What Is The Controversy Surrounding Psa Screening
In recent years, there has been some controversy surrounding the PSA test. In 2012, the U.S. Preventive Services Task Force assigned the PSA test a D rating. This meant that the USPSTF concluded the harms that resulted from PSA testing, such as unnecessary biopsies and negative treatment side effects, outweighed the benefits of finding and managing the disease early. This recommendation did not include exceptions for men at increased risk of developing the disease, such as African American men, those with a family history of the disease, and those with BRCA gene mutations. The USPSTF recommendation is important as it guides primary care physicians in preventive care and can impact insurance coverage and reimbursement for screening. Prior to its D rating, the PSA test had an I rating, meaning the USPSTF concluded there was insufficient evidence to assess the pros and cons of testing.;
In May 2018, the USPSTF updated their recommendation on PSA screening. In response to new research demonstrating the benefits of PSA screening , an increase in the number of men choosing active surveillance, and advocacy efforts, the USPSTF released a draft;recommendation in April 2017 that assigns the PSA test a C rating for men ages 55to 69 . This rating has now been certified official by the task force.
Facts About Prostate Cancer You Might Not Know
Though 71.5 percent of U.S. men who are diagnosed with this disease are between the age of 55 and 74, 3.9 percent are over 84.
Half a percent of the diagnoses are in men 35 to 44.
Obesity is a risk factor.
An immediate family member with the BRCA1 or BRCA2 mutation is believed to mean a higher risk for prostate cancer.
PSA testing is not an effective screening tool.
Dr. Hermans interests include reducing the over-diagnosis and over-treatment of prostate cancer by utilizing the latest biomarkers and imaging techniques. He is at the forefront of treatment and research of urologic cancers.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. Shes also a former ACE-certified personal trainer.;
Top image: Shutterstock/Sherry Yates Young
Are Older Men Undertreated
Schwartz and colleagues reviewed the treatment decisions and factors influencing them in a cohort of men with localized prostate cancer. Age, comorbidity, and Gleason score were found to be independent predictors of suboptimal treatment. It was concluded that most men older than 70 years with moderately or poorly differentiated tumors and no to mild comorbidity were given suboptimal treatment. Most of these men were undertreated, receiving watchful waiting therapy when potentially curative therapy could have been applied. With optimal treatment, clinical outcomes could have been improved.
Thompson and colleagues investigated otherwise healthy octogenarians diagnosed with prostate cancer who underwent radical prostatectomy. At the last follow-up visit, 10 patients had survived more than a decade after surgery, and 3 patients had died within 10 years of surgery. The remaining 6 patients were alive at less than 10 years of follow-up. Seventy-four percent of patients were continent. No patient had died of prostate cancer, and the 10-year, all-cause survival rate was similar to that observed in healthy patients 60 to 79 years old undergoing radical prostatectomy. These findings indicate that careful selection of patients even older than 80 years can achieve satisfactory oncologic and functional outcomes after surgery. It is important to note, however, that the rate of urinary incontinence after surgery exceeds that of younger counterparts.
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Types Of Imaging Studies
If your doctor suspects your cancer might be spreading, they will likely order more imaging tests. A common imaging workup may include a;bone scan;and a;CT scan;of the abdomen and pelvis. An;MRI;might be done as well. Some research centers are also using magnetic MRIs or PET scans to further refine the staging of prostate cancer.
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The prostate is a walnut-sized gland found between the bladder and the rectum in males. Its primary job is to produce seminal fluid. The prostate creates a protein, the prostate-specific antigen, or PSA. A PSA screening test is a blood test approved by the FDA in 1994 to measure the levels of PSA in a mans blood.
Small amounts of PSA ordinarily circulate in the bloodstream and can be measured by a PSA test to monitor the health of the prostate. This test is intended to screen for prostate cancer, find other prostate-related conditions, or monitor PSA levels in those in treatment for prostate cancer. This is a simple blood test which reports PSA levels as nanograms of PSA per milliliter of blood.
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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:
Experts In Urology Care
If you are experiencing symptoms consistent with urinary issues, we urge you to complete our urologic cancer risk assessment form.
Not everyone should get a PSA test. Why? Because many men 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 . So a PSA test is recommended only for men who might be at greater risk for dying of prostate cancer for example, younger men with a family history of prostate cancer or African-American men.
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 Park’s Department of Radiation Medicine, serves on the NCCN Prostate Cancer Panel.
