, and, possibly, diet.
In addition, people with a history of inflammatory bowel disease have a higher risk of colorectal cancer than people without such conditions.
What Can You Do To Make A Colonoscopy Preparation Easier
There are things that might help you to drink the solution more easily. These include using a straw to drink the liquid and cooling the solution in the refrigerator before drinking it. You can add lemon drops or chew ginger candy. You will need to stay close to the bathroom during bowel preparation period. A split-dose might make the preparation easier. You will know you have done a good job when your diarrhea looks clear and yellowish, like urine.
You may experience skin irritation around the anus due to the passage of liquid stools. To prevent and treat skin irritation, you should:
- Apply Vaseline® or Desitin® ointment to the skin around the anus before drinking the bowel preparation medications. These products can be purchased at any drug store.
- Wipe the skin after each bowel movement with disposable wet wipes instead of toilet paper. These are found in the toilet paper area of the store.
- Sit in a bathtub filled with warm water for 10 to 15 minutes after you finish passing a stool. After soaking, blot the skin dry with a soft cloth. Then apply Vaseline or Desitin ointment to the anal area, and place a cotton ball just outside your anus to absorb leaking fluid.
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Who Should Get A Digital Rectal Exam
Not all medical institutions agree on when men should begin screening for prostate cancer or even if a DRE should be part of the screening.
To help detect prostate cancer in its early stages, the American Cancer Society recommends that men talk to their doctors about the benefits, risks, and limitations of prostate cancer screening before deciding whether to be tested.
For most men at average risk, discussions about screening begin at age 50. However, some doctors recommend that men at higher risk of prostate cancer — African-American men or men with a family history of prostate cancer — start screening earlier.
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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Possible Inaccurate Or Unclear Test Results
As an example, neither the PSA test nor the DRE is 100% accurate. These tests can sometimes have abnormal results even when a man does not have cancer , or normal results even when a man does have cancer . Unclear test results can cause confusion and anxiety. False-positive results can lead some men to get prostate biopsies when they dont have cancer. And false-negative results can give some men a false sense of security even though they might actually have cancer.
How Do I Screen For Prostate Cancer
There are two main early stage screening methods a digital rectal exam , and a blood test measuring PSA levels. PSA screening is regarded as the best method to screen for prostate cancer in men over 40 or those of a certain risk factor.
While men might be intimidated by a DRE, itâs a quick and safe screening technique used by a physician, and should cause no significant pain.
A Digital Rectal Exam is a simple, painless and quick procedure. A physician inserts a gloved and lubricated finger into the rectum and feels the prostate to identify if the prostate is enlarged, has lumps or is an abnormal texture compared to a healthy example.
Although this procedure is a very clear indicator of prostate health, the entire prostate canât be examined during a DRE. This is why physicians will also take into account PSA blood work, health history, and other risk factors. Overall, itâs often difficult to detect prostate cancer early, itâs mostly found through PSA testing so PSA screenings should be done regularly, starting at the age of 40-50.
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What Do Colorectal Cancer Screening Guidelines Say About Who Should Have Colorectal Cancer Screening
Expert medical groups, including the US Preventive Services Task Force , strongly recommend screening for colorectal cancer. Although some details of the recommendations vary, most groups now generally recommend that people at average risk of colorectal cancer get screened at regular intervals beginning at age 45 or 50 .
The expert medical groups generally recommend that screening continue to age 75 for those aged 76 to 85 years, the decision to screen is based on the individuals life expectancy, health conditions, and prior screening results.
People who are at increased risk of colorectal cancer because of a family history of colorectal cancer or documented advanced polyps or because they have inflammatory bowel disease or certain inherited conditions may be advised to start screening earlier and/or have more frequent screening.
The Highly Unreliable Psa
Although marketed as potentially life-saving, the PSA blood test is associated with a very high false positive rate leads to the detection of mainly non-lethal diseases is NOT cancer-specific its limits of normal are artificial is commonly NOT the same result on repeat studies as it fluctuates normally can be artificially raised or lowered by several processes without a cancer being present often rises with age as the prostate grows is normally high with big prostates and, MOST IMPORTANTLY, commonly fails to indicate the 15 per cent or so of potentially lethal high-grade prostate cancers with significant amounts of pattern 4 and or, 5 disease as these cancers often make little or no PSA. Furthermore, should an elevated PSA lead to a significant prostate cancer being detected, the elevated PSA is commonly caused by the enlarged benign portion of the prostate and NOT the cancer.
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Medical History And Physical Exam
Your doctor will ask about your medical history to learn about possible risk factors, including your family history. You will also be asked if youre having any symptoms and, if so, when they started and how long youve had them.
As part of a physical exam, your doctor will feel your abdomen for masses or enlarged organs, and also examine the rest of your body. You may also have a digital rectal exam . During this test, the doctor inserts a lubricated, gloved finger into your rectum to feel for any abnormal areas.
