What Is A Prostate Cancer Screening Like
A prostate cancer screening can be conducted in one of two ways. The first, a PSA test, is a simple blood draw. The second is a brief rectal exam that takes less than 30 seconds to perform.
For a screening, if a patient comes and asks for a prostate cancer screening, it begins with a blood test, said Ehdaie. Its a small vial of blood, and then a medical history and physical examination. In the physical examination there will be a digital rectal examination in which the physicians finger is inserted into the rectum to feel the prostate.
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Psa Levels After Treatment
A continuous rise in your PSA level can be the first sign that your cancer has come back. This should be picked up by your regular PSA tests.
The exact change in PSA level that suggests your cancer has come back will depend on which treatment you had. Speak to your doctor or nurse about your own situation.
Your PSA level should drop so low that its not possible to detect it at six to eight weeks after surgery. This is because the prostate, which produces PSA, has been removed. A rise in your PSA level may suggest that you still have some prostate cancer cells.
After radiotherapy or brachytherapy, your PSA should drop to its lowest level after 18 months to two years. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA.
Your PSA level may actually rise after radiotherapy treatment, and then fall again. This is called PSA bounce. It could happen up to three years after treatment. It is normal, and doesnt mean that the cancer has come back.
If your PSA level rises by 2 ng/ml or more above its lowest level, this could be a sign that your cancer has come back. Your doctor will continue to check your PSA level and will talk to you about further tests and treatment options.
What Are The Prostate Cancer Symptoms I Need To Look Out For
In its early stages, prostate cancer may not show any symptoms. Symptoms of early prostate cancer can include:
- difficulty passing urine
- a slow, interrupted flow of urine
- frequent passing of urine, including at night
- incontinence.
Symptoms associated with advanced prostate cancer include:
- blood in urine
- pain during urination
- lower back or pelvic pain.
These symptoms are also found in men who may have benign prostatic hyperplasia , a common, non-cancerous enlargement of the prostate gland.
If you experience these symptoms, visit your doctor.
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Should I Have A Psa Test
If you have no symptoms of prostate cancer and are thinking about having a PSA test, you should ask your doctor about the risks and benefits.
While some studies suggest PSA reduces mortality on a population basis, the test picks up large numbers of cancers that would have caused no symptoms or harm in the patient. This is known as overdiagnosis. Overdiagnosis of prostate cancer can lead to unnecessary treatments that have side effects such as sexual impotence, urinary incontinence and bowel problems.
It is important to balance the potential benefit of detecting a prostate cancer early against the risk that detection and treatment may not be necessary. Treatment may affect your lifestyle but it may also save your life.
Make your own decision about whether to be tested after a discussion with your doctor. Ensure you get good quality information to make an informed decision.
Screening tests for breast, bowel and cervical cancer can save lives, but there is still confusion around PSA testing for prostate cancer. Find more information here.
Remember, if you have any concerns or questions, please contact your doctor.
How Often Should Men Have A Prostate Screening
A prostate screening is extremely important to have regularly. Because, without them, a mans health is at a high risk of developing prostate cancer. Knowing how often prostate screenings should be had can be helpful to those men who are not sure.
A mans health is just as important to maintain as a womans. But most people are under the assumption that womens health needs more attention. However, that is not true. Men are at risk of developing prostate cancer, and it can become very problematic if not addressed.
Keep reading to find out how often a man should have a prostate screening.
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What Happens At A Follow
Discussion with your doctor or nurse
At each appointment, your doctor or nurse will ask how youve been since your last appointment.
Tell them about any symptoms or treatment side effects youve had, as well as any other problems or concerns. You can tell them how you are feeling emotionally as well as physically. You can also discuss any practical problems you might have, such as problems at work or with day-to-day activities. You may be given a questionnaire about your physical, social, emotional and practical needs. You might hear this called a holistic needs assessment form.
Your GP or hospital doctor or nurse can help you deal with side effects, or refer you to someone else who can. For example, if you have problems with leaking urine , they might refer you to a continence service. Or if you have problems getting or keeping erections , they can refer you to an erectile dysfunction service. They can also help you get support for emotional problems, such as feeling anxious or depressed, and practical problems, such as managing your finances.
