When Is Bph Treatment Necessary
The course of BPH in any individual is not predictable. Symptoms, as well as objective measurements of urethral obstruction, can remain stable for many years and may even improve over time for as many as one-third of men, according to some studies. In a study from the Mayo Clinic, urinary symptoms did not worsen over a 3.5-year period in 73% of men with mild BPH. A progressive decrease in the size and force of the urinary stream and the feeling of incomplete bladder emptying are the symptoms most correlated with the eventual need for treatment. Although nocturia is one of the most annoying BPH symptoms, it does not predict the need for future intervention.
If worsening urethral obstruction is left untreated, possible complications are a thickened, irritable bladder with reduced capacity for urine infected residual urine or bladder stones and a backup of pressure that damages the kidneys.
- Inadequate bladder emptying resulting in damage to the kidneys
- Complete inability to urinate after acute urinary retention
- Incontinence due to overfilling or increased sensitivity of the bladder
- Symptoms that trouble the patient enough to diminish his quality of life
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Currently, the main options to address BPH are:
- Watchful waiting
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The Test Is Often Not Needed
Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:
- An enlarged prostate gland.
- Recent sexual activity.
- A recent, long bike ride.
Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.
Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.
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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
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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.
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Favorite Online Support Networks And Advocacy
PHEN is an organization geared toward African-American men a group that has the nations highest prostate cancer incidence and mortality rates. It offers support groups, survivor networks, and a monthly newsletter that features new treatments and clinical trials. Their annual Fathers Day Rally event takes place at churches nationwide.
Talking With Your Doctor
Different kinds of doctors and other health care professionals manage prostate health. They can help you find the best care, answer your questions, and address your concerns. These health care professionals include:
- Family doctors and internists
- Physician assistants and nurse practitioners
- Urologists, who are experts in diseases of the urinary tract system and the male reproductive system
- Urologic oncologists, who are experts in treating cancers of the urinary system and the male reproductive system
- Radiation oncologists, who use radiation therapy to treat cancer
- Medical oncologists, who treat cancer with medications such as hormone treatments and chemotherapy
- Pathologists, who identify diseases by studying cells and tissues under a microscope
View these professionals as your partnersâexpert advisors and helpers in your health care. Talking openly with your doctors can help you learn more about your prostate changes and the tests to expect.
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Using The Psa Blood Test After Prostate Cancer Diagnosis
Although the PSA test is used mainly to check for prostate cancer, it can also help your doctor:
- Choose a treatment. Along with an exam and tumor stage, the PSA test can help determine how advanced a prostate cancer is. This may affect treatment options.
- Check treatment success. After surgery or radiation, the doctor can watch your PSA level to see if the treatment worked. PSA levels normally fall if all of the cancer cells were removed or destroyed. A rising PSA level can mean that prostate cancer cells are present and your cancer has returned.
If you choose a watchful waiting approach to treatment, your PSA level can tell your doctor if the disease is progressing. If so, youâll need to think about active treatment.
During hormone therapy, the PSA level can show how well the treatment is working and when itâs time to try another treatment.
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If I Have Elevated Psa Levels What Should I Ask My Healthcare Provider
If you have any symptoms of prostate cancer, or if it runs in your family, ask your provider:
- Should I have regular tests to check my PSA level?
- What can I do to lower my risk for prostate cancer?
- What other tests or monitoring do I need?
- What are my treatment options if I get prostate cancer?
- What other signs or symptoms should I look out for?
A note from Cleveland Clinic
An elevated PSA level can be a sign of prostate cancer, but it doesnt always mean you have cancer. Your healthcare provider will watch you and do more tests to arrive at a diagnosis. Prostate cancer is often slow-growing and may never become life-threatening. If you have symptoms of prostate problems, such as difficulty urinating, don’t hesitate to let your provider know.
Last reviewed by a Cleveland Clinic medical professional on 04/06/2021.
References
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Cell Cycle Inhibitor P27
The cell cycle inhibitor p27 is a putative tumor suppressor gene. Loss of p27 is associated with a poor prognosis in patients with breast, colorectal, and prostate carcinoma. In men treated with radical prostatectomy, loss of p27 expression correlates with an increased probability of cancer recurrence and lower survival rates. Decreased p27 expression also is associated with high-grade cancer cells, positive surgical margins, seminal vesicle invasion, and lymph node metastases.
Psa Testing For Detection Of Prostate Cancer
The introduction of prostate-specific antigen testing into clinical practice has greatly increased the detection of localized prostate cancer and, by doing so, has decreased the diagnosis of regional and metastatic disease. PSA testing has had such a profound clinical effect that questions have arisen regarding the significance of the cancers that are being detected.
Stage, grade, tumor volume, and PSA testing are used to determine whether a prostate cancer is clinically significant or insignificant. However, there is no generally accepted precise definition for this distinction.
The goal of early detection of prostate cancer is to identify clinically significant cancers at a time when treatment is most likely to be effective. The risk of death from prostate cancer is significant in those with moderate- to high-grade tumors. This is especially true in younger men. Long-term survival is compromised when the cancer has spread beyond the confines of the prostate, into the regional lymph nodes, and to distant sites.
Several studies have shown that with a PSA cutoff of 4.0 ng/mL, clinically insignificant cancers are detected in fewer than 20% of men, but nearly 50% of all the cancers detected because of an elevated PSA level are localized, and these patients are candidates for potentially curative therapy. Only a small proportion of prostate cancers detected by PSA testing and treated with radical prostatectomy are low-volume and low-grade tumors.