The Tricky Prostate Cancer Label
The all-inclusive prostate cancer label leaves the public with the impression that all prostate cancers are potentially lethal. Unfortunately, this very deceptive generic prostate cancer label includes both the bogus Gleason 6 and real prostate cancers. Even worse, this confusion allows predatory urologists to game the cancer label and imply that pseudo-cancers like the Gleason 6 are real and use falsehoods and scare tactics to bully patients into unneeded treatments for profiteering. Easily done since the only thing these vulnerable patients hear is the terrorizing cancer word.
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What Would You Say To Men Who Dont Want To Get A Prostate Check
A rectal exam is recommended but optional. We recommend both, but if theyll just let you do a blood test, thats better than not doing anything at all.
If concern about the rectal exam is the only reason youre not getting screened, talk to your doctor about it. We can discuss the risks and benefits. None of the evaluation tests are mandatory, but the reason we do that is that it improves our ability to detect cancer. So, if thats why youre not being evaluated, we can talk and decide if we can do other tests.
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Benefits Of Screening In Studies Have Not Been Clear
Doctors are still studying if screening tests will lower the risk of death from prostate cancer. The most recent results from 2 large studies were conflicting, and didnt offer clear answers.
- Early results from a large study done in the United States found that annual screening with PSA and DRE did detect more prostate cancers than in men not screened, but this screening did not lower the death rate from prostate cancer. However, questions have been raised about this study, because some men in the non-screening group actually were screened during the study, which might have affected the results.
- A European study did find a lower risk of death from prostate cancer with PSA screening , but the researchers estimated that about 781 men would need to be screened to prevent one death from prostate cancer.
- Neither of these studies has shown that PSA screening helps men live longer overall .
Prostate cancer is often slow-growing, so the effects of screening in these studies might become clearer in the coming years. Both of these studies are being continued to see if longer follow-up will give clearer results. Prostate cancer screening is being studied in several other large studies, as well.
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How Is The Test Performed
To perform a DRE, your doctor will gently insert a gloved, lubricated finger into your anus. This allows them to feel for any abnormalities. For example, an enlarged prostate feels like a bulge behind the rectum wall. Prostate cancer may feel like bumps on the normally smooth surface of the prostate.
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Men may feel pain or the urge to urinate during the exam. This is because your doctor is applying firm pressure to the prostate.
A DRE is typically done as part of a routine physical examination for both men and women. During a gynecological exam, your doctor may perform a DRE to check the space between the rectum and the vagina for any abnormalities. Most men and women feel only minor discomfort during the procedure. People with hemorrhoids or anal fissures may experience a small amount of bleeding.
A DRE isnt suitable for detecting colon cancer. Only a small portion of the lower colon may be accessed during a DRE. However, a DRE may be used to obtain a stool sample. If blood is present in the stool, it may indicate colon cancer or other problems.
Blood isnt always visible to the naked eye in a stool sample, so your doctor may wish to conduct a fecal occult blood test to confirm.
Prostate Mri Can Help You Avoid Unnecessary Biopsy
Prostate biopsies are used to confirm cancer in high-risk patients suspected to have aggressive prostate cancer. Uncomfortable and invasive, men undergoing the procedure are extremely prone to complications like antibiotic-resistant infections and sepsis. Its estimated that 18% of patients experience some sort of complication, while as many as 4% develop an infection requiring hospital care.
27% of the one million prostate biopsies performed each year are unnecessary.
Typically, a biopsy will be recommended to a patient for one of two reasons: they tested high for levels of the PSA protein, or, the results from a digital rectal exam show they may have prostate cancer. The issue here is that PSA tests are not always accurate.
A males PSA level can be affected by a number of other factors, such as recent sexual activity, an enlarged prostate, and prostatitis. Even a long bicycle ride can cause levels to spike. This leaves a lot of room for false-positives â which lead to unnecessary biopsies.
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What Is Colorectal Cancer
Colorectal cancer is a disease in which abnormal cells in the colon or rectum divide uncontrollably, ultimately forming a malignanttumor.
Parts of the colon. Drawing of the front of the abdomen that shows the four sections of the colon: the ascending colon, the transverse colon, the descending colon, and the sigmoid colon. Also shown are the small intestine, the cecum, and the rectum. The cecum, colon, rectum, and anal canal make up the large intestine. The cecum, ascending colon, and transverse colon make up the upper, or proximal, colon the descending colon and sigmoid colon make up the lower, or distal, colon.
Most colorectal cancers begin as a growth, or lesion, in the tissue that lines the inner surface of the colon or rectum. Lesions may appear as raised polyps, or, less commonly, they may appear flat or slightly indented. Raised polyps may be attached to the inner surface of the colon or rectum with a stalk , or they may grow along the surface without a stalk .
Colorectal polyps are common in people older than 50 years of age, and most do not become cancer. However, a certain type of polyp known as an adenoma is more likely to become a cancer.
Colorectal cancer is the third most common type of non-skin cancer in both men and women . It is the second leading cause of cancer death in the United States after lung cancer. In 2021, an estimated 149,500 people in the United States will be diagnosed with colorectal cancer and 52,980 people will die from it .