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How Do You Test For Prostate Cancer

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Use In Men Already Diagnosed With Prostate Cancer

How to Test for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

The PSA test can also be useful if you have already been diagnosed with prostate cancer.

  • In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
  • The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
  • PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .

Further Testing For Advanced Cancer

If there’s a significant chance the cancer has spread from your prostate to other parts of the body, further tests may be recommended.

These include:

  • an MRI scan, CT scan or PET scan these scans build a detailed picture of the inside of your body
  • an isotope bone scan, which can tell if the cancer has spread to your bones a small amount of radiation dye is injected into the vein and then collects in parts of the bone where there are any abnormalities

New Prostate Cancer Blood Test

If you have an abnormal PSA score, your doctor may recommend another newertest that gives a better sense of yourprostate cancer risk. The prostate health index is one such test that is a more accurateblood test and measures your risk for having prostate cancer. Its approvedby the FDA for men who have PSA scores between 4 and 10.

What are the benefits of the PHI test?

  • Fewer unnecessary biopsies: Some men who have elevated PSA scores are unsure about getting an invasive biopsy. This tool can be used to better determine whether your risk is high enough to warrant a biopsy.
  • More accurate: This test is better at detecting prostate cancer. It can also detect whether you have a more aggressive type of cancer. This information can guide doctors to a more targeted treatment plan for you.

If you score low on the PHI test, your doctor may recommend monitoring youover time to see if your levels rise enough to cause concern.

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Use In Men Who Might Have Prostate Cancer

The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.

PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.

  • Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
  • Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
  • If the PSA is more than 10, the chance of having prostate cancer is over 50%.

If your PSA level is high, you might need further tests to look for prostate cancer.

To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.

What Have Randomized Trials Of Prostate Cancer Screening Found

How Do You Test For Prostate Cancer

Several large, randomized trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and digital rectal exam were evaluated for their ability to decrease a mans chances of dying from prostate cancer.

The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but had about the same rate of deaths from the disease . Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment.

A second large trial, the European Randomized Study of Screening for Prostate Cancer , compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer .

The United States Preventive Services Task Force has estimated that, for every 1,000 men ages 55 to 69 years who are screened for 13 years :

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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.

What Tests Detect Prostate Cancer Early

Because prostate cancer cant necessarily be detected at home, its a good idea to learn about the tests that provide early detection. Keep in mind that these tests cant decipher whether or not you have prostate cancer and, following the test, your doctor will most likely suggest a prostate biopsy. If youre wondering how to check for prostate cancer at home, your best bet is to leave it to your health care professional.

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What Are Some Of The Limitations And Potential Harms Of The Psa Test For Prostate Cancer Screening

Detecting prostate cancer early may not reduce the chance of dying from prostate cancer. When used in screening, the PSA test can help detect small tumors. Having a small tumor found and treated may not, however, reduce the chance of dying from prostate cancer. That is because many tumors found through PSA testing grow so slowly that they are unlikely to be life threatening. Detecting such tumors is called overdiagnosis, and treating them is called overtreatment.

Overtreatment exposes a person unnecessarily to the potential complications associated with prostate surgery and radiation therapy. These include urinary , gastrointestinal , and sexual side effects .

In addition, finding cancer early may not help someone who has a fast-growing or aggressive prostate tumor that may have spread to other parts of the body before being detected.

The PSA test may give false-positive results. A false-positive test result occurs when the PSA level is elevated but no cancer is actually present. A false-positive test result may create anxiety and lead to additional medical procedures, such as a prostate biopsy, that can be harmful. Possible side effects of biopsies include serious infections, pain, and bleeding.

False-positive test results are common with PSA screening only about 25% of people who have a prostate biopsy due to an elevated PSA level are found to have prostate cancer when a biopsy is done .

Screening For Prostate Cancer: What Do You Need To Know About Digital Rectal Examination

Tests to Diagnose and Monitor Prostate Cancer

The digital rectal examination is a clinical examination during which the attending physician makes a series of gestures to feel the patients prostate at the level of his rectum. This touch is risk-free for the patient and only lasts a maximum of two minutes. During the digital rectal examination, the doctor checks the consistency, texture and volume of the surface of the prostate. He can therefore detect abnormalities such as an enlarged prostate, abnormally hard or presenting nodules. In order to deepen this examination, the doctor will refer the patient to a urologist for more precision. However, it should be kept in mind that the presence of an abnormality in the prostate is not synonymous with the existence of a prostate cancer. A complementary examination makes it possible to establish a diagnosis with certainty.

