Should Doctors Look For Trouble
How hard should doctors look for prostate cancers? In an editorial accompanying the Coltman team’s study, Johns Hopkins researcher H. Ballentine Carter, MD, notes that a man’s lifetime risk of prostate cancer is 16%. Yet his risk of dying from prostate cancer is only 3%.
“In the age range of 60 years to 80 years, about 30% to 40% of men have small prostate cancers,” Carter tells WebMD. “Now, this article tells us, we have the ability today to detect those.”
If doctors look harder for prostate cancers, they will find them. If they do this, a lot of men will have unnecessary surgery or radiation therapy. If they don’t, some men who might have been saved by early detection will die.
“We already know we are overdetecting the disease,” Carter says. “A lot of men who have prostate cancer are not going to have their disease harm or bother them during their lifetimes. Unless they were biopsied, they never would have known that they had prostate cancer during their life. The lower we set the PSA threshold, the more unnecessary treatments we’ll have.”
Like Coltman, Carter says a man’s risk factors for prostate cancer have to be taken into account. But he would be very careful about sending a man with a midrange PSA level to get a biopsy.
Carter warns that it’s a different story for men in their 40s. For them, a midrange PSA level may well mean trouble.
“These are the men we should be concerned about if they have a prostate level of 2.5 or 3,” he says.
Tests For Chronic Pelvic Pain Syndrome
There is no single test to diagnose CPPS. Your doctor will need to rule out other possible causes of your symptoms before they make a diagnosis. This can take some time.
You might be diagnosed with CPPS if youve had some of the symptoms listed above for more than three of the last six months. But your doctor may diagnose CPPS sooner than this.
They will ask you about your symptoms or give you a questionnaire to fill in. Your doctor may also ask about your medical history. This can help them work out what is causing your symptoms, and which treatments are most likely to help.
Youll need to have a urine test to make sure you dont have a urine infection. You may also have a physical examination, including a digital rectal examination , and some other tests, such as a PSA test. Ask your doctor for more information about other tests you may have. For some tests, you might need to visit a doctor at the hospital who specialises in urinary problems or a specialist nurse.
Worried about having a DRE?
Its natural to feel worried or embarrassed about having tests, but some men find the idea of having a DRE upsetting. For example, if youve ever been sexually abused, you might feel very upset about having this test.
Theres no right or wrong way to feel, and its your choice whether or not to have a DRE. If you do decide to have a DRE, explain your situation to your doctor. They can talk you through the test and help to reassure you. It may also help to talk to a counsellor.
Recommendations For Psa Testing
According to a 2019 position statement from the European Association of Urology, a baseline PSA test in men aged 45 years at risk of prostate cancer should be used in combination with family history, ethnicity, and other factors to establish individualized screening frequency.
The American Urological Association and the American Cancer Society offer divergent recommendations on prostate-specific antigen screening. The AUA recommends baseline PSA testing, along with digital rectal examination , at age 40 for all men with a life expectancy of 10 years or more, with subsequent testing intervals determined on the basis of the PSA level and DRE results.
The ACS does not specify an age at which to pursue screening in asymptomatic men with a life expectancy of 10 years or more rather, the ACS advises clinicians to provide men with information on the risks and benefits of screening so the patient can make an informed decision. In addition, the ACS recommends that men whose initial PSA level is below 2.5 ng/mL can be screened every 2 years, but men with higher PSA values should be tested annually.
From these findings, the investigators concluded that potentially curable prostate cancer is not compromised when measuring PSA every other year in men with PSA levels of 2 ng/mL or less, as long as the DRE findings are normal.
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Bph Or Prostatitis But Still Normal Psa Levels Possible
I have been offered a PSA test and physical Postrate examination due to some symptoms that I am experiencing since few months. I have read few articles whereby there is an argument that raised PSA levels does not always imply BPH and there are other reasons for PSA levels to go high. What I want to know is if the reverse is also true ? Meaning, could PSA levels be still normal inspite of having BPH or Prostatitis ? Had anyone had similar experience or perhaps any medical practitioner here could clarify this ? Thanks.
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How High Can Psa Levels Go With Prostatitis
PSA levels can vary by age and individual. As mentioned before, there is no standard range for PSA levels, but typically anything greater than 4.0 ng/mL indicates a problem. However, your PSA level can be below 4.0 ng/mL and you can have prostatitis. After antibiotic treatment, an elevated PSA level due to prostatitis should decline.
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Diagnosis And Treatment Of Female Prostate Cancer
Due to the challenges of diagnosis, the signs of female prostate cancer are often mistakenly attributed to underlying conditions in the urinary tract or reproductive system.