You might feel embarrassed talking about some of the side effects of treatments, such as erection problems. But remember doctors and nurses see people with these problems every day, so be as open as you can. They are there to help.
PSA test
You may be asked to avoid any vigorous exercise or ejaculating in the 48 hours before a PSA test, as this could cause a temporary rise in your PSA level.
What Is A Normal Psa Test Result
There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.
However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer . In addition, various factors can cause a mans PSA level to fluctuate. For example, a mans PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugsincluding finasteride and dutasteride , which are used to treat BPHlower a mans PSA level. PSA level may also vary somewhat across testing laboratories.
Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of White men. Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group.
In general, however, the higher a mans PSA level, the more likely it is that he has prostate cancer. Moreover, a continuous rise in a mans PSA level over time may also be a sign of prostate cancer.
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Prostate Cancer Screening Ages 55 To 69
This is the age range where men will benefit the most from screening.Thats because this is the time when:
- Men are most likely to get cancer
- Treatment makes the most sense, meaning when treatment benefits outweigh any potential risk of treatment side effects
Most men will get prostate cancer if they live long enough. Some prostatecancers are more aggressive others can be slow-growing. Doctors will takeyour age and other factors into consideration before weighing the risks andbenefits of treatment.
You should ask your doctor how often he or she recommends you get screened.For most men, every two to three years is enough.
Depending on the results of your first PSA test, your doctor may recommendyou get screened less frequently.
What Are The Symptoms Of Prostate Cancer
Not everyone with prostate cancer has symptoms, so regular screening should be a part of your annual physical, starting at the age of 40-50. However, prostate symptoms should never be ignored and should be brought up to a physician.Ã
Typical symptoms of prostate cancer, according to the Prostate Conditions Education Council , include:Ã
- Frequent urination
- Pain or burning during urination
- Blood in the urine or ejaculate
- Bone pain in the hips, ribs or back
- Back pain
Read our guide to common pee problems that may be signs of prostate cancer if you are experiencing urination problems.
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Screening For Prostate Cancer In African American Men
Burden
In the United States, African American men are more likely to develop prostate cancer than white men . African American men are also more than twice as likely as white men to die of prostate cancer .1 The higher death rate is attributable in part to an earlier age at cancer onset, more advanced cancer stage at diagnosis, and higher rates of more aggressive cancer . These differences in death from prostate cancer may also reflect that African American men have lower rates of receiving high-quality care.
Available Evidence
The USPSTF searched for evidence about the potential benefits and harms of PSA-based screening for prostate cancer in African American men.
Potential Benefits
The PLCO trial enrolled 4% African American men, which is not enough to determine whether the overall trial results differed for African American men.17 The ERSPC trial did not record or report any race-specific subgroup information. The low proportion of persons of African descent in European countries during the study period makes it likely that these groups were not well represented.
Potential Harms
An analysis from the PLCO trial found that African American men were significantly more likely to have major infections after prostate biopsy than white men .13 Evidence is insufficient to compare the risk of false-positive results, potential for overdiagnosis, and magnitude of harms from prostate cancer treatment in African American vs other men.
Advising African American Men
Psa Screening Blood Test
A Prostate-specific antigen is made by the cells of the prostate gland. PSA testing is a common method to test for prostate cancer. PSA is found in semen, with a small amount in the blood. Men without prostate cancer often have PSA levels under 4 nanograms per milliliter of blood. Elevated PSA level increases the likelihood of having prostate cancer .
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:
Reasons for a Low PSA:
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Common Thoughts And Feelings
You may feel all sorts of things after you finish treatment. Some men are relieved and feel ready to put the cancer behind them and get back to normal life. But others find it difficult to move on. Adjusting to life after cancer can take time.
For some men, the emotional impact of what they have been through only hits them after they have finished treatment. You might feel angry for example, angry at what you have been through, or about the side effects of treatment. Or you might feel sad or worried about the future.
