Neuromuscular And Chronic Pain Therapy
Patients with CP/CPPS will often complain of pain and spasm of the pelvic floor muscles. Therapies aimed at relaxation of these muscle groups and proper use of pelvic floor muscle may therefore be expected to be beneficial. Unfortunately, not very many large clinical trials have been published, data is available from small trials. For instance, biofeedback physical therapy and pelvic floor re-education lead to a significant improvement of the NIH-CPSI score in men with CP/CPPS . In another study, myofascial trigger point release and pelvic floor re-education also lead to a significant improvement in NIH-CPSI score and also improved sexual function in men with CP/CPPS . Also, a sham-controlled study of men with CP/CPPS found that electromagnetic therapy could significantly improve the NIH-CPSI score of the patients, with the greatest improvement in the pain related symptoms . Amytriptyline and gabapentin can both be useful for the management of chronic pain and chronic muscle pain conditions and we have used them with some success in the management of patients with CP/CPPS.
Changes In Your Psa Level
A PSA level that is in the normal range may nonetheless need clarification if recent blood tests show that it has increased. For instance, an annual PSA test may show that your PSA level has increased from 2 ng/mL to 3 ng/mL. Although your PSA level is under 4 ng/mL, and therefore within the normal range, the increase may have been caused by early-stage prostate cancer.
If your PSA level is already above 4 ng/ml and screening reveals another significant increase, then clarification is even more urgent. Thatâs why we recommend proactive PSA testing. That being said, regular PSA testing cannot provide a basis for diagnosing the cause of an elevated PSA level.
Prostate Cancer Treatment Options: What Are They
Prostate cancer is, most often, a slow-growing cancer.
For some men, prostate cancer causes no symptoms or long-term issues, so treatment isn’t necessary.
In these cases, doctors may recommend active surveillance. That is, they’ll keep an eye on the development of the tumor using various tools and tests, including:
- Digital rectal exams
- Transrectal ultrasounds
- Prostate biopsies
Men who require treatment for their condition are most often treated with surgery, radiation therapy, hormone therapy, or a combination of these modalities.
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Improving Sensitivity Of Psa Testing
Prostate-specific antigen testing with a cutoff of 4.0 ng/mL has a sensitivity of 67.5-80%, which implies that 20-30% of cancers are missed when only the PSA level is obtained. Sensitivity can be improved by lowering the cutoff or by monitoring PSA values so that a rise in PSA level of more than 20-25% per year or an increase of 0.75 ng/mL in 1 year would trigger performance of a biopsy regardless of the PSA value.
The specificity of PSA at levels higher than 4.0 ng/mL is 60-70%. Specificity can be improved by using age-adjusted values, PSA velocity , and the ratio of free PSA to total PSA . Another method is to adjust the PSA according to the size of the prostate or volume determinations of the transitional zone, which produces most of the PSA, and the peripheral zone, which produces less PSA but a majority of prostate cancers.
In the European Randomized Study of Screening for Prostate Cancer, Schroder et al studied a strategy for the early detection of prostate cancer that excluded digital rectal examination results and used a PSA cutoff of 3.0 ng/mL as the only indication for a biopsy. This protocol was compared with one in which a PSA level of 4.0 ng/mL or higher or the presence of a positive DRE or transrectal ultrasound was the indication for a biopsy. In a follow-up study, Schroder et al confirmed a substantial reduction in mortality from prostate cancer as a result of PSA testing.
There Are Several Causes Of Elevated Psa Aside From Prostrate Cancer
The PSA blood test is a screening tool used in the detection of prostate cancer. Sometimes, test results will indicate an elevation in PSA blood levels. Fortunately, this does not definitively mean a cancer diagnosis. Known causes of elevated PSA can range from simple activities such as cycling prior to the blood test, to an inflammation of the prostate. In fact, a number of benign medical issues can affect PSA numbers.
In general, PSA screening should begin as men reach their 50s. However, men who are at a higher risk of developing prostate cancer, such as African American men and those who have a history of prostate cancer in their family, should begin PSA testing by 40.
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If Screening Test Results Arent Normal
If you are screened for prostate cancer and your initial blood PSA level is higher than normal, it doesnt always mean that you have prostate cancer. Many men with higher than normal PSA levels do not have cancer. Still, further testing will be needed to help find out what is going on. Your doctor may advise one of these options:
- Waiting a while and having a second PSA test
- Getting another type of test to get a better idea of if you might have cancer
- Getting a prostate biopsy to find out if you have cancer
Its important to discuss your options, including their possible pros and cons, with your doctor to help you choose one you are comfortable with. Factors that might affect which option is best for you include:
- Your age and overall health
- The likelihood that you have prostate cancer
- Your own comfort level with waiting or getting further tests
If your initial PSA test was ordered by your primary care provider, you may be referred to a urologist for this discussion or for further testing.
