Sunday, September 25, 2022

How To Screen For Prostate Cancer

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Getting A Prostate Biopsy

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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.

Research Needs And Gaps

There are many areas in need of research to improve screening for and treatment of prostate cancer, including

  • Comparing different screening strategies, including different screening intervals, to fully understand the effects on benefits and harms
  • Developing, validating, and providing longer-term follow-up of screening and diagnostic techniques, including risk stratification tools, use of baseline PSA level as a risk factor, and use of nonâPSA-based adjunctive tests that can distinguish nonprogressive and slowly progressive cancer from cancer that is likely to become symptomatic and affect quality or length of life, to reduce overdiagnosis and overtreatment
  • Screening for and treatment of prostate cancer in African American men, including understanding the potential benefits and harms of different starting ages and screening intervals and the use of active surveillance given the large disparities in prostate cancer mortality in African American men, this should be a national priority
  • How to better inform men with a family history of prostate cancer about the benefits and harms of PSA-based screening for prostate cancer, including the potential differences in outcomes between men with relatives who died of prostate cancer and men with relatives diagnosed with prostate cancer who died of other causes
  • How to refine active prostate cancer treatments to minimize harms

Medical History And Physical Exam

If your doctor suspects you might have prostate cancer, he or she will ask you about any symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors, including your family history.

Your doctor will also examine you. This might include a digital rectal exam , during which the doctor inserts a gloved, lubricated finger into your rectum to feel for any bumps or hard areas on the prostate that might be cancer. If you do have cancer, the DRE can sometimes help tell if its only on one side of the prostate, if its on both sides, or if its likely to have spread beyond the prostate to nearby tissues. Your doctor may also examine other areas of your body.

After the exam, your doctor might then order some tests.

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Screening: Safe And Painless Way To Detect Prostate Cancer

A simple blood test called a prostate specific antigen test and a digital rectal exam are currently the best screening methods available for prostate cancer. Prostate cancer screening is safe and painless and can detect prostate cancer early, when it is most treatable.

However, prostate cancer screening is not for everyone. You should know:

  • Some prostate cancers are slow-growing and there is a chance that slow-growing disease may never affect a mans health.
  • Prostate cancer screening detects the presence of cancer it will not show if a cancer is slow-growing or aggressive. Only a qualified physician can make that determination.
  • The test result could be inaccurate or unclear, leading to unnecessary anxiety, another test, or a biopsy or treatment you dont need. Talk to your doctor about benefits and risks before you decide to be screened.
  • Treatment can be life-saving. However, it may cause temporary or long-lasting side effects, such as incontinence or erectile dysfunction
  • If a screening shows you have prostate cancer, its important to talk with a prostate cancer specialist who can help you evaluate your options and make the choice thats right for you.

Before you decide to be screened, talk with your doctor about whether and when prostate cancer screening is right for you. If you dont have a doctor, please call 1-800-DOCTORS. Well be happy to help.

Specialist Referral And Biopsy

Guidance updated on PSA testing for prostate cancer

Your doctor will discuss your prostate check results with you. If the PSA and DRC results suggest you have a high risk for prostate cancer, your doctor will refer you to a urologist .

The specialist will discuss having a prostate biopsy, in which a small sample of your prostate gland cells are taken for examination.

The aim of the biopsy is to confirm whether or not you have prostate cancer and, if so, whether it needs treatment. The treatment options will then be discussed with you.

If the biopsy shows no evidence of cancer, you may be advised to attend future check-ups.

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Healthy People 2030 Target

There is no Healthy People 2030 target related to being screened for prostate cancer. There is a target goal to increase the proportion of men who have discussed the advantages and disadvantages of the PSA test to screen for prostate cancer with their health care provider.

Healthy People 2030 is a set of goals set forth by the Department of Health and Human Services.

Note: Goals are indicated as blue line on Detailed Trend Graphs.

Screening Tests Have Risks

Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying fromcancer.

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What If A Screening Test Shows An Elevated Psa Level

If a man 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 man continue with PSA tests and DREs at regular intervals to watch for any changes over time.

If a mans PSA level continues to rise or if a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. A urine test may be recommended to check for a urinary tract infection. The doctor may also recommend imaging tests, such as a transrectal ultrasound, x-rays, or cystoscopy.

If prostate cancer is suspected, the doctor will 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. Most often, the needles are inserted through the wall of the rectum . A pathologist then examines the collected tissue under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to diagnose prostate cancer.

Portable Prostate Cancer Test May Help Reach Underserved Men

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

by Cornell University

A highly portable and rapid prostate cancer screening kit could provide early warning to populations with higher incidence of prostate cancer and particularly those with limited access to health care, such as African American men.

The proof-of-concept test, described online Nov. 12 in the journal Current Research in Biotechnology, is inexpensive and uses a test strip and a small cube-shaped 1.6-inch reader to quantify a marker of prostate cancercalled prostate-specific antigen from a drop of blood in minutes.

“We’ll be able to take a drop of blood in a community setting such as a barbershop and be able to deliver results in 10 to 15 minutes right there, which can indicate when somebody needs to come in for further tests,” said Dr. Saurabh Mehta, the Janet and Gordon Lankton Professor in the Division of Nutritional Sciences and the paper’s senior author. Balaji Srinivasan, a research associate in Mehta’s research group, is the paper’s first author.

