Accessing Clinical Trials At Ucsf
UCSF is currently conducting research in four main areas:
- Identification of genetic and lifestyle factors that predispose men to clinically significant prostate cancer
- Discovering alterations in genes and proteins to improve current prostate cancer treatment
- Developing new therapies for men with recurrent widespread prostate cancer
- Preventing progression of early-stage untreated disease
To learn more, search for a trial or contact us, visit Cancer Clinical Trials at UCSF.
How To Check Your Prostate
This article was co-authored by Robert Dhir, MD. Dr. Robert Dhir is a board certified Urologist, Urological Surgeon, and the Founder of HTX Urology in Houston, Texas. With over 10 years of experience, Dr. Dhirs expertise includes minimally-invasive treatments for enlarged prostate , kidney stone disease, surgical management of urological cancers, and mens health . His practice has been named a Center of Excellence for the UroLift procedure, and is a pioneer in non-surgical procedures for ED using his patented Wave Therapy. He earned his undergraduate and medical degrees from Georgetown University and was awarded honors in pre-medical studies, urology, orthopedics, and ophthalmology. Dr. Dhir served as chief resident during his urological surgical residency at University of Texas at Houston / MD Anderson Cancer Center in addition to completing his internship in general surgery. Dr. Dhir was voted Top Doctor in Urology for 2018 to 2019, one of the top three Best Rated Urologists in 2019 & 2020 for Houston Texas, and Texas Monthly has named him to the 2019 & 2020 Texas Super Doctors Rising Stars list.wikiHow marks an article as reader-approved once it receives enough positive feedback. This article received 11 testimonials and 86% of readers who voted found it helpful, earning it our reader-approved status. This article has been viewed 1,073,580 times.
Take Time To Make A Treatment Decision
Most prostate cancers grow relatively slowly, so immediate treatment is rarely necessary. Many men can safely take months to decide what to do. The decision process can be complicated. The chosen treatment can significantly affect your life, which makes it especially important to take time to educate yourself and confidently choose the approach that is most appropriate for you.
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Discuss Prostate Cancer Testing With Your Doctor
Medical authorities do not recommend that all men should be tested for prostate cancer. In fact, most authorities suggest that men should make their own choice about whether or not to have a PSA test. If you decide to be tested, it is recommended that it should be done every two years from 50 to 69 years of age, and only if your health is such that you expect to live for at least another seven years.
Men at high risk of prostate cancer, such as men with a family history of prostate cancer , or men who have previously had an elevated test result, can start two-yearly testing from age 45. Your doctor can help you decide whether this is necessary.
While there is now some evidence that regular testing may prevent prostate cancer deaths, there are concerns that many men may be diagnosed and treated unnecessarily as a result of being screened, with a high cost to their health and quality of life .
However, the option of active surveillance, where a low-risk cancer is watched closely instead of being treated, helps to lower these risks. Active surveillance is now used quite commonly in Australia for men with low-risk prostate cancer.
If you are unsure whether or not to be tested after considering the benefits and uncertainties of testing and your own risk of prostate cancer, discuss it with your doctor.
In Australia, if you choose to be tested for prostate cancer the tests are covered by Medicare.
What Is Done If A Screening Test Shows An Elevated Psa Level
If someone who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to have an elevated PSA level, the doctor may recommend another PSA test to confirm the original finding. If the PSA level is still high, the doctor may recommend that the person continue with PSA tests and digital rectal exams at regular intervals to watch for any changes over time .
If the PSA level continues to rise or a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. These may include imaging tests, such as magnetic resonance imaging or high-resolution micro-ultrasound.
Alternatively, the doctor may recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. The biopsy needle may be inserted through the wall of the rectum or through the perineum . A pathologist then examines the collected tissue under a microscope. Although both biopsy techniques are guided by ultrasound imaging so the doctor can view the prostate during the biopsy procedure, ultrasound cannot be used alone to diagnose prostate cancer. An MRI-guided biopsy may be performed for patients with suspicious areas seen on MRI.
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Seeing Your Gp When You Are Worried About Prostate Cancer
You might go to see your GP because you’re worried about prostate cancer. This might be because you know someone with it or have heard about prostate cancer or the PSA test in the news.
Or you might have some urinary symptoms, such as difficulty passing urine.
Whatever reason you have, don’t delay seeing your GP. It’s important to remember that most prostate cancers don’t cause symptoms and it is more likely that any symptoms you have are due to other causes. But if it is, the earlier it is picked up the higher the chance of successful treatment. You won’t be wasting your doctor’s time.
Try not to be embarrassed. What you tell your GP is confidential. Doctors are used to discussing intimate problems and will try to put you at ease.
What Are The Limitations Of Prostate Ultrasound Imaging
Men who have had the tail end of their bowel removed during prior surgery are not good candidates for ultrasound of the prostate gland because this type of ultrasound typically requires placing a probe into the rectum. However, the radiologist may attempt to examine the prostate gland by placing a regular ultrasound imaging probe on the perineal skin of the patient, between the legs and behind the scrotum of the patient. Sometimes the gland can be examined by ultrasound this way, but the images may not be as detailed as with the transrectal probe. An MRI of the pelvis may be obtained as an alternative imaging test, because it may be obtained with an external receiver coil.
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Examination Of Your Prostate Gland
When your doctor examines you, it might include feeling your prostate gland. To do this your doctor puts a gloved finger into your back passage to check for abnormal signs. They feel for any lumps or your prostate feeling larger than it should for your age. Doctors call this a digital rectal examination .
It’s normal to feel anxious about this test and it might be uncomfortable. But it usually only lasts a few minutes.
How Should I Prepare For The Exam
Your blood must be sent to a laboratory for analysis, so your PSA results wont be available immediately. Your doctor will let you know when they have the results.