Palm Beach County Urologist Seeing False Psa Levels In Men Due To Covid Vaccines
Prostate cancer is the most common cancer in men, diagnosed with 243,000 estimated cases for 2021.
For men heading into the doctor’s office for their annual exams, Dr. Diego Rubinowicz, a urologist in Palm Beach County, says you may get a false PSA reading.
The blood level of PSA in men is often elevated when diagnosed with prostate cancer, but Rubinowics says research is showing if you recently got your COVID-19 vaccine, PSA levels could be temporarily elevated.
Dr. Rubinowicz recommends delaying your PSA test a few weeks after your most recent COVID-19 vaccination and/or going for a second PSA test if you and your physician are concerned about a false elevation.
The month of June is mens health month, and doctors across the country urge patients to stay on top of their annual exams.
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Should Men At Elevated Risk Be Screened More Aggressively
It might sound logical to screen high-risk men earlier or urge men to adopt a healthy lifestyle to lower their risk for prostate cancer, but these areas have not been studied sufficiently. Therefore, physician organizations recommend more research and individualizing decisions about whether to get screened. Meanwhile, some leading organizations have issued recommendations, including:
- The American Urological Association The AUA recommends individualizing decision-making for men younger than age 55 who are high risk because they are African-American or have a positive family history. ” rel=”nofollow”> 7)
- The U.S. Preventive Services Task Force The USPSTF largely agrees largely with AUAs position and its 2018 recommendations are based on AUAs evidence review.
- The American Cancer Society The ACS takes this a step further, urging discussion about screening begin earlier for African-American men and men with first-degree relatives who have had prostate cancer.
What Factors Can Affect Your Psa Levels
Since prostate-specific antigen is an enzyme made by healthy prostate cells, it is normal to find some in every mans bloodstream. However, PSA levels vary from person to person, as there are several factors that can increase them.
Thus, a high PSA level does not necessarily indicate the presence of prostate cancer. There are other things to consider, such as your physical characteristics, lifestyle, health, or recent medical procedures.
Physical characteristics
Your age is an important factor. PSA levels over 2.5 ng/mL would be cause for concern for men under 50. For men over 60 years of age, however, PSA levels under 4.5 ng/mL are considered normal. The amount of naturally occurring PSA in your blood gets higher as you age. Furthermore, people of certain ethnic groups may have naturally higher PSA levels.
Way of life
Certain activities are not recommended before taking a PSA test. If you exercise vigorously less than 48 hours before your PSA test, you could experience elevated PSA levels. This is especially common in people who ride bicycles for extended periods of time.
Anal sex or prostate stimulation within a week of a PSA test could lead to a high PSA number. Moreover, although not proven, ejaculation in the 48 hours before a PSA test could lead to a “false positive” test.
Your health
Medical interventions
Any operation in the area near your prostate could cause a temporary spike in PSA levels.
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What Is Transrectal Ultrasound
Transrectal ultrasound is the examination of prostate using a machine called ultrasound. We insert a finger like probe into the rectum to examine the prostate. Ultrasound creates a picture of prostate using high-frequency sound waves. These sound waves come out of the probe and are transmitted through body tissues. The sound waves then bounce off the tissue and return to the probe. These returning sound waves are called echoes and are translated and recorded into photographic images. Transrectal Ultrasonography provides excellent visualization of the prostate and abnormalities that may be present in the prostate. We can also easily guide the biopsy needle under ultrasound guidance into the prostate where cancer is suspected.
The ultrasound machines in our offices are capable of doing color doppler studies and three dimensional reconstruction of the gland. Usually there is increased blood flow within the cancerous lesion or adjacent to the lesion and color doppler helps us precisely guide the biopsy needle into the lesion for accurate biopsy.
Transrectal ultrasonography is also used to estimate the prostate volume accurately to calculate PSA density.
Transrectal ultrasonography also provides images sensitive enough to defect capsular involvement and extention of cancer into the seminal vesicles .
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 a mans 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 men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the use of the PSA test in conjunction with a digital rectal exam to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing to help doctors determine the nature of the problem.
In addition to prostate cancer, a number of benign conditions can cause a mans PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis and benign prostatic hyperplasia . There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
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Diseases That Cause Elevated Psa Levels
1. Age-related benign prostatic hyperplasia
A significant enlargement of the prostate gland can cause your PSA level to rise. While the overall volume of the prostate tends to increase in men as they age, the increase actually develops only in the transitional zone of the prostate as an abundance of nodules form and begins to compress the peripheral zone. While men often donât notice the growth directly, it can manifest itself in a more frequent urge to urinate.