“It’s creating that first point of contact that hopefully builds rapport and brings health care services to the people at the point of need,” Mehta said.

The kit comes with a test strip, similar to those found in at-home COVID-19 antigen or pregnancy tests. Users would draw a drop of blood and apply it to the test strip, and in about 15 minutes, two lines appear on the strip.

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About Prostate Cancer And The Prostate

The prostate gland is a male reproductive organ positioned just below the bladder. In addition to assisting in semen production, the prostate produces a protein called prostate-specific antigen, which circulates in the blood, whether or not there is cancer in the prostate.2 The PSA test is a blood analysis that measures how much prostate-specific antigen is in the blood. Sometimes a higher than expected PSA level in the blood can indicate cancer, which can then be confirmed with further prostate testing.

Prostate cancer is common it is the second most common type of cancer in men .1 About 175,000 men in the U.S. will be diagnosed with prostate cancer this year, but the death rate from this disease has dropped by more than half since 19931, driven by advances in testing and research. Many men with early-stage prostate cancer experience no symptoms, which is why it is so important for men in the high-risk groups to discuss the benefits of receiving a prostate test with their doctor.

Despite clear evidence that PSA testing has contributed to lowering the death rate from prostate cancer,3 PSA testing by itself is not an indication of cancer. There are other conditions that can cause elevated PSA levels, including an enlarged prostate or infection.

Getting The Results Of The Biopsy

Your biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. Getting the results usually takes at least 1 to 3 days, but it can sometimes take longer. The results might be reported as:

  • Positive for cancer: Cancer cells were seen in the biopsy samples.
  • Negative for cancer: No cancer cells were seen in the biopsy samples.
  • Suspicious: Something abnormal was seen, but it might not be cancer.

If the biopsy is negative

If the prostate biopsy results are negative , and the chance that you have prostate cancer isnt very high based on your PSA level and other tests, you might not need any more tests, other than repeat PSA tests sometime later.

But even if many samples are taken, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer , your doctor might suggest:

  • Getting other lab tests to help get a better idea of whether or not you might have prostate cancer. Examples of such tests include the Prostate Health Index , 4Kscore test, PCA3 tests , and ConfirmMDx. These tests are discussed in Whats New in Prostate Cancer Research?
  • Getting a repeat prostate biopsy. This might include getting additional samples of parts of the prostate not biopsied the first time, or using imaging tests such as MRI to look more closely for abnormal areas to target.

Prostate cancer grade

Gleason score

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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 .

The Use Of Psa As A Screening Tool Has Been Said To Result In Overdetection And Overtreatment Of Prostate Cancer What Is Your Opinion On This

FSI

I think its true. Before the PSA test came along, we almost always diagnosed prostate cancer when it was too late. Through PSA testing, we can discover life-threatening tumors in time to cure them, but we also detect possible harmless cancers in some patients whose PSA was elevated because of other benign conditions. In those times, most men underwent treatment, and some had unnecessary effects that reduced their quality of life. Of course, this was a big concern, even though PSA screening reduced the prostate cancer death rate by more than half.

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Benefits And Risks Of Screenings

The benefit of any cancer screening test is to find cancer early, when it easier to treat. But the value of PSA screening for prostate cancer is debated. No single answer fits all men.

Prostate cancer often grows very slowly. PSA levels can begin to rise years before a cancer causes any symptoms or problems. It is also very common as men age. In many cases, the cancer will not cause any problems or shorten a man’s life span.

For these reasons, it is not clear if the benefits of routine screenings outweigh the risks or side effects of being treated for prostate cancer once it is found.

There are other factors to think about before having a PSA test:

  • Anxiety. Elevated PSA levels does not always mean you have cancer. These results and the need for further testing can cause a lot of fear and anxiety, even if you do not have prostate cancer.
  • Side effects from further testing. If your PSA test is higher than normal, you may need to have a one or more biopsies to find out for sure. A biopsy is safe, but can cause problems such as an infection, pain, fever, or blood in the semen or urine.
  • Overtreatment. Many prostate cancers will not affect your normal life span. But since it is impossible to know for sure, most people want to get treatment. Cancer treatment can have serious side effects, including problems with erections and urinating. These side effects can cause more problems than the untreated cancer.

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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What Are Clinical Trials And Are They Right For You

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

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If You Want A Psa Test

PSA Test: Prostate Cancer Screening Harmful to Men?

Although there is no prostate screening programme, men aged over 45 can ask their GP for a PSA test.

If you ask to have the test your GP first explains all the possible benefits and risks. They give you written information to read. Your doctor or practice nurse can answer any questions that you have.

If you still want to have the test after considering the information, your GP or practice nurse will take a blood sample.

If you have the test you should not have

  • A urinary tract infection
  • Ejaculated for 48 hours beforehand
  • Exercised heavily in the previous 48 hours
  • Had a prostate biopsy within the last 6 weeks

These things may raise your PSA level.

Your GP may also examine your prostate. They do this by gently putting a gloved finger into your back passage and feeling your prostate gland. They call this digital rectal examination or DRE.

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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.

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