Psa Test: The Current Prostate Screening Standard
Before recommending when you should be screened for prostate cancer, yourdoctor will consider many factors, such as:
- Family history, particularly whether any of your family members have had prostate cancer
- Race, as African-American men have a higher risk of developing prostate cancer
If your doctor determines you should undergo screening, he or she will mostlikely recommend the PSA test. For more than 30 years, the PSA test hasbeen the gold standard in prostate cancer screening. This simple blood testmeasures how much prostate-specific antigen is in your blood.
Psa Test For Prostate Cancer
The prostate gland makes a protein called prostate specific antigen . This protein helps to nourish sperm. Normally, only tiny amounts of it enter the bloodstream.
Cancer cells in the prostate interfere with proper functioning and can cause large amounts of PSA to enter the bloodstream. Therefore, when high levels of PSA are detected in the bloodstream, this may indicate cancer.;
Early prostate cancer often has no symptoms. However, high PSA levels can occur five to 10 years before the onset of prostate cancer symptoms. In such circumstances, the PSA test can help to indicate the presence of cancer at an early stage.
Other tests are needed to confirm a diagnosis because an abnormal PSA test can be due to non-cancerous causes. Equally, it is possible for a man to have a normal PSA level when cancer is present.
Tests To Diagnose And Stage Prostate Cancer
Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.
If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.
The actual diagnosis of prostate cancer can only be made with a prostate biopsy .
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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.
How Is The Procedure Performed
In men, the prostate gland is located directly in front of the rectum, so the ultrasound exam is performed transrectally in order to position the imaging probe as close to the prostate gland as possible.
For a transrectal ultrasound, you will be asked to lie on your side with your knees bent. A disposable protective cover is placed over the transducer, it is lubricated, inserted through the anus and placed into the rectum.
The images are obtained from different angles to get the best view of the prostate gland.
If a suspicious lesion;is identified with ultrasound or with a rectal examination, an ultrasound-guided biopsy;can be performed. This procedure involves advancing a needle into the prostate gland while the radiologist;watches the needle placement with ultrasound. A small amount of tissue is taken for microscopic examination.
A prostate-specific antigen test, which measures the amount of PSA in the blood, may be administered to determine if a patient is at high risk for cancer. In this case, a biopsy is performed and an ultrasound probe is used to guide the biopsy to specific regions of the prostate gland.
When the exam is complete, you may be asked to dress and wait while the ultrasound images are reviewed.
This ultrasound examination is usually completed in less than 20 minutes.
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Both Tests Are Better Than One
Using these tests together is better than using either test alone. PSA testing together with a DRE may help find a dangerous cancer early when it is easier to treat.
If a problem is found, more tests will be done to find out whether you have prostate cancer or another health problem. Further tests can include:
- a follow-up PSA test
- a transrectal ultrasound a test that uses sound waves to make a picture of the rectum and nearby organs, including the prostate
- a biopsy of the prostate tissue samples of the prostate are looked at under a microscope;
Can I Check For Prostate Cancer At Home
It is strongly advised under any circumstances not to self-examine for prostate cancer at home either by yourself or with a partner. Not only does it take a skilled professional to assess how the prostate feels to make an accurate determination of overall prostate health, self-examinations have the potential to cause injury.
âSince the prostate is an internal gland, itâs extremely important that only licensed medical professionals conduct the exam. At-home self-exams should not be administered in order to avoid injury or self-harm. Regular screening is important for prostate cancer, as the disease often does not present symptoms until it is too late. Talk to your doctor about making sure you receive a regular DRE check-up at each visit.â
While actually screening yourself for prostate cancer at home is ill advised, you can still monitor your risk factors for prostate cancer between yearly check-ups, like practicing a healthy diet and exercising regularly.
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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.