Follow-up appointments can also cause different emotions. You might find it reassuring to see the doctor or nurse, or you may find it stressful, particularly in the few days before your appointments.
Worries about your cancer coming back
You may worry about your cancer coming back. This is natural, and will often improve with time. There are things you can do to help manage your concerns, such as finding ways to reduce stress. Breathing exercises and listening to music can help you relax and manage stress. Some people find that it helps to share what theyre thinking with somebody else, like a friend. If you are still struggling, you can get help for stress or anxiety on the NHS you can refer yourself directly to a psychological therapies service or ask your GP.
If youre worried about your PSA level or have any new symptoms, speak to your doctor or nurse. If your cancer does come back, youll be offered further treatment.
Feeling isolated
What Symptoms Should I Look Out For
If your cancer does come back, the first sign is likely to be a rise in your PSA level, rather than any symptoms. And problems will often be side effects of treatment rather than a sign that your cancer has come back.
However, its important to let your doctor or nurse know if you do get any new symptoms or side effects, or are worried that your cancer might have come back. If your cancer has come back and has spread from the prostate to other parts of the body, it can cause symptoms, such as extreme tiredness rel=nofollow> fatigue), bone pain and problems urinating.
Your doctor or nurse can help find out what might be causing your symptoms and help you manage any side effects. They can also look at your PSA level and do other tests to see whether or not your cancer might have come back.
What other tests might I have?
If your doctor or nurse is concerned about your PSA level or if you have new symptoms that suggest your cancer might have come back, they may recommend that you have some other tests, such as a prostate biopsy, MRI scan, CT scan, bone scan or PET scan.
Your doctor or nurse will explain these tests to you if you need them, or you can get in touch with our Specialist Nurses for more information.
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What Are The Risks Of Prostate Cancer Screenings
Because prostate cancer is often such a slow-growing disease, its possible that even if the cancer is found, it may not affect the length or quality of your life.
False positives can also be a concern. Its possible to have high PSA levels even though theres no cancer. So, for some patients, screening may lead to unclear results and ultimately unnecessary evaluation.
This is why its important to talk with your doctor about whether prostate cancer screenings are right for you. Theyll walk you through the risks and benefits of screening to help you make your decision.
Estimate Of Magnitude Of Net Benefit
Conclusions from decision analysis models, which are consistent with the findings of randomized trials and cohort studies, suggest that more aggressive screening strategies, particularly those that use a lower PSA threshold for biopsy than generally used in the United States, provide the greatest potential reduction in death from prostate cancer. However, these strategies are also associated with more false positives, more biopsies, and higher rates of overdiagnosis.24
Options for reducing the overdiagnosis rate include lowering the age at which to stop screening, extending the interval between screenings, and using higher PSA thresholds for biopsy. However, no strategy completely eliminates overdiagnosis. PSA-based screening for prostate cancer every 2 or 4 years instead of annually appears to provide a good trade-off between a reduction in overdiagnosis and a small reduction in mortality benefit.24
Although active surveillance may reduce exposure to the potential harms of active treatment, it may not be viewed favorably by some men who value definitive action, are concerned about repeat biopsies, or want to avoid a potential increase in metastatic cancer.
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Early Cancer Detection Can Save Lives And Cut Treatment Costs But When Should You Start Having Prostate Exams And Do You Need To Have Them At All
When it comes to screening for prostate cancer, some men may be confused or apprehensive about beginning to get annual exams.
As prostate cancer affects one out of every six men, the American Cancer Society and other leading medical organizations recommend older men discuss having annual prostate cancer screenings with their primary care doctor to help detect the disease early. Early detection of the disease helps cure it in 90 percent of cases.
Generally, it is recommended that men with an average risk of prostate cancer start being screened with a digital rectal exam and PSA blood-level exam when they hit the age of 50. African-American men and men who have a father, brother or son who were diagnosed with prostate cancer when they were younger than 65 are at higher risk and should start screenings at age 40. Men who have had more than one of these close relatives diagnosed before age 65 are at even higher risk.
Guideline : 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.
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