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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

When Should I Get Tested

Beginning at about age 45, all men should talk to their doctor about screening for prostate cancer. If you are Black or have a family history of prostate or other cancers, you may be at higher risk and should talk to your doctor beginning at age 40. Other risk factors include an increased age and a history of exposure to chemicals.

Routine prostate cancer screening starts with a PSA blood test and may include a rectal examboth are quick and simple.

A Prostate-Specific Antigen blood test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated for other reasons. Learn more about the PSA test here.

A Digital Rectal Exam is a physical exam that is done when a doctor or nurse inserts a gloved, lubricated finger into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities.

Talk to your doctor about your risk for prostate cancer and when to begin screening. If you do not have a doctor, do not have insurance, or cannot afford a test, find out if free screenings are available in your area on our Free Testing Map. If you do not see a free screening in your area, check back in the fall. Many screenings occur in September, during Prostate Cancer Awareness Month.

Watch prostate cancer experts Dr. Lowentritt and Dr. Siegel in this video discuss screening and diagnosis:

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Psa Screening Blood Test

The American Cancer Society reports that men with a total PSA level of between 4 and 10 have roughly a 1 in 4 chance of having prostate cancer. With a total PSA of over 10, the chance of having prostate cancer rises to over 50%. Following the PSA test, if the levels are high, a doctor may suggest a repeat screening test or a prostate biopsy.

In addition to prostate cancer, there are many other factors that can affect a mans PSA levels.

Reasons for a High PSA:

  • Enlarged prostate: An enlarged prostate can be caused by conditions like BPH, or benign prostatic hyperplasia, which is a non-cancerous enlargement of the prostate.
  • Age: As men get older, its normal for PSA levels to slowly rise .
  • Prostatitis: Infection or inflammation of the prostate gland, known as prostatitis, can also raise PSA levels.
  • Bicycle Riding: Because the bicycle seat puts pressure on the prostate, some studies have shown that cycling may cause PSA levels to rise.
  • Urologic procedures: Some urologic procedures can lead to higher PSA levels for a small period of time. Some studies have also shown that a digital rectal exam might also raise these levels.
  • Medicines: Certain medicine, like testosterone or other medicines that raise testosterone levels, might cause a rise in PSA.

Reasons for a Low PSA:

How Soon Will Prostate Test Results Be Available

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Results for simple medical tests such as some urodynamic tests, cystoscopy, and abdominal ultrasound are often available soon after the test. The results of other medical tests such as PSA blood test and prostate tissue biopsy may take several days to come back. A health care provider will talk with the patient about the results and possible treatments for the problem.

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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.

Getting A Prostate Biopsy

For some men, getting a prostate biopsy might be the best option, especially if the initial PSA level is high. A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. This test is the only way to know for sure if a man has prostate cancer. If prostate cancer is found on a biopsy, this test can also help tell how likely it is that the cancer will grow and spread quickly.

For more details on the prostate biopsy and how it is done, see Tests to Diagnose and Stage Prostate Cancer.

For more information about the possible results of a prostate biopsy, see the Prostate Pathology section of our website.

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What Are Additional Tests For Detecting Prostate Problems

If the DRE or the PSA blood test indicates a problem may exist, the health care provider may order additional tests, including urinalysis, urodynamic tests, cystoscopy, abdominal ultrasound, transrectal ultrasound with prostate biopsy, and imaging studies such as magnetic resonance imaging or computerized tomography scan.

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How is the PSA Test Used to Diagnose Prostate Cancer?

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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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Further Tests For Prostate Cancer

If results of the PSA test or the DRE are abnormal, a urologist will likely recommend a biopsy, where small samples of tissue are removed from the prostate and examined.

If cancer is diagnosed, other tests may be used to check the progression of the cancer, including:

  • magnetic resonance imaging scan of the prostate – often done before a biopsy
  • bone scan – to check whether or not cancer cells have spread to the bones
  • computed tomography scan – a specialised x-ray
  • pelvic lymph node dissection – a nearby lymph node is removed and examined to check whether or not cancer cells have entered the lymphatic system .

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Prostate Specific Antigen Test

A blood test called a prostate specific antigen test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.

As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.

PSA levels also can be affected by

  • Certain medical procedures.

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