The lab report will show the level of PSA in your blood as:
In addition to looking at the amount of PSA in your blood, your doctor will assess how quickly this number is changing. Many things can affect PSA, so test results require careful analysis by an expert. Your doctor will take all of your health information into account.
If you have an abnormal PSA test result, it doesnt mean you have prostate cancer. Most men with a high PSA level dont have prostate cancer. About of men who have a biopsy due to a high PSA level have prostate cancer.
Its also possible for men with prostate cancer to have normal DRE and PSA test results.
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Is The Psa Test Recommended For Prostate Cancer Screening
Beginning around 2008, as more was learned about both the benefits and harms of prostate cancer screening, a number of professional medical organizations began to caution against routine population screening with the PSA test. Most organizations recommend that individuals who are considering PSA screening first discuss the risks and benefits with their doctors.
Some organizations do recommend that men who are at higher risk of prostate cancer begin PSA screening at age 40 or 45. These include Black men, men with germline variants in BRCA2 , and men whose father or brother had prostate cancer.
In 2018, the United States Preventive Serves Task Force updated its recommendation statement for prostate cancer screening from a D to a C in men ages 55 to 69. The updated recommendation, which applies to the general population as well as those at increased risk due to race/ethnicity or family history, is as follows:
- For individuals ages 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one. Before making the decision, a person should discuss the potential benefits and harms of screening with their clinician and consider these in the context of their own values and preferences.
- PSA-based screening for prostate cancer is not recommended for individuals 70 years and older.
How Do Doctors Check For Prostate Cancer
There are various methods by which doctors can detect prostate cancer in men. These include PSA tests, Biopsy, Digital rectal examination, and MRI scan. You should understand how each one of these tests is performed. Listed below are the pros and cons of each test. You should be well-informed before visiting a doctor. Also, be aware that some doctors may recommend a repeat biopsy. In such cases, your doctor will recommend a second biopsy.
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How Do I Screen For Prostate Cancer
There are two main early stage screening methods a digital rectal exam , and a blood test measuring PSA levels. PSA screening is regarded as the best method to screen for prostate cancer in men over 40 or those of a certain risk factor.
While men might be intimidated by a DRE, itâs a quick and safe screening technique used by a physician, and should cause no significant pain.
A Digital Rectal Exam is a simple, painless and quick procedure. A physician inserts a gloved and lubricated finger into the rectum and feels the prostate to identify if the prostate is enlarged, has lumps or is an abnormal texture compared to a healthy example.
Although this procedure is a very clear indicator of prostate health, the entire prostate canât be examined during a DRE. This is why physicians will also take into account PSA blood work, health history, and other risk factors. Overall, itâs often difficult to detect prostate cancer early, itâs mostly found through PSA testing so PSA screenings should be done regularly, starting at the age of 40-50.
What Kind Of Doctor Will I See For A Dre
A primary care doctor or a gynecologist usually does a DRE. A gynecologist is a doctor who specializes in the health of womens reproductive system. Other types of doctors, including gastroenterologists, surgeons, and oncologists may do DREs. A gastroenterologist is a doctor who specializes in the gastrointestinal tract. An oncologist is a doctor who treats cancer.
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When Is A Psa Test Needed
If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.
Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.
- You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
- Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
- If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
04/2014
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.
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Imaging Tests For Prostate Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. One or more imaging tests might be used:
- To look for cancer in the prostate
- To help the doctor see the prostate during certain procedures
- To look for spread of prostate cancer to other parts of the body
Which tests you might need will depend on the situation. For example, a prostate biopsy is typically done with transrectal ultrasound and/or MRI to help guide the biopsy. If you are found to have prostate cancer, you might need imaging tests of other parts of your body to look for possible cancer spread.
The imaging tests used most often to look for prostate cancer spread include:
How Prostate Cancer Is Diagnosed
There are many tests used for diagnosing prostate cancer. Not all tests described here are commonly used for every person. Your doctor may consider these factors when choosing a diagnostic test:
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The type of cancer suspected
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Your signs and symptoms
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Your age and general health
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The results of earlier medical tests
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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.
Weighing Your Options For Treatment
If you test positive for prostate cancer, you have some options as to what youd like to do about it. Until recently, nearly everyone opted for surgery or radiation, while some patients choose not to undergo treatment, instead opting for active surveillance, during which the cancers are left alone but regularly monitored to be certain that theyre not growing.
Certainly, screening can lead to earlier prostate cancer detection, and with earlier detection, youre eligible for multiple different treatments or active surveillance, said Sia Daneshmand, MD, director of urologic oncology at USC Urology of Keck Medicine of USC and associate professor of urology at Keck School of Medicine of USC. So we encourage patients who are candidates for screening to discuss it with their urologist and/or primary care physician so that we can determine whats the best course of treatment for them.
There also is a new option for those seeking prostate cancer treatment. Its called High-Intensity Focused Ultrasound , which uses ultrasound beams to non-surgically destroy prostate tumors.
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What Does The Psa Test Involve
The PSA test involves taking a blood sample and sending it to a laboratory for analysis. The results indicate:
- Normal levels: Most healthy adult males have PSA levels below 4 nanograms per milliliter .
- Borderline levels: PSA levels of 410 ng/ml are borderline. There is a 25% chance that cancer is present, and the person will usually need additional tests.
- High levels: If PSA levels are over 10 ng/ml, there is a 50% chance that the person has prostate cancer. The specialist will likely recommend more testing, including a prostate biopsy.
It is important to note that PSA levels can naturally vary from person to person. A person with high levels may not have prostate cancer. On the other hand, about 15% of people who test positive for prostate cancer after a biopsy have PSA levels below 4 ng/ml.
Prostate cancer is not the only cause of high PSA levels. Find out more about the other causes here.