There Are Risks To Getting Prostate Cancer Tests And Treatments
If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.
Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.
When Is Psa Screening Recommended
The American Cancer Society recommends that men talk to their doctor before having a screening test to check for prostate cancer. That way youâll understand the risks and benefits of testing. Then, you and your doctor can decide whether to go ahead with screenings using a PSA test and digital rectal exam.
When that discussion should take place is based on your age, level of risk, and general health.
What Should You Ask Your Doctor
If youâre thinking about getting screened for prostate cancer, here are some questions to ask at your next doctor appointment:
1. Am I at higher-than-normal risk for prostate cancer?
2. Would I benefit from getting a screening test for it?
3. What risks do I face if I decide to be tested?
4. If cancer is found, should I be treated? What will determine that?
5. When is “watchful waiting” a better option than treatment? And what does that involve?
American Cancer Society: “Can prostate cancer be prevented?” and “Diet and physical activity factors that affect risks for select cancers.” “Key Statistics for Prostate Cancer,” âScreening Tests for Prostate Cancer,â âCan Prostate Cancer Be Found Early?â âWhatâs New in Prostate Cancer Research?â
American Urological Association: âEarly Detection of Prostate Cancer.â
Medline Plus: âProstate Cancer Screening.â
National Cancer Institute: âPCA3 mRNA test,â âHigh Grade.â
The BMJ: âOverdiagnosis in primary care: framing the problem and finding solutions.â
Mayo Clinic: “Lycopene.”
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Psa In Other Biologic Fluids And Tissues
Concentration of PSA in human body fluids
|female serum||0.01 – 0.53|
It is now clear that the term prostate-specific antigen is a misnomer: it is an antigen but is not specific to the prostate. Although present in large amounts in prostatic tissue and semen, it has been detected in other body fluids and tissues.
In women, PSA is found in female ejaculate at concentrations roughly equal to that found in male semen. Other than semen and female ejaculate, the greatest concentrations of PSA in biological fluids are detected in breast milk and amniotic fluid. Low concentrations of PSA have been identified in the urethral glands, endometrium, normal breast tissue and salivary gland tissue. PSA also is found in the serum of women with breast, lung, or uterine cancer and in some patients with renal cancer.
Tissue samples can be stained for the presence of PSA in order to determine the origin of malignant cells that have metastasized.
What Are The Risks Of Prostate Cancer Screening
A couple of the risks to discuss with your doctor are:
Overdiagnosis. This means you get diagnosed with a condition that wouldnât have caused symptoms or problems. Some prostate cancers grow so slowly that theyâd never give you problems during your lifetime. So, you could end up getting tests or treatments that you donât need.
False-positive test result. This is an incorrect result. It says you have a certain health condition when you actually donât. It could lead to follow-up tests that you donât need.
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Forensic Identification Of Semen
PSA was first identified by researchers attempting to find a substance in seminal fluid that would aid in the investigation of rape cases. PSA is now used to indicate the presence of semen in forensic serology. The semen of adult males has PSA levels far in excess of those found in other tissues therefore, a high level of PSA found in a sample is an indicator that semen may be present. Because PSA is a biomarker that is expressed independently of spermatozoa, it remains useful in identifying semen from vasectomized and azoospermic males.
PSA can also be found at low levels in other body fluids, such as urine and breast milk, thus setting a high minimum threshold of interpretation to rule out false positive results and conclusively state that semen is present. While traditional tests such as crossover electrophoresis have a sufficiently low sensitivity to detect only seminal PSA, newer diagnostics tests developed from clinical prostate cancer screening methods have lowered the threshold of detection down to 4 ng/mL. This level of antigen has been shown to be present in the peripheral blood of males with prostate cancer, and rarely in female urine samples and breast milk.
No studies have been performed to assess the PSA levels in the tissues and secretions of pre-pubescent children. Therefore, the presence of PSA from a high sensitivity test cannot conclusively identify the presence of semen, so care must be taken with the interpretation of such results.
Two Main Screening Tests
There are two tests commonly used to screen for prostate cancer:
- The Digital Rectal Exam : 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.
- The Prostate Specific Antigen Test: This exam measures the level of PSA in the blood. The levels of PSA in the blood are often higher in men who have prostate cancer. The PSA level may also be high in other conditions that affect the prostate.Usually, the higher the bloods PSA level is, the more likely it is that a prostate problem is present. But other factors, such as age and race, also can raise PSA levels. PSA levels also can be impacted by certain medical procedures, some medications, an enlarged prostate or a prostate infection.Since your PSA level may be high for other reasons, your doctor will need to interpret the test results.
If the results of the PSA and/or DRE suggest that you might have prostate cancer, your doctor will need to do a prostate biopsy to find out. This means a sample of your prostate tissue will be removed with a needle and sent to a lab, where a specialist will determine if it contains cancer cells.
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Finding Prostate Cancer Early
There is no national screening program for the early detection of prostate cancer. Doctors have different opinions about whether all men without symptoms of prostate cancer should be tested.
There is concern that testing healthy men will cause unnecessary harm and lead to treatments that may not offer long-term benefits. Treatment for prostate cancer can leave men with side effects such as erectile dysfunction and continence issues, which can affect their quality of life.
