What If A Screening Test Indicates The Possibility Of Prostate Cancer
If prostate cancer is suspected, a biopsy will be recommended. During this procedure, a physician inserts a hollow needle through the wall of the rectum to collect prostate tissue samples, which can be evaluated under a microscope for evidence of cancer.
Moffitt Cancer Center offers prostate cancer screening without referrals. To request an appointment with a specialist in our Urologic Oncology Program, call or complete a new patient registration form online.
Detecting Prostate Cancer Will Increase Your Chances Of Survival
With most cancers, early detection is key to increasing survival. But, counterintuitive as it may be, this is not necessarily the case for prostate cancer. This type of cancer differs from others because it is almost inevitable with age. If every man over the age of 85 were to have a biopsy of their prostate, chances are that 100% would have it. Theres even an old saying, Some men die from prostate cancer, but all old men die with it.
In some cases, early detection of prostate cancer may cause more harm than good. Finding and treating a slow-growing tumor that is unlikely to be life-threatening is called overtreatment. Overtreatment needlessly exposes patients to the serious side effects of biopsies, chemotherapy, radiation, or surgery. These side effects can be invasive and life-altering, such as urinary incontinence, persistent diarrhea, or sexual dysfunction. All in all, this is why many experts dont recommend men screen for PSA if over the age of 70because theres little to gain in the early detection of this mostly low-risk cancer.
Information For Well Men Aged 50 And Over
You can refer to the infographic above and direct patients to the information sheet for well men aged 50 and over for a summary of the potential benefits and risks of PSA testing.
The information sheet for well men includes the above infographic, which explains the PSA test. It also includes a list of the potential advantages and disadvantages of the PSA test for men to consider when making a decision.
The Office for Health Improvement and Disparities created this information on behalf of the NHS.
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Who Should Get A Psa Test
Not everyone should get a PSA test. Why? Because many in this country are treated for low-risk prostate cancer that is discovered through the PSA test, even when it is unlikely that the disease will ever cause symptoms or lead to death. And treatment is associated with significant side effects, including impotence and incontinence . You should discuss whether prostate cancer early detection is right for you with your personal primary care physician.
To avoid the risks of over-treatment, Roswell Park follows the guidelines established by the National Comprehensive Cancer Network . The NCCN brings together world-renowned experts from 30 of the nations top cancer centers to write guidelines that specify the best ways of preventing, detecting and treating cancer. The guidelines are updated at least every year, on the basis of the latest research.
Michael Kuettel, MD, PhD, MBA, Chair of Roswell Parkâs Department of Radiation Medicine, serves on the NCCN Prostate Cancer Panel.
If you decide that Prostate Cancer Early Detection is right for you, the NCCN recommends PSA testing as follows:
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What Happens If You Have Been Diagnosed With Prostate Cancer
If you just received a prostate cancer diagnosis, you probably have many questions, and you may think of more. It can be helpful to write them down in one place so you dont forget them when you speak with your doctor.
You might want to ask about your:
- cancers stage, grade , and spread
- treatment options
- costs and whether your insurance might cover them
It will also be important to rely on a close, trusted support network. Consider the use of therapy or support groups to help navigate your emotions.
And, if its medically safe, light exercise, time outdoors, and participating in activities you enjoy are all important for your overall well-being.
After doctors inform you of the potential risks and benefits of prostate cancer screening, you may still have other questions.
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How To Tell If Your Cancer Has Metastasized
Prostate cancer metastasis may be suspected if you have specific symptoms such as new lower back pain or elevated liver enzymes. These may be signs your cancer has spread to your spine or your liver, respectively. If your prostate-specific antigen levels continue to rise despite treatment, especially if they are rising particularly fast, this may be a sign that cancer is metastasizing somewhere in your body.
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Effectiveness Of Early Detection
Potential Benefits of Screening
To understand the potential benefits of PSA-based screening for prostate cancer, the USPSTF examined the results of the ERSPC, PLCO, and CAP trials and site-specific reports from 4 ERSPC trial sites. To understand the effectiveness of treatment of screen-detected, early-stage prostate cancer, the USPSTF also examined the results of 3 randomized trials and 9 cohort studies.3
The ERSPC trial randomly assigned a core group of more than 160,000 men aged 55 to 69 years from 7 European countries to PSA-based screening vs usual care.8 Four ERSPC sites reported on the cumulative incidence of metastatic prostate cancer. After a median follow-up of 12 years, the risk of developing metastatic prostate cancer was 30% lower among men randomized to screening compared with usual care . The absolute reduction in long-term risk of metastatic prostate cancer associated with screening was 3.1 cases per 1000 men.11 After a median follow-up of 13 years, the prostate cancer mortality rate among men aged 55 to 69 years was 4.3 deaths per 10,000 person-years in the screening group and 5.4 deaths per 10,000 person-years in the usual care group .8 The ERSPC trial did not find a reduction in all-cause mortality.8
Neither the ERSPC, PLCO, or CAP trials, nor any of the ERSPC site-specific analyses, found an overall all-cause mortality benefit from screening for prostate cancer.
Potential Benefits of Treatment
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All Men Older Than 55 Should Have Their Psa Screened Regularly
Many people want to knowat what age do you need a prostate exam? The answer is that it depends. The decision of when, or even if, you screen for prostate cancer is an individual one. Many experts recommend screening for individuals over the age of 40 if they have a high risk of prostate cancer, such as African American men or those with a family history of prostate cancer.