The NCCN recommends that only men in these categories receive a PSA test for early detection of prostate cancer:
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Normal Psa Levels By Age Chart
We mentioned earlier in this article that PSA levels increase with age due to age related growth of the prostate gland. A doctor will therefore take into account an age-adjusted PSA level when discussing your prostate health:
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Age Range |
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0 to 6.5 |
Although there are normal PSA levels by age range, it is still important to screen routinely to ensure these normal levels are not rising.
Four Key Mistakes To Avoid If You Are Diagnosed With Low
Here are key mistakes Dr. Hu has identified
- Mistake: Automatically opting for treatment when you have low-risk prostate cancer.;Even though treatment for low-risk prostate cancer is generally;not;recommended, in the recent study, more than 85% of the men with low-risk prostate cancer chose to have some sort of treatment. The most common treatment was radiation therapy , and the second most common was surgery . Just 15% opted to skip treatment. The good news is that, as the study went on, there was a trend toward a greater percentage of men opting for active surveillancea trend that has accelerated according to recent surveys. However, Dr. Hu thinks too many men are;still;missing out on this proven approach.
- Mistake: Choosing active surveillancebut not doing follow-up tests.;According to the results of this study,;fewer than 5%;of the men who skipped treatment complied with recommended monitoring. They had fewer office visits, and fewer repeat PSA tests, compared with men who had some form of active treatmentand only 13% underwent a second biopsy within two years, as recommended.
If abnormalities are detected on the digital rectal examination or PSA test, patients should undergo urologic evaluation with transrectal ultrasound-guided prostate biopsy. No further urologic evaluation is necessary in patients who have an unremarkable digital rectal examination and a normal serum PSA level, because the incidence of prostate cancer is only 0.4 percent in this group.15
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Half Of Men Over 60 Have Prostate Cancer But Most Die Of Other Causes
A new study;looking at the prevalence of prostate cancer in men over 60 years of age found that just about 50 percent of men have the cancer. This statistic isnt as distrubing as it sounds; most prostate cancers never develop into a harmful form of the disease and a large proportion of men will pass away from other causes without their prostate cancer progressing and becoming invasive.
The current study, published in the Journal of the National Cancer Institute,;examined 320 men from Russia and Japan who had died at the age of 60 or older between 2010 and 2011. None of the men had been diagnosed with prostate cancer before their death. Men from Russia were used for the survey because they have similar fat intakes and sun exposures compared to North American men. Japanese men were examined because the incidence of prostate cancer is lower in the male population of Japan, most likely resulting in different diet compared to Caucasian North American men.
How often men should be tested for prostate cancer is a topic of debate among healthcare professionals. After all, the bottom line is that most American men will get prostate cancer if they live long enough. But many of them never experience any ill effects from the cancer, and typically die of natural causes having nothing to do with the prostate. And in fact, many doctors believe that prostate cancer is over-treated because not all men progress;to a dangerous form of the disease.
My Psa Is Elevated Now What Should I Do
- www.madanderson.org – Check out MD Anderson’s wide variety of articles, videos, resources, research stories about clinical trials, treatment options, screening guidelines.
- www.cancer.gov – The National Cancer Institute site provides information that ranges from simple background to more complicated explanations of the disease and treatment.
- : The American Cancer Society offers information on the disease as well as community support programs.
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Mri/ultrasound Fusion Guided Biopsy: Working Together For Your Health
At UVA Health, we are proud to offer a new prostate cancer detection option: MRI/ultrasound fusion guided biopsy. Through a unique partnership between the UVA Radiology and Urology departments, we are able to use MRI imaging to help guide a biopsy in real time. This makes the biopsy much more accurate. It also reduces the risk of false negative or false positive results, and decreases the odds that you may have to repeat a biopsy.
The Role Of Psa In Choosing The Best Treatment
If you have received a diagnosis of prostate cancer, your PSA levels can be used along with the results of other tests and physical exams and your tumors Gleason score to help determine which tests are needed for further evaluation and to decide on the best treatment plan. After treatment has begun, your PSA and other tests will be used to determine how well the treatment is working: The more successful the therapy, the lower the PSA.
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In Men Over : Bph May Be The Cause Of High Psa
Benign;prostatic;hyperplasia;;is an enlargement of the prostate gland, but its not prostate cancer. “BPH;means more cells, so that means more cells making;PSA,” explains Dr. Castle.
BPH;is the most common prostate problem in men over age 50. It;may not need to be treated unless its causing frequent or difficult urination.