What Do You Want Men To Know About Prostate Cancer
The important thing to know is that, if you live long enough, you will probably get prostate cancer. If you live into your 80s, about 80 percent of men have some sort of prostate cancer. That doesnt mean theyre going to die from prostate cancer because, as a percentage, very few men die from prostate cancer. It means its important to be aware of it and consider screening early, so if its a high-grade type, we can identify it and treat it.;
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Do All Men Who Are Treated For Prostate Cancer Lose Sexual And Urinary Function
Its definitely not true that all men are incontinent and impotent after treatment for prostate cancer. Urinary incontinence is usually temporary.;
There can be a sexual impact for guys who have normal function. If the cancer is near their nerve bundle, theyre going to have a decrease in sexual function. If its not, and we can do bilateral nerve sparing surgery, studies show 70 percent can get back their normal sexual function. It all depends on where the cancer is. But the truth is that we cant predict very well who will be the 30 percent who will haveor still haveED; some already do have ED because of age, diabetes, hypertension or renal failure.
Deciding If You Need A Prostate Screening
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Ruling Out Prostate Cancer
If you have symptoms of BPH, your doctor might also test for prostate cancer. An early examination is important because only a comprehensive exam will determine whether you have BPH, which is a benign condition, or whether you have prostate cancer, which is best to diagnose early. Important tests for detecting prostate cancer include a digital rectal examination and prostate-specific antigen test.
- Digital rectal examination : During this test, your urologist will feel your prostate. The exam shows whether your prostate is hard or asymmetrical, both of which can be signs of cancer, or soft, which is less likely to indicate cancer. Your urologist will insert a lubricated, gloved finger into your rectum. If your doctor feels anything that may indicate prostate cancer, you may need to have more tests to make an accurate diagnosis.
- Prostate-Specific Antigen Test: This blood test measures a protein produced by the cells of the prostate gland. It is always done and evaluated in conjunction with a DRE.
It is important to recognize that a high PSA reading alone does not mean that you have cancer. An elevated PSA could be a sign of a number of conditions, including BPH, or prostatitis, an inflammation of the prostate. There is no evidence that prostatitis and BPH cause cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
What Is The Outlook
It is difficult to give an outlook . Your symptoms may last a long time, although they may come and go or vary in severity. Painkillers can keep discomfort to a minimum.
Most men diagnosed with chronic prostatitis/CPPS tend to have an improvement in their symptoms over the following six months. In one study, about a third of men had no further symptoms one year later. In another large study, one third of men showed moderate to marked improvement over two years.
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Determining Whether Prostate Cancer Is Aggressive
If a biopsy sample is found to contain cancer, the pathologist analyzing the specimen takes a deeper look at the cancer cells to determine how aggressive the disease is likely to be.
If the cancer cells appear significantly abnormal and dissimilar from healthy cells under a microscope, the cancer is considered more aggressive and expected to advance quickly. Conversely, cancer cells that look relatively similar to healthy cells indicate that its less aggressive and may not spread as fast.
Prostate cancers are assigned a Gleason score depending on how abnormal the cells look..
Gleason score: Gleason scores range from 2 to 10, going from least to most aggressive prostate cancers.
There are different types of cancer cells in a prostate tumor, so the final Gleason score is determined by adding the scores of the two main areas of the tumor.
First, the primary part of the tumor is assigned a number between 1 and 5. Lower numbers indicate that the cells appear relatively similar to healthy cells, while higher numbers show that the cells are abnormal-looking. Then, another number between 1 and 5 is assigned to describe the second most prevalent area of the tumor.
Finally, the two numbers assigned to the different parts of the prostate tumor are added. So, if most of the tumor is given a 4, and some of the tumor is more aggressive and given a 5, the final Gleason score would be 9.
There are many biomarker tests, including:
- Oncotype DX® Genomic Prostate Score
What Will Happen After Treatment
Youll be glad when treatment is over. But its hard not to worry about cancer coming back. When cancer comes back it is called a recurrence. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. At first, your visits may be every few months. Then, the longer youre cancer-free, the less often the visits are needed.
Be sure to go to all follow-up visits. Your doctors will ask about your symptoms, examine you, and might order blood tests and maybe other tests to see if the cancer has come back.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your doctor to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life,;making healthy choices and feeling as good as you can.
