Prostate Cancer Is The Most Common Nonskin Cancer Among Men In The United States
Prostate cancer is found mainly in older men. Although the number of men with prostate cancer is large, most men diagnosed with this disease do not die from it. Prostate cancer causes more deaths in men than any other cancer except lung cancer. Prostate cancer occurs more often in African-American men than in white men. African-American men with prostate cancer are more likely to die from the disease than white men with prostate cancer.
How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:
Examination Of Your Prostate
When your doctor examines you it might include feeling your prostate gland. To do this your doctor puts a gloved finger into your back passage to check for abnormal signs, such as a lumpy, hard prostate. Doctors call this test a digital rectal examination .
It’s normal to feel a bit anxious about this test and it might be uncomfortable. But it usually only takes a few minutes.
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There Is No Standard Or Routine Screening Test For Prostate Cancer
Although there are no standard or routine screening tests for prostate cancer, the following tests are being used or studied to screen for it:
Digital rectal exam
Digital rectal exam is an exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel the prostate for lumps or anything else that seems unusual.
Prostate-specific antigen test
A prostate-specific antigen test is a test that measures the level of PSA in the blood. PSA is a substance made mostly by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. The level of PSA may also be high in men who have an infection or inflammation of the prostate or benign prostatic hyperplasia .
A PSA test or a DRE may be able to detect prostate cancer at an early stage, but it is not clear whether early detection and treatment decrease the risk of dying from prostate cancer.
Studies are being done to find ways to make PSA testing more accurate for early cancer detection.
When Should I Get Tested
Deciding to get tested is a personal decision made after a consultation with your doctor. Some important factors to consider are your age, race, family history, and history of exposure . Visit our Am I at Risk?page to learn more and check out our recommended age and testing guidelines, which are based on the NCCN provided recommendations.
All men are at risk of prostate cancer, so it is important to talk with your doctor to make an informed decision. Detecting prostate cancer early gives you the best chance of living longer. In fact, when it is caught early, the 5-year survival rate is over 99 percent.
Talk to Nathan about Prostate Cancer Screening is an interactive conversation that can help you decide whether to get screened. In partnership with the CDC, Nathan was developed to share information and answer your questions about prostate cancer screening and treatment. He also suggests some questions you might want to ask your doctor. Click the image below to get started!
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Need For This Guidance
New Zealand men currently receive conflicting advice about prostate cancer testing and treatment. Some men may benefit from early diagnosis and treatment, but have limited opportunity to access appropriate health services.
Unlike other cancers, prostate cancer often grows slowly. With routine prostate specific antigen testing, many men can be diagnosed with a cancer that is not going to progress during their lifetime. Such a diagnosis may increase mens exposure to unnecessary treatment-related harms.
On the other hand, some men will still develop aggressive and potentially life-threatening prostate cancer. These men may benefit from prompt diagnosis and treatment.
Preparing For A Prostate Exam
Theres nothing special that you need to do to prepare for a prostate exam. Tell your doctor if you have anal fissures or hemorrhoids, as a DRE may aggravate these conditions.
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.
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What If My Test Results Are Abnormal
If the results of early detection tests like the PSA screening or the digital rectal exam suggest that you might have prostate cancer, your doctor will conduct further testing. The PSA may be repeated, or you may be sent to a specialist for more tests such as a transrectal ultrasound and a prostate biopsy.
In a prostate biopsy, a tissue sample is taken from your prostate. Cancer can only be diagnosed with a tissue sample.
Recent research has yielded additional tests that in addition to the PSA and subsequent DRE and Biopsy that can give a doctor more information on to determine the probability of both finding cancer during a biopsy and determining how aggressive that cancer is likely to be. Read more on those tests.
Worried About Having A Dre
Its natural to feel worried or embarrassed about having tests, but some men find the idea of having a DRE upsetting. For example, if youve been sexually abused as a child or an adult, you might feel very upset about having this test. Theres no right or wrong way to feel about this, and it is your choice whether or not you have tests for prostate cancer.
It might be helpful to talk to a counsellor about your experience, thoughts and fears. Or you could contact a charity for people whove been sexually abused, such as the National Association for People Abused in Childhood or SurvivorsUK. If you do decide to have a DRE, explain your situation to your doctor as they can talk through the test with you and help to reassure you.
When I had the DRE I thought, For a few seconds of discomfort, I can live with it. Yeah its uncomfortable, but it could save your life. A personal experience
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Who Should Get A Digital Rectal Exam
Not all medical institutions agree on when men should begin screening for prostate cancer or even if a DRE should be part of the screening.
To help detect prostate cancer in its early stages, the American Cancer Society recommends that men talk to their doctors about the benefits, risks, and limitations of prostate cancer screening before deciding whether to be tested.
For most men at average risk, discussions about screening begin at age 50. However, some doctors recommend that men at higher risk of prostate cancer — African-American men or men with a family history of prostate cancer — start screening earlier.
Neural Innervation Of The Prostate
The gland is abundantly innervated by the parasympathetic and by the sympathetic . According to Gupta and McVary there is widespread agreement that expulsion of the contents of the gland during emission is under adrenergic control while cholinergic nerves are secretomotor. In regard to the sensory innervation of the prostate, McVary et al. state that the majority of the afferents to the ventral prostate is localised to sensory nerves from the L5 and L 6 segments of the spinal cord but there is a smaller degree of innervation from T13 to L2.