Unfortunately, the initial stage of cancer in the Skene glands is asymptomatic. Once your menstrual cycle is disrupted, sex becomes painful, or youre always feeling sick, the disease is quite advanced.
Treatment of female prostate cancer follows a similar strategy to that of other reproductive cancers. If chemical and radiation therapies arent successful in eradicating tumors, then surgery will likely be required to excise them. Frequently, the surgical removal of larger tumors and the chemical destruction of smaller tumors happen simultaneously.
In more severe cases, the organ or organs containing the cancerous growths must be removed as well. This could include your Skene glands, uterus, ovaries, or your entire reproductive system . Whenever cancer in the Skene glands goes undiagnosed and untreated, bladder cancer may follow.
Medical experts have theorized that female prostate cancer could be linked to a history of sexually transmitted infections. The Skene glands, like the male prostate, act as guardians against infections that travel throughout the reproductive system.
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Ejaculation Is A Potential Cause Of Mildly Elevated Psa
“Ejaculation can cause a mild elevation of your PSA level, and so can having a digital rectal exam,” says Milner. “These types of PSA elevations are usually not enough to make a significant difference unless your PSA is borderline. PSA should return to normal in two to three days.”
To avoid this type of elevation, doctors will usually draw blood for a person’s PSA level before doing a rectal exam. Ask your doctor if you should avoid ejaculation for a few days before a PSA test.
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Psa Transition Zone Density
Kalish introduced PSA density of the transition zone as a refinement to the original PSAD. This refinement is predicated on the following 2 assumptions:
That measuring transition zone volume with TRUS is more accurate than measuring the entire prostate volume because of the difficulty in measuring the true border of the apex in the longitudinal view
That most of the PSA entering the circulation arises from the transition zone
Zisman et al have offered a new index using the peripheral zone fraction of PSA to predict the presence of prostate cancer in men with PSA levels of 4-10 ng/mL. They point out that the PZ contributes little to tPSA. The PZ fraction can be calculated by using the following formula:
tPSA Ã /total prostate volume
PZ volume is measured by subtracting TZ volume from total prostate volume while neglecting the central zone.
Zisman et al compared the positive and negative predictive values using tPSA, PSAD, PSA-TZ, and PSA peripheral zone density . The efficacy rates of PSA and PSA-TZ were similar, at 60% PSA-PZ had a 70% efficacy rate, PSAD an 80% rate. The negative predictive values were superior to the positive predictive values, ranging from 78% to 83% for PSA, from 78% to 88% for PSAD, from 87% to 92% for PSA-TZ, and from 81% to 100% for PSA-PZ.
My Psa Levels Are Raisedwhat Does This Mean
A raised PSA level may mean a number of things. It can be due to an enlargement of the prostate , a urine infection, inflammation of the prostate or even after recent intercourse and ejaculation.
If your PSA level is increased, another test may be required within 1 to 3 months. This is because the PSA can sometimes return to normal levels. If the levels are still raised after the second test, this may suggest something is going on in the prostate and further tests may be done to determine if it is cancer or something else.
Prostate cancer is confirmed by performing a biopsy. This involves using a special needle to take small pieces of tissue from different parts of the prostate. The decision to perform a biopsy is based upon your likelihood of having prostate cancer. This takes into account the result of the PSA blood test, any abnormalities noticed during the digital rectal examination , and whether you have a family history of prostate cancer. Sometimes, a magnetic resonance imaging scan of the prostate is ordered to help decide if a biopsy is required and also to help doctors direct the needle to areas of the prostate that looks most suspicious.
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What Does An Elevated Psa Level Mean If Ive Had Prostate Cancer In The Past
If youve ever had treatment for prostate cancer, youll have regular PSA screenings for the rest of your life. An increasing PSA level may mean the cancer has returned. Your care team may use other tests, including imaging scans and biopsies, to check for signs of cancer. If cancer returns, your team will discuss your treatment options with you.
What’s A Raised Psa Level
The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood .
If you’re aged 50 to 69, raised PSA is 3ng/ml or higher.
A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of another condition that’s not cancer, such as:
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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.
What Is Psa And Why Is It Important To Monitor
Prostate-specific antigens s are naturally occurring. Cells within the prostate gland produce PSA, which is typically found in semen, but may be present in trace amounts in the blood as well.
The blood test is one of two exams used in the early screening of prostate cancer. Approved by the FDA in 1986, the test was intended to monitor the progression of the disease among those who were already diagnosed, according to the National Cancer Institute .