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How Is Prostatitis Treated
Treatment depends on the type of prostatitis.
Chronic prostatitis/chronic pelvic pain syndrome. Treatment for chronic prostatitis/chronic pelvic pain syndrome aims to decrease pain, discomfort, and inflammation. A wide range of symptoms exists and no single treatment works for every man. Although antibiotics will not help treat nonbacterial prostatitis, a urologist may prescribe them, at least initially, until the urologist can rule out a bacterial infection. A urologist may prescribe other medications:
- 5-alpha reductase inhibitors such as finasteride and dutasteride
- nonsteroidal anti-inflammatory drugsalso called NSAIDssuch as aspirin, ibuprofen, and naproxen sodium
- cans such as chondroitin sulfate
- muscle relaxants such as cyclobenzaprine and clonazepam
- neuromodulators such as amitriptyline, nortriptyline , and pregabalin
Alternative treatments may include
- warm baths, called sitz baths
- local heat therapy with hot water bottles or heating pads
- physical therapy, such as
- Kegel exercisestightening and relaxing the muscles that hold urine in the bladder and hold the bladder in its proper position. Also called pelvic muscle exercises.
- myofascial releasepressing and stretching, sometimes with cooling and warming, of the muscles and soft tissues in the lower back, pelvic region, and upper legs. Also known as myofascial trigger point release.
Questions To Ask The Doctor
- What treatment do you think is best for me?
- Whats the goal of this treatment? Do you think it could cure the cancer?
- Will treatment include surgery? If so, who will do the surgery?
- What will the surgery be like?
- Will I need other types of treatment, too?
- Whats the goal of these treatments?
- What side effects could I have from these treatments?
- What can I do about side effects that I might have?
- Is there a clinical trial that might be right for me?
- What about special vitamins or diets that friends tell me about? How will I know if they are safe?
- How soon do I need to start treatment?
- What should I do to be ready for treatment?
- Is there anything I can do to help the treatment work better?
- Whats the next step?
How Is Prostate Cancer Diagnosed
A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope.
A biopsy is a procedure that can be used to diagnose prostate cancer. A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope to see if there are cancer cells.
A Gleason score is determined when the biopsy tissue is looked at under the microscope. If there is a cancer, the score indicates how likely it is to spread. The score ranges from 2 to 10. The lower the score, the less likely it is that the cancer will spread.
A biopsy is the main tool for diagnosing prostate cancer, but a doctor can use other tools to help make sure the biopsy is made in the right place. For example, doctors may use transrectal ultrasound;or magnetic resonance imaging to help guide the biopsy. With transrectal ultrasound, a probe the size of a finger is inserted into the rectum and high-energy sound waves are bounced off the prostate to create a picture of the prostate called a sonogram. MRI uses magnets and radio waves to produce images on a computer. MRI does not use any radiation.
What Other Screening Tests Are Used To Detect Prostate Cancer
Because a biopsy is an invasive procedure, your doctor may first use one or more of the following methods to screen for prostate cancer:
When your doctor takes a detailed medical history, they may ask you about your symptoms, underlying health conditions and whether you consume alcohol or tobacco in any form. Your doctor may also ask you whether any of your close family members such as a father, uncle or brother were diagnosed with prostate cancer at a young age . You may also be asked other questions such as whether you have experienced weight loss or a change in sex drive.
Digital rectal examination
A thorough physical examination will also allow your doctor to assess your general health by looking for any signs of disease.;
Your doctor may order a digital rectal examination . During a DRE, your doctor will insert a gloved, lubricated finger into your; rectum and try to feel for any lumps, irregularities or hard areas on the prostate that could suggest cancer. This examination will also provide clues as to whether the cancer is in one or both sides of the prostate and whether it has spread to the nearby structures.
Prostate-specific antigen blood test
Your doctor may order blood tests to look for blood counts or inflammatory markers . One blood test may measure the levels of a type of protein called PSA, which is made by both normal and cancerous cells in the prostate.;
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