Testing may identify fast-growing or aggressive cancers that have the potential to spread to other parts of the body and would benefit from treatment. It may also detect very slow-growing cancers that are unlikely to be harmful.
Weigh up all the risks and benefits before deciding whether to be tested for prostate cancer, particularly if you dont have symptoms. Talking to your doctor can help.
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.
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Get To And Stay At A Healthy Weight
Being overweight or obese can increase your risk for many types of cancer. You can control your weight with the choices you make about healthy eating and exercise:- Avoiding excessive weight gain throughout life- Balance the calories you take in with the amount of physical activity you do
If you are overweight, try to get to a healthy weight and stay there. Losing even a small amount of weight has health benefits and is a good place to start. Watching your portion sizes is an important part of weight control especially for foods high in fat and sugar. Low-fat and fat-free doesnt always mean low-calorie, so read labels and try to eat vegetables, fruits, and whole grains in the place of higher-calorie foods.
Use In Men Already Diagnosed With Prostate Cancer
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 .
What Is Screening For Prostate Cancer
Some men get a PSA test to screen for prostate cancer. Talk to your doctor, learn what is involved, and decide if a PSA test is right for you.
Cancer screeningexternal icon means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.
There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.
Lymph Node Biopsy As A Separate Procedure
A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.
Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.
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Causes Of Prostate Cancer
The causes of prostate cancer are largely unknown. But certain things can increase your risk of developing the condition.
The chances of developing prostate cancer increase as you get older. Most cases develop in men aged 50 or older.
For reasons not yet understood, prostate cancer is more common in black men and less common in Asian men.
Men whose father or brother were affected by prostate cancer are at slightly increased risk themselves.
Recent research also suggests that obesity increases the risk of prostate cancer.
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:
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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.
An Abnormal Psa Test: What Comes Next
If your PSA score is in the abnormal range, your doctor may recommend yourepeat the PSA test. If your levels are still high, your doctor mightrecommend one of the newer prostate cancer screening tests available today.
These tests can help better assess your risk for prostate cancer anddetermine whether a biopsy is necessary. Only a prostate biopsy candefinitively diagnose prostate cancer.
For individualized recommendations that suit you, ask your doctor about:
- What age you should start prostate cancer screening
- New blood, urine and imaging tests that are available
- Improved biopsy techniques, if applicable
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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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During Watchful Waiting Or Active Surveillance
If you choose observation or active surveillance, your PSA level will be monitored closely to help decide if the cancer is growing and if treatment should be considered.
Your doctor will watch your PSA level and how quickly it is rising. Not all doctors agree on exactly what PSA level might require further action . Again, talk to your doctor so you understand what change in your PSA might be considered cause for concern.
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Guideline 1: Men Over The Age Of 40 Who Have No Symptoms Of A Prostate Problem Should Think About Having A Psa Test To Help Work Out Their Risk Of Getting Prostate Cancer Later In Life
This is known as a baseline PSA test. If a man aged between 40 and 49 years has a PSA level higher than 0.7ng/ml, this may mean he has a higher risk of getting prostate cancer. He and his GP or practice nurse should talk about having regular PSA tests in the future. This might be a good way to spot any changes in the mans PSA level that might suggest prostate cancer.
These statements make a strong case for better risk assessment in primary care, and hopefully better targeting of high risk men, whilst at the same time reducing unnecessary interventions for those at low risk. Dr Jon Rees, GP with a specialist interest in urology and chair of the Primary Care Urology Society.
Changes In Your Testicles
Although testicular cancer is rare, it is one of the most common cancers in men aged between 15 and 45. It is also one of the most curable cancers if found early.
The causes of this cancer are unclear, but men who have had an undescended testicle are at increased risk. Be aware of what is normal for you and if you see or feel any changes, see your doctor. Don’t let embarrassment get in the way.
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Preparing For A Prostate Exam
If you decide to get a prostate cancer screening, your doctor will likely order a blood test, so inform the person drawing your blood if youre prone to dizziness.
Your doctor may ask you to sign a consent form before performing a cancer screening.
When To Start Prostate Exams
The American Cancer Society recommends that men aged 50 start prostate cancer screenings. However, African American men and men with a family history of prostate cancer should start screening at age 45. In general, most experts recommend getting a prostate exam every three to five years.
Your doctor will check the prostate gland for any lumps or abnormalities during a prostate exam. It’s not painful, but some men may feel uncomfortable during the exam.
These are some types of prostate exams:
- Digital Rectal Exams : During a DRE, the doctor physically examines the rectum to feel for any abnormalities in the prostate. This exam can help detect prostate cancer in its early stages
- Prostate-Specific Antigen Tests : A PSA test measures the level of PSA, a protein produced by the prostate present in the blood. A high PSA level may be a sign of prostate cancer
If any of the above tests is abnormal, further testing may include:
- Biopsies: A needle is used to sample tissues for cancer cells. This is typically done as an MRI-guided biopsy.
- Imaging exams
- Screening Tests: Screening tests can sometimes have incorrect or unclear test results, making it essential to speak with your doctor about the risks and benefits of this test. Men should talk to their doctor about how often they should get a prostate exam, depending on their health status.
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