What Questions Should I Ask My Healthcare Provider
If you have prostate cancer, you may want to ask your healthcare provider:
- Why did I get prostate cancer?
- What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
- Has the cancer spread outside of the prostate gland?
- What is the best treatment for the stage of prostate cancer I have?
- If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
- What are the treatment risks and side effects?
- Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
- Am I at risk for other types of cancer?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.
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 Should I Expect If Im Told I Have Elevated Psa
If your provider finds an elevated PSA level, youll have repeat tests to check your prostate. Many men with elevated PSA levels even those who have prostate cancer live long, healthy lives. Prostate cancer may not need treatment, depending on how slowly the tumor is growing. Keep up with your regular appointments and tests so your care team can keep tabs on your health.
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Prostate Cancer Screening: An Imperfect Test
Prostate cancer is the most common cancer in men other than nonmelanoma skin cancer, and the second-leading cause of cancer death in men, according to the American Cancer Society .
The only screening test available for it is the PSA test, a blood test that can reveal elevated levels of prostate specific antigen in the bloodstream. But PSA tests are imperfect. Several factors can contribute to elevated levels.
PSA screening for all men has been criticized because it can lead to false positive results, unnecessary medical tests, and patient anxiety.
Moreover, the test sometimes reveals the presence of nonaggressive cancer that is unlikely to require treatment or cause problems if left alone. Some men are overtreated for it and suffer unnecessarily from some of the long-term complications of treatment, such as urinary incontinence and erectile dysfunction.
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What Else Can Cause An Elevated Psa Besides Prostate Cancer
If you are a man in your 50s or older, you likely have a PSA drawn with your routine annual blood work. For men who receive an elevated PSA result, prostate cancer may be an immediate concern. However, prostate cancer is not the only condition that can cause the PSA to become elevated. Board-certified urologists Drs. Ahmad and Ali Kasraeian and the expert team at Kasraeian Urology in Jacksonville, FL have a deep understanding of the complex behavior of the PSA and carefully monitor patients PSA levels to identify any cause for concern. Learn more about PSA elevations here, including why other than prostate cancer your PSA may be high.
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Understanding Psa Test Results
28 August 2020
Medicare data suggests that up to 21% of Australian men aged 4574 choose to have a Prostate Specific Antigen Test each year, and about 19% of men aged over 74 also undergo testing.
While PSA testing helps to identify men with an increased risk of undiagnosed prostate cancer, and can help to diagnose prostate cancers earlier, it can also produce false positive results, and in some men picks up cancers that are so slow growing that they do not affect a mans life expectancy, a finding known as over-diagnosis. False positives and over-diagnosis can cause harm, which means men and their doctors need to carefully consider the pros and cons of testing, based on each mans age and other individual characteristics.
For men with no family history of prostate cancer and no symptoms, the current guidelines recommend that men who decide to undergo regular testing should be offered PSA testing every two years from age 50 to 69.
For men with a family history of prostate cancer who decide to undergo testing, the guidelines recommend men be offered PSA testing every two years from age 40/45 to 69, with the starting age depending on the strength of their family history.
Learn more here >
What is PSA?
Prostate Specific Antigen is a protein made in the prostate gland. The prostate is a walnut-sized gland that sits below the bladder in front of the rectum. It surrounds the urethra, the passage in the penis through which urine and semen pass.
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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The Relationship Between Constipation And The Prostate Is Kind Of Like The Old Chicken And Egg Conundrum
The egg: Constipation, aka the build-up of feces in the intestine , can put pressure on the bladder and the prostate, which can cause symptoms resembling those associated with an enlarged prostate. The chicken: an enlarged prostate can put pressure on the rectum and cause constipation. But wait, theres more
Psa And Prostate Cancer: What Do My Numbers Mean
The prostateis a walnut-sized gland that sits below the bladder in men. It is responsible for creating semen, the milky liquid that carries sperm out of the body when a man ejaculates.
A PSA test is a blood test used to screen for prostate cancers. PSA is a protein produced in the prostate by both cancerous and noncancerous tissue. Elevated PSA levels can indicate the presence of cancer, but high PSA levels can also be a result of non-cancerous conditions like benign prostatic hyperplasia , or an infection. PSA levels also rise naturally as you age.
Elevated PSA levels do not necessarily mean that you have prostate cancer. PSA tests arent always accurate: many men who have prostate cancer have normal PSA levels. Alternatively, some men have high PSAs but dont have cancer. Or they have a slow growing form of cancer that would never have had symptoms or caused them any harm.
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Loss Of Libido And Erectile Dysfunction
The hormones that are often used to treat advanced prostate cancer can decrease libido and cause erectile dysfunction , which occurs when a man isnt able to have or keep an erection to have sex, according to the University of Rochester Medical Center in Rochester, New York.
As a result, for couples, theres a real struggle to recover that sense of life together how to be intimate without having sex, says Michael J. Morris, MD, an oncologist at Memorial Sloan Kettering Cancer Center in New York City.