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What If My Biopsy Results Are Positive
Following a positive biopsy result, the next step is to determine the cancers staging the extent to which cancer has developed by growing and possibly spreading. You will undergo a bone scan, an MRI of the pelvis, or a CT scan. In the near future, PET scanning specifically for prostate cancer will be widely available. Ruckle says you and your physician should customize your prostate cancer care based on your desires, fears, age, current health status, motivation, and lifestyle.
There is a wide spectrum of treatments, Ruckle says. It is really important that patients understand that it is not a one-size-fits-all treatment by any means. Different prostate cancer treatments bear various side effects from close observation with deferred treatment if necessary, focal therapy to radiation therapies to robotic surgical removal.
We have a lot of resources and options to help men get through this and not have it adversely affect their life or their lifestyle, Ruckle says.
Learn more about prostate cancer screening and treatment options online. Loma Linda University Health is committed to your health and safety. Visit MyChart to schedule a telehealth visit or in-person appointment, or call .
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Hyperplastic Tissue And Epithelial
The interpretation of PSA may vary according to the amount of BPH tissue and the epithelial-stromal ratio. Most PSA is produced in the hyperplastic transitional zone of the prostate. A relatively small amount of PSA is produced in the peripheral zone, where 80% of prostate cancers originate. Cancers developing in the transitional zone tend to produce large amounts of PSA.
High-grade cancer cells tend to lose their ability to produce PSA. A Gleason grade 5 prostate cancer produces less PSA than a grade 3 cancer does. Some patients with advanced prostate cancer may have low or undetectable PSA levels.
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Diagnosing An Enlarged Prostate
As with all incontinence conditions, a thorough diagnosis must be developed before action can be taken. You may have heard of some of these exams. And if you havent, now is a good time to familiarize yourself with them. Not only is knowledge power, but it also eliminates surprises.
Because those with BPH can experience symptoms from mild to severe, the treatment options featured here are organized from least invasive to more intense.
Preliminary Confirmation Of The Importance Of Baseline Prostate Size And Psa Level
The recently reported Medical Therapy of Prostatic Symptoms study is the largest and longest BPH study ever undertaken.24 The results of this landmark study demonstrated that doxazosin and finasteride, alone and in combination, significantly reduce the risk of BPH clinical progression finasteride alone and combination therapy appear to be more effective than -blocker therapy in reducing the long-term risk of AUR and incidence of BPH-related surgery.
Roehrborn and colleagues25 analyzed prostate volume changes over time in the placebo group of this large long-term study and determined that both baseline prostate volume and PSA level were excellent predictors of future prostate growth. This prediction of prostate growth suggests that baseline prostate volume and PSA level may also have utility in predicting clinical parameters of progression.
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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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Changes To Psa Screening Recommendations
In many cases, men with increased PSA levels do not have cancer, and these men suffer a great deal of anxiety and financial cost as a result of unnecessary biopsies. Additionally, the biopsy itself is associated with a small risk of bleeding and infection. Also, low PSA levels do not necessarily indicate the absence of cancer.
In May 2018, the U.S. Preventive Services Task Force updated its recommendation for PSA testing to screen for prostate cancer. Both the USPSTF and the American Academy of Family Physicians recommend that men between the ages of 55 and 69 years should make individual decisions about screening only after a discussion with their physician about the risks and benefits of screening. For men over age 70 years, PSA tests are not recommended, as the risk of the disease itself does not outweigh the risks of testing. There are no specific screening recommendations for men at higher risk of prostate cancer since there is insufficient evidence of the mortality benefits of screening. Many physicians will recommend regular testing in high-risk men only after discussing the associated risks and benefits. For those who decide to undergo screening, they should not be screened more frequently than every 2 years.
If you have questions about prostate cancer, risk factors, and screening recommendations, consult a trusted healthcare provider. Pharmacists can consult on the treatment of prostate cancer and the associated side effects.
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High Psa May Call For More Testing
All men are at risk for prostate cancer. Out of every 100 American men, about 10 will get prostate cancer during their lifetime, and two to three men will die from prostate cancer. Almost all prostate cancers occur in men older than age 55 years, and half of the men who die from prostate cancer are over age 80 years. African-American men and men with a family history of prostate cancer have the highest risk.
Testing for prostate cancer includes both a PSA blood test and a digital rectal exam . A DRE allows the doctor to manually inspect the prostate for size and condition. In up to one-half of patients with an enlarged prostate found on DRE, the PSA level is above normal.
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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Normal Psa Levels Chart By Numbers And Age
Dr.Megan Ralf
A Medical laboratory Scientist who devoted his life to medical and laboratory sciences, writes his everyday expertise dealing with various pathological conditions through laboratory diagnosis of different body fluids, also participating in many workshops for first aids, infection control, and urgent care. Also Dr Megan Ralf coaching many medical teams.
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What Are The Symptoms Of Benign Prostatic Hyperplasia
Lower urinary tract symptoms suggestive of benign prostatic hyperplasia may include
- urinary frequencyurination eight or more times a day
- urinary urgencythe inability to delay urination
- trouble starting a urine stream
- a weak or an interrupted urine stream
- dribbling at the end of urination
- nocturiafrequent urination during periods of sleep
- urinary incontinencethe accidental loss of urine
- urine that has an unusual color or smell
Symptoms of benign prostatic hyperplasia most often come from
- a blocked urethra
- a bladder that is overworked from trying to pass urine through the blockage
The size of the prostate does not always determine the severity of the blockage or symptoms. Some men with greatly enlarged prostates have little blockage and few symptoms, while other men who have minimally enlarged prostates have greater blockage and more symptoms. Less than half of all men with benign prostatic hyperplasia have lower urinary tract symptoms.3
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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.
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. Thats 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.
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