Your primary care doctor may be able to tell the difference between;BPH;and prostate cancer by doing a digital rectal exam, but commonly this will require evaluation by a urologist and further testing, such as a biopsy or imaging studies.
When You Should Screen For Psa Levels
Colloquially, prostate cancer screening is thought to be routinely undertaken by men over the age of 40. The American Urological Association recommends the following:
- Men under 40: No screening – there is no evidence to suggest a benefit of screening under 40
- Men aged between 40 to 54: No screening if youre at average risk. If youre at a high risk , the decision should be made by yourself and your doctor.
- Men aged between 55 to 69: Screening with doctor approval. This is the age group is identified as having the greatest benefit of screening
- Men aged over 70 or less than a 10-15 year life expectancy: Routine screening not recommended unless you are in excellent health where they may be benefit
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How To Get A Psa Test
Consult with your general practitioner or urologist about receiving a PSA test in their offices. PSA tests are typically covered without co-pay or deductible by Medicare once a year for men 50 years and older. Many states now have laws which require private health insurers to cover the costs for PSA testing. However, additional PSA test costs may need to be covered by the patient. For those without insurance, or for those with insurance that does not cover PSA testing, free tools are available through advocacy groups, such as ZERO.
Companies such as;imawaretm;also offer in-home PSA testing kits and telemedicine appointments to discuss your PSA test results with a licensed physician. All imaware test kits are easy to use. After registering the test kit online, results will populate in the secure patient portal within 5-7 business days. You can submit your receipt of this test to insurance for potential reimbursement.
“At-Home testing is now at a point where results can be provided accurately and quickly within 5 business days, with real physicians providing telemedicine support through the entire testing process”
Dr. Diamandis – Lunenfeld-Tanenbaum Research Institute, Sinai Health System
HALO Dx
Thanks For The Welcome
lewvino
Have not had a biopsy yet, the Oncologist – actually as I understand the Head of the Department has agreed to see me on 4 August as it is very apparent with the bone scans and PSA levels and DRE that this is prostrate cancer and prostrate cancer in the bone.
I turned 63 in April this year. I am being treated at the Veterans Health Center in Washington DC and so far have been very impressed with the people and facility.
lewvino – did you face prostrate cancer in the bone?
Thanks for the information on the other forum – I will be sure to check there also.
My New Motto – LIVE LONG AND PROSPER!
I AM going to beat this thing!
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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.
Does My Psa Level Determine Whether I Have Prostate Cancer
Your provider looks at two factors related to your PSA:
- Your PSA level: A higher level means a higher risk of prostate cancer.
- A continuous rise: PSA levels that continue to rise after two or more tests may mean you have cancer.
But the PSA level alone doesnt determine if you have cancer or not. Two men can even have the same PSA levels but different risks of prostate cancer. And a high PSA level may reflect prostate problems that arent cancer.
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What Are Psa Levels
Cells in the prostate gland produce PSA, and levels typically remain below 4 nanograms per milliliter .
Most individuals with prostate cancer have PSA levels above 4 ng/mL. However, some men with prostate cancer have a normal PSA level. Similarly, some men with a higher than average PSA do not have prostate cancer.
These variations mean that a PSA test alone cannot rule out or diagnose prostate cancer. However, the PSA test can identify whether a person has a higher risk of developing the disease.
Initial testing may include both a PSA test and a DRE.
During a DRE examination, a doctor inserts a finger into the rectum to check the prostate for anomalies.
If both of these tests suggest prostate cancer, then the doctor will arrange for a biopsy to confirm the diagnosis.
Interpretation Provides Information To Assist In Interpretation Of The Test Results
When total prostate-specific antigen concentration is below 2.0 ng/mL, the probability of prostate cancer in asymptomatic men is low, further testing and free PSA may provide little additional information. When total PSA concentration is above 10.0 ng/mL, the probability of cancer is high and prostate biopsy is generally recommended.
The total PSA range of 4.0 to 10.0 ng/mL has been described as a diagnostic “gray zone,” in which the free:total PSA ratio helps to determine the relative risk of prostate cancer . Therefore, some urologists recommend using the free:total ratio to help select which men should undergo biopsy. However, even a negative result of prostate biopsy does not rule-out prostate cancer. Up to 20% of men with negative biopsy results have subsequently been found to have cancer.
Based on free:total PSA ratio: the percent probability of finding prostate cancer on a needle biopsy by age in years:
Free:total PSA ratio
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