Depending on the type of treatment that caused the ED, the ability to have an erection may improve over time, according to the University of Rochester Medical Center. You and your partner may want to explore other ways to be intimate in your relationship. A sex therapist or couples counselor may be able to help. There are also treatments available for erectile dysfunction, such as medications and implants.
Pros And Cons Of The Psa Test
- it may reassure you if the test result is normal
- it can find early signs of cancer, meaning you can get treated early
- PSA testing may reduce your risk of dying if you do have cancer
- it can miss cancer and provide false reassurance
- it may lead to unnecessary worry and medical tests when there’s no cancer
- it cannot tell the difference between slow-growing and fast-growing cancers
- it may make you worry by finding a slow-growing cancer that may never cause any problems
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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.
Causes Of An Elevated Prostate Specific Antigen
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What Are The Stages Of Prostate Cancer
Your healthcare provider uses the Gleason score and Grade Groups to stage prostate cancer based on its projected aggressiveness. To get this information, the pathologist:
- Assigns a grade to each type of cell in your sample. Cells are graded on a scale of three to five . Samples that test in the one to two range are considered normal tissue.
- Adds together the two most common grades to get your Gleason score .
- Uses the Gleason score to place you into a Grade Group ranging from one to five. A Gleason score of six puts you in Grade Group 1 . A score of nine or higher puts you in Grade Group five . Samples with a higher portion of more aggressive cells receive a higher Grade Group.
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.
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Should You Panic About Prostate Cancer If You Learn That Your Psa Is Shockingly High
Is it at all possible for a man who does not have prostate cancer to have a VERY high PSA?
Absolutely. Many benign conditions can cause a very elevated PSA, including recent surgeries, trauma or catheterization due to urinary retention, says Michael Herman, MD, director of urologic oncology at South Nassau Communities Hospital in Oceanside, NY.
The most common benign cause of a very high PSA is a urinary tract infection or prostatitis.
Also, some people simply have an elevated PSA without prostate cancer. Just because someone has a high PSA does not mean they have prostate cancer, but it does need to be evaluated very carefully.
PSA stands for prostate specific antigen. High levels are correlated to the likelihood of prostate cancer, but its not 100 percent reliable.
This is why a man can have a PSA in the normal range and still be diagnosed with the disease.
How Common Is Benign Prostatic Hyperplasia
Benign prostatic hyperplasia is the most common prostate problem for men older than age 50. In 2010, as many as 14 million men in the United States had lower urinary tract symptoms suggestive of benign prostatic hyperplasia.1 Although benign prostatic hyperplasia rarely causes symptoms before age 40, the occurrence and symptoms increase with age. Benign prostatic hyperplasia affects about 50 percent of men between the ages of 51 and 60 and up to 90 percent of men older than 80.2
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How Is Prostate Cancer Treated
Treatment options for prostate cancer include:
- Surgery to remove the prostate .
- High intensity focused ultrasound .
- Cryotherapy .
- Hormone treatment, also called androgen suppression therapy.
You may continue to have PSA level tests during and after prostate cancer treatment. These tests check that the treatment is working.
When To See A Doctor
Some of the first symptoms of patients who have an elevated PSA level is difficult or painful urination, pain in the abdomen or pelvic area, and a frequent urge to urinate. These symptoms can be signs of BPH, prostatitis, prostate cancer, and kidney stonesall of which require different treatment. If you are experiencing any of these symptoms, it is important to talk with your doctor. Your doctor will be able to help determine the cause of your problems and provide an individualized treatment plan.
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Symptoms Of Prostate Cancer
- Frequent urge to pass urine, especially at night
- Weak or interrupted urine stream
- Pain or burning when passing urine
- Blood in the urine or semen
- Painful ejaculation
- Nagging pain in the back, hips, or pelvis
Prostate cancer can spread to the lymph nodes of the pelvis. Or it may spread throughout the body. It tends to spread to the bones. So bone pain, especially in the back, can be a symptom of advanced prostate cancer.
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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Noncancerous Prostatic Disease And Urologic Manipulation
The serum PSA level can also be altered by noncancerous prostatic disease and urologic manipulations. Elevation of PSA levels has been demonstrated in acute prostatitis, subclinical or chronic prostatitis, and urinary retention. Nadler et al reported that serum PSA levels higher than 4.0 ng/mL in 148 men with subclinical prostatitis could be attributed to their disease because all these men had negative findings from biopsies repeated on multiple occasions.
No significant change occurs in the PSA level after a digital rectal examination , but a vigorous prostate massage can produce a short-term 2-fold increase. Cystoscopy, urethral catheterization, and transrectal ultrasonography of the prostate do not tend to elevate the PSA level. Needle biopsy of the prostate raises the PSA level by a median of 7.9 ng/mL within 5 minutes after the biopsy, and this level persists for 24 hours.
The time it takes for PSA to return to baseline levels depends on the precipitating event and the half-life . After a biopsy, 2 to 4 weeks may elapse before the PSA returns to its original level. If an infection occurs as a result of the biopsy, the return to baseline levels may take longer. After ejaculation, PSA levels have been reported to return to their original levels within 48 hours, whereas fPSA returns to baseline at 6 hours because of its shorter half-life .