2. Age-related BPH combined with chronic inflammation
In addition to BPH, chronic inflammation of the prostate can also lead to an elevated PSA level. In such cases, the two factors can act independently of one another, with each contributing to varying degrees to an increase in your PSA level.
3. Age-related BPH combined with prostate cancer
After learning from their urologists that they have benign prostatic hyperplasia, many men assume that this must also be the reason for their elevated PSA levels. However, while the enlargement will certainly tend to increase their PSA levels, prostate cancer may also be playing a role, for instance, by causing a continuous rise in their PSA levels.
4. Age-related BPH combined with acute prostatitis
5. Age-related BPH combined with multiple different tumors
Problems With The Psa Test
There are reasons doctors donât agree on whether you need this test:
- Finding prostate cancer early doesnât always protect you. The PSA test often finds small, slow-growing tumors that arenât life-threatening. Treating them anyway, whether itâs with surgery or radiation, can expose you to harmful side effects and complications. Also, finding cancer early may not help if you have an aggressive tumor or if it spread to distant body parts before you found it.
- The results arenât always accurate. If you have a high level but you donât have cancer, the test results can create a lot of worry and lead to medical procedures you donât need. A negative result if you really do have cancer can prevent you from getting treatment you do need.
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How Does Bph Occur
The prostate goes through two main periods of growth. In early puberty, the prostate doubles in size. Then, around age 25, the prostate begins to grow again and continues to grow throughout most of a man’s life.
The continuing enlargement of the prostate does not usually cause problems until later in life. However, the second period of growth may, many years later, result in BPH. According to the National Institute of Diabetes and Digestive and Kidney Diseases:
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BPH rarely causes symptoms before age 40.
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More than half of men in their 60s have some symptoms of BPH.
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As many as 90 percent of men in their 70s and 80s have some symptoms of BPH.
Does A High Psa Level Mean I Have Prostate Cancer
There is no set rule about what constitutes an abnormal PSA reading on a blood test. Since prostate cancer is not the only source of PSA, an elevated PSA may reflect an enlarged or inflamed benign prostate gland. High PSA levels are often the result of benign prostate hyperplasia, enlargement of the prostate that occurs in most men as they age. When interpreting the test results, doctors take a number of factors into consideration, including the patients age and ethnicity as well as rate of rise of PSA.
It is hard to detect the difference between PSA made by normal prostate tissue and PSA made by prostate cancer cells, says , a medical oncologist at Dana-Farber Cancer Institute. We know that as the PSA rises and gets higher and higher, the odds that that PSA is coming from a cancer than a normal prostate increases.
Still, most men considered tohave an elevated PSA do not have a detectable prostate cancer. About 25 percentof those who undergo a prostate biopsyin which a small section of the prostateis removed and examined for signs of cancerare found to have prostate cancer.
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What Causes Elevated Psa
An elevated PSA level may indicate the presence of prostate cancer, but there are several other, non-cancerous, reasons for a high reading of this particular blood test. High levels may indicate prostatitis or benign prostatic hyperplasia . They may also be caused by a recent prostate biopsy, bicycle riding, a recent digital rectal exam, or a recent ejaculation.
A PSA blood test is a medical exam that is used to help determine if a man is suffering from prostate cancer or any other prostate problems. This test is also used by doctors during prostate cancer treatment to determine whether or not the treatment that is being used is working properly. An elevated PSA level can be caused by anything that has irritated the prostate, although some irritations will only cause a temporary increase in PSA levels.
Prostatitis occurs when an infection causes the prostate to become inflamed. Many times this condition will not last for a long time, but may reoccur. Some men will have long-term or chronic prostatitis. Treatment for this condition varies, depending on the initial cause. Bacterial infections that cause this condition will generally be taken care of with antibiotics that are prescribed by a doctor.
Causes Of An Elevated Psa Level
Prostate cancer typically leads to an elevated PSA level. Given that early-stage prostate cancer is generally limited to asymptomatic malignant changes at the cellular level, men have no way of knowing that something is wrong. This is why prostate cancer screening in the form of PSA testing is the best method of early detection. Please refer to the PSA Table for help in interpreting your PSA scores.
In addition to prostate cancer, age-related prostate enlargement , prostatitis and urinary tract infections can also lead elevated PSA levels.
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Is The Psa Test Recommended For Prostate Cancer Screening
Until about 2008, some doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50. Some organizations recommended that men who are at higher risk of prostate cancer, including African-American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45. However, as more was learned about both the benefits and harms of prostate cancer screening, a number of organizations began to caution against routine population screening. Most organizations recommend that men who are considering PSA screening first discuss the risks and benefits with their doctors.
Currently, Medicare provides coverage for an annual PSA test for all Medicare-eligible men age 50 and older. Many private insurers cover PSA screening as well.