Right now Medicare covers yearly PSA screenings for men 50 and older who are Medicare-eligible. Many private insurers likewise cover the test. Patient advocacy groups, such as ZERO The End of Prostate Cancer, offer support in accessing PSA testing and finding free testing in your community.
While age and genetics both affect PSA levels, lifestyle factors actually play the largest role. Thats why simple changes to health, diet, and exercise routines can naturally bring down PSA levels.
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Can Kidney Stones Affect Your Psa Count
Typically, no. While kidney infections or UTIs can cause an elevated PSA count, kidney stones generally do not. Kidney stones are formed in the kidneys and pass through the bladder and urethra. PSA is produced in the prostate. If you had a kidney stone that got caught in your urethra at the prostate, and caused further inflammation of the prostate, it could result in a spike in your PSA level.
What Happens If My Biopsies Comes Back Negative
Just because your biopsies are negative, does not mean that you do not have cancer in your prostate. You need to be seen on a regular basis for digital rectal examination and PSA testing. If there is significant change in your PSA, we may suggest repeat biopsies. The average risk of finding cancer in a repeat biopsy following a benign diagnosis is about 18%.
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Individualized Prostate Cancer Screening
Coltman says that men and their doctors can no longer rely on PSA levels alone when deciding whether to have a prostate biopsy.
“The situation now is that the individual man with his individual urologist will have to assess what the person feels are his risk factors,” he says. “In consultation with his doctor, the individual man must come to grips with the question of whether or not a biopsy should be done. It will become a more personalized interaction.”
Who’s at high risk? Men with the following factors have the highest risk of prostate cancer:
- Age. A man’s risk of prostate cancer increases with age.
- Race. “African American men have the highest incidence of prostate cancer and the highest death rate from prostate cancer of any men in the world,” Coltman says.
- Family history. A man’s risk increases if his brother or father has had prostate cancer.
Screening Tests For Prostate Cancer
Screening is testing to find cancer in people before they have symptoms. Its not clear, however, if the benefits of prostate cancer screening outweigh the risks for most men. Still, after discussing the pros and cons of screening with their doctors, some men might reasonably choose to be screened.
The screening tests discussed here are used to look for possible signs of prostate cancer. But these tests cant tell for sure if you have cancer. If the result of one of these tests is abnormal, you will probably need a prostate biopsy to know for sure if you have cancer.
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Prostate Cancer In 15% Of Men With Normal Psa
Best Test May Be to Follow PSA Levels Over Time, Expert Says
May 26, 2004 — Fifteen out of every 100 older men with a normal PSA test actually has prostate cancer, a new study shows.
PSA — prostate-specific antigen — is a chemical marker given off by cells of the prostate gland. Suspiciously high PSA levels are often an early sign of prostate cancer. A PSA over 4 ng/mL usually means that a man will have to undergo needle biopsy of his prostate.
Men breathe a sigh of relief when their doctor tells them their PSA is normal. But some men with a low PSA do have cancer. Until now, it wasn’t clear how many, says researcher Charles A. Coltman Jr., MD, chair of the Southwest Oncology Group in San Antonio.
“Our study emphasizes that there is a range of PSA levels, from 0 to 4, across which a man can have prostate cancer,” Coltman tells WebMD. “There is not a clear cut cutoff based on PSA alone which allows you to define individuals who need to be biopsied.”
Driving home Coltman’s point is a dramatic picture. It shows a high-grade prostate cancer — from a man whose PSA level was less than 1. The picture and the study it illustrates appear in the May 27 issue of The New England Journal of Medicine.
Psa Elevation From Large Prostate Glands
Big prostate glands produce more PSA than small prostate glands. The best way to measure the size of the prostate is by using a scan. Finding an oversized gland can be good news, providing a benign and reassuring explanation for why the PSA is high.
Until recently, the only way to sort through all these possibilities of PSA elevation was to puncture the prostate 12 times with a needle biopsy to remove tissue cores for evaluation under the microscope. Due to an inordinate fear of missing cancer, many doctors recommended random biopsy anytime the PSA was slightly elevated. One million men are biopsied in the United States every year. This aggressive behavior was perhaps justified when biopsy was the only way to find cancer.
We now know, however, that scans using multi-parametric magnetic resonance imaging are more accurate than a needle biopsy. The beauty of using a scan is that only men who have a suspicious abnormality detected by MRI need to undergo a biopsy. And importantly, the biopsy can be targeted. Only one or two cores are required. No more fishing through the rest of the gland with random needle sticks! Men with clear scans can avoid a biopsy altogether. Changing the policy from random biopsy to MP-MRI would solve the problem of over-diagnosis in men with high PSA.
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