As for men 55-69 years old, the answer is a little less clear. Nowadays, most experts recommend making an informed decision with your doctor after discussing the risks and benefits of screening. The benefits of screening include finding an aggressive prostate cancer that would have otherwise spread to other parts of your body. But the risks of screening are as mentioned abovediscovering and then overtreating cancer that may be asymptomatic and not life-threatening. Ultimately, the decision is up to you!
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:
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When To Get A Prostate Cancer Screening
A prostate screening can help your doctor find prostate cancer early, but youll need to decide if the benefits of the exam outweigh the risks. Have a discussion with your doctor about prostate cancer screenings.
The U.S. Preventive Services Task Force now recommends that men ages 55 to 69 decide for themselves whether to undergo a prostate-specific antigen screening test, after talking it over with their doctor.
They recommend against screening for men at or above the age of 70.
The American Cancer Society strongly recommends that no one be screened without discussion of the uncertainties, risks, and potential benefits of prostate cancer screening.
They give these specific recommendations for the date at which these discussions with a healthcare provider should take place:
- Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative diagnosed with prostate cancer at an early age .
- Age 40 for men at even higher risk .
You should also speak with your doctor about a prostate exam if youre experiencing symptoms of a prostate problem, such as frequent or painful urination or blood in your urine.
After this discussion, if you decide to get a prostate cancer screening, the ACS and the American Urologic Association recommend getting a prostate-specific antigen blood test.
What Happens If You Have A Likert Score Of 3 Or More
This result on its own doesnt mean that you definitely have prostate cancer. But its more likely that you do. Your doctor is likely to recommend for you to have a biopsy.
The MRI scan also helps doctors know where to take the biopsy from. You usually have tissue samples taken from the suspected area of cancer and also from the rest of the prostate. Doctors call these targeted biopsies and systematic biopsies. This is because not all cancers can be seen on an MRI scan.
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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.
When Should I Get Tested
Visit Am I at Risk? to learn more. All men are at risk of prostate cancer, so it is important to talk with your doctor to make an informed decision. Check out our recommended age and testing guidelines, which are based on the NCCN provided recommendations.
Detecting prostate cancer early gives you the best chance of living longer. In fact, more than 99 percent of men survive prostate cancer when it is caught early.
Watch prostate cancer experts, Dr. Lowentritt and Dr. Siegel in this video discuss detection and diagnosis:
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If Your Psa Levels Are Low You Dont Have Prostate Cancer
Unfortunately, screening for prostate cancer using PSA has significant limitations. The ideal prostate-specific antigen level in men without prostate cancer is generally less than 4 nanograms/milliliter . But a low or normal PSA level does not necessarily rule out prostate cancer. One study of 18,882 men enrolled in a prostate cancer prevention trial had their PSA checked once a year for seven years. At the end of that period, 15.2% of men with a normal PSA level tested positive for prostate cancer on a biopsy! Of those individuals, 14.9% went on to be diagnosed with high-grade prostate cancer . This study naturally raised a lot of concerns about the ability of the PSA test to accurately detect the presence of cancer.
The unreliability of the PSA test is one reason why the FDA recommends a digital rectal exam in combination with a PSA blood testhowever, DREs are also notoriously unreliable, to the extent that many urologists choose not to perform them at all. A meta-analysis study demonstrated this unreliability showing that DREs accurately detected prostate cancer in only 41% of patients .
What Virus Is Associated With Nasopharyngeal Carcinoma
In recent years, scientists have studied how theEpstein-Barr virus may cause cells in the nasopharynx to become cancer, but theres still a lot to learn. In developed countries, most people infected with EBV have infectious mononucleosis , and their immune system is able to recognize and destroy the virus.
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Genetic Testing For Some Men With Prostate Cancer
Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.
Screening For Prostate Cancer
Prostate cancer is typically treatable if caught early. More than 90 percent of prostate cancers are found when the disease is in the beginning stages, confined to the prostate and nearby organs.
Unlike screenings for breast and colon cancers, there are no universal screening guidelines for prostate cancer. The U.S. Preventive Services Task Force recommends that men age 55 to 69 weigh the benefits and risks before deciding whether they should undergo screening, which is typically performed with a blood test that measures levels of a protein called prostate-specific antigen .
However, men in high-risk groupssuch as those who are of African-American descent and/or have a first-degree relative diagnosed with prostate cancer before age 65should consider speaking with their doctor about starting screenings at an earlier age.
Men older than 70 shouldnt be routinely screened for prostate cancer, according to the USPSTF.
Regardless of age or risk factors, men should get checked if they suddenly experience issues with urination, erectile dysfunction or unexplained pain.
The USPSTF suggests that, before deciding on a screening, men should seek expert advice about the benefits and harms of screening. Risks may include:
- False positives
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When Should Men Get A Prostate Exam
According to the American Cancer Society, men and people who were assigned male at birth should have their first prostate exam by age 50. If you have a family history of prostate cancer, you should consider having your first prostate exam at age 45.
Additionally, Black men are at a higher risk for being diagnosed with prostate cancer. For this reason, healthcare providers often recommend that Black men have their first prostate exam around age 45.
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
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Prostate Exam Vs Colonoscopy: Whats The Difference
At first glance, it might seem that a prostate exam is similar to a colonoscopy. After all, both exams involve your rectal area. However, these two tests are quite different.
While a prostate exam involves feeling the prostate with a gloved finger, a colonoscopy examines the walls of your colon by inserting a flexible camera into your rectum. The prostate is not examined at all during this procedure unless your healthcare provider manually performs an exam.
A prostate exam is a fairly quick procedure performed in an office setting. A colonoscopy, on the other hand, is an outpatient procedure in the hospital that requires IV sedation.
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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