A collection of nerves that is located in the fascia covering the prostate is named the prostatic plexus. They arise from the lower portion of the pelvic plexus and are distributed not only to the prostate but also to the corpora cavernosa of the penis and urethra. Injury or damage to these nerves impacts on the mechanisms of erection and can thus cause erectile dysfunction .
Dense neuropeptide Y innervation is present throughout the prostatic stroma but most studies have not found the neuropeptide to be involved in the contraction of the prostate .
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How Long Will I Have To Wait To See A Doctor
Most people in this country have to wait to see their doctor! Thats because people have different health needs and how long it takes to get the right help can be very unpredictable. Its our long-held philosophy that you should be able to see a doctor on the day you need to and not have to wait for days.
The most seriously ill people are seen first. The really good news is that you can now see on the clinic website pages what the expected wait time is at that clinic! That means you can find another clinic near to you with a shorter wait time, if need be, or choose to come another day.
What Do The Results Mean
If the doctor identifies an abnormality with the prostate, they will discuss the findings with the patient. The doctor may be able to tell the patient what the abnormality may mean. This could include cancer, prostatitis, and an enlarged prostate.
Men need to understand what PSA levels mean too. If a PSA test is done, the doctor will be able to tell the patient how much prostate-specific antigen is in their blood.
The PSA test provides a measurement in ng/ml.
Here is an indication of what the measurements mean:
- If the PSA levels are under 4ng/mL, then the test is normal. This means the mans prostate should be healthy and not have serious abnormalities.
- If the PSA levels are between 4ng/mL and 10ng/mL, then it means there might be a problem with a mans prostate. In these cases, it might mean there is inflammation or infection in the prostate gland.
- When the PSA level is higher than 10ng/mL, then it is considered to be too high. In this case, the doctor may order further tests. The doctor may suspect prostate cancer in this case4. There may also be an excessive enlargement of the prostate gland.
A urologist also needs to look at how fast changes in PSA levels occur. For this reason, multiple PSA tests may be ordered.
There are several things that can affect PSA levels. The doctor needs to ensure it is not affected by medication or other factors before making a final diagnosis.
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Living With Prostate Cancer
As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.
Nevertheless, it can affect your life. As well as the possible side effects of treatment, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.
You may find it beneficial to talk about the condition with your family, friends, a family doctor and other men with prostate cancer.
Financial support is also available if prostate cancer reduces your ability to work.
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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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 .
What Is A Prostate Exam
A prostate exam is a screening to determine if there are any prostate issues including prostate cancer. The prostate gland is a male reproductive organ that produces semen the fluid that carries the sperm when a man ejaculates.
What are the types of screenings for prostate cancer?
There are two screening tests for prostate cancer including:
PSA testTypically, under 4 nanograms per milliliter of blood is considered normal. Using the PSA test results alone is not a good indicator of whether a man has prostate cancer because all men are different. A man with a PSA above 4 could be completely healthy, whereas a man with a PSA under 4 could have cancer.
Digital rectal examA digital rectal exam is a manual test where the doctor feels the prostate from inside the rectum.
What can you expect during prostate exam?
During a PSA test, your doctor will take a blood sample and send to a laboratory for analysis. Results can be ready as quickly as 24 hours or take as long as a week after blood is taken.
During a digital rectal exam, your doctor will insert a lubricated finger into the rectum and he or she will feel the prostate to check for any abnormalities. Although the procedure will likely be uncomfortable, it should not cause severe pain or damage any internal structures.
If your doctor finds any abnormalities, he or she will discuss further testing such as a prostate biopsy. A prostate biopsy can determine if you have prostate cancer.
How often should you have a prostate exam?
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What Will Happen At My First Prostate Check
This largely depends on the nature of the consult. If youve never had a prostate check before, it would often involve the GP taking a thorough history of your health background, examination and tests.
PSA is likely the most common form of test, and simply involves a blood test.
The test that many men feel nervous about is called a DRE however it is no longer recommended as an initial screening test for prostate cancer. Only if you begin exhibiting signs or symptoms synonymous with prostate cancer, is your doctor likely to refer you on for further test / specialist consultation.
What Are We Looking For
Many men experience issues with their prostate gland as they age. The symptoms for benign prostate enlargement and prostate cancer are very similar – most men present first with urinary issues. When your prostate has simply enlarged the surface is usually smooth. We begin to suspect prostate cancer when the surface is hard and lumpy. It’s a key difference and the best way to find out is via a rectal exam.
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Nursing Allied Health And Interprofessional Team Monitoring
One of the major concerns regarding prostate cancer screening is overdiagnosis, which involves overtreatment of low-grade prostate cancer and decreasing the quality of life of the patient by adding treatment-associated side effects and psychological harm when in reality, cancer would not have caused any clinical problems in the patient. This outcome can be overcome by active surveillance . Active surveillance is one of the management strategies in which a super select group of low-grade cancer patients are under close monitoring and followed through their disease course with the expectation to intervene only if cancer progresses. This approach will lead to the avoidance of treatment-associated side effects in such patients. This monitoring is only achievable by cumulative efforts and coordination of care amongst the interdisciplinary team members.
Examination Of The Rectum
- Rectal tumor? Many of rectal cancer can be palpated.
- Blood on the glove? Hint for a lower gastrointestinal bleeding.
- Mobility of the rectal mucosa in relation to the prostate? Particularly in advanced prostate cancer, the mobility of the rectal mucosa is of value in assessing the operability before radical prostatectomy.
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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.