How To Screen Prostate Cancer

Diagnosis Of Prostate Cancer

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

Check out this factsheet for a summary of the video.

Diagnosis is the process of finding out the cause of a health problem. Diagnosing prostate cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist called a urologist or order tests to check for prostate cancer or other health problems. A urologist is a doctor who specializes in treating conditions of the genital and urinary tracts, including the prostate.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as prostate cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of prostate cancer.

The following tests are usually used to rule out or diagnose prostate cancer. Many of the same tests used to diagnose cancer are used to find out the stage . Your doctor may also order other tests to check your general health and to help plan your treatment.

Prostate Cancer Screeningwhen To Start And How To Screen

Kimia Kohestani1,2, Marina Chilov3, Sigrid V. Carlsson1,4

1Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at the University of Gothenburg , Memorial Sloan Kettering Cancer Center , 4Departments of Surgery and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center , , USA

Contributions: Conception and design: SV Carlsson Administrative support: SV Carlsson Provision of study material or patients: All authors Collection and assembly of data: All authors Data analysis and interpretation: SV Carlsson, K Kohestani Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Keywords: Prostate cancer screening baseline prostate-specific antigen

Submitted Dec 11, 2017. Accepted for publication Dec 20, 2017.

doi: 10.21037/tau.2017.12.25

Prostate Cancer Screening Ages 40 To 54

The PSA test is a blood test that measures how much of a particular protein is in your blood. Its been the standardfor prostate cancer screening for 30 years.

Your doctor will consider many factors before suggesting when to startprostate cancer screening. But hell probably start by recommending the PSAtest.

While the general guidelines recommend starting at age 55, you may need PSAscreening between the ages of 40 and 54 if you:

Have at least one first-degree relative who has had prostate cancer
Have at least two extended family members who have had prostate cancer
Are African-American, an ethnicity that has a higher risk of developing more aggressive cancers

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What Is The Chance Of A Diagnosis Of Prostate Cancer

Around 17,000 new cases of prostate cancer are diagnosed each year in Australia. It affects mostly men in older age groups and is rare in men under 50 years of age.

The chance of developing prostate cancer is significantly higher in men who have a close relative with prostate cancer the risks are higher if the relative was diagnosed before the age of 60.

If you have a family history of prostate cancer, talk to your doctor.

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 .

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Less Prostate Cancer Screening Reduces Overdiagnosis But May Miss Aggressive Cases

Over the past 15 years, public health authorities have downgraded recommendations for the prostate-specific antigen test as a screening tool to reduce the overdiagnosis and overtreatment of men with low-grade prostate cancer. Now, researchers from Weill Cornell Medicine have found that while these efforts have been effective, the incidence of higher-grade disease and metastasis at diagnosis have risen. The research was published March 22 in the Journal of the National Cancer Institute.

To our knowledge, this is the first study to demonstrate nationally that low-grade prostate cancer is no longer the most commonly diagnosed type of prostate cancer, said senior author Dr. Jim Hu, the Ronald P. Lynch Professor of Urologic Oncology at Weill Cornell Medicine and director of the LeFrak Center for Robotic Surgery at NewYork-Presbyterian/Weill Cornell Medical Center. One of the weaknesses of PSA/prostate cancer screening was that it led to over-detection of indolent cancers that would not harm men, subjecting them to anxiety and future testing.

It is encouraging to see that urologists in the United States have moved away from overutilization of radical therapies for the management of low-risk prostate cancer, added first author Dr. Leonardo Borregales.

Benefits Of Early Detection And Treatment

The goal of screening for prostate cancer is to identify high-risk, localized prostate cancer that can be successfully treated, thereby preventing the morbidity and mortality associated with advanced or metastatic prostate cancer.

Adequate evidence from randomized clinical trials shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened.3, 4 Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened.3 Current results from screening trials show no reductions in all-cause mortality from screening. There is inadequate evidence to assess whether the benefits for African American men and men with a family history of prostate cancer aged 55 to 69 years are different than the benefits for the average-risk population. There is also inadequate evidence to assess whether there are benefits to starting screening in these high-risk groups before age 55 years.

Adequate evidence from RCTs is consistent with no benefit of PSA-based screening for prostate cancer on prostate cancer mortality in men 70 years and older.

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Patient Population Under Consideration

This recommendation applies to adult men in the general US population without symptoms or a previous diagnosis of prostate cancer. It also applies to men at increased risk of death from prostate cancer because of race/ethnicity or family history of prostate cancer. The sections below provide more information on how this recommendation applies to African American men and men with a family history of prostate cancer.

What Is A Normal Psa Test Result

What it’s like to go for a rectal screening for prostate cancer

There is no specific normal or abnormal level of PSA in the blood. In the past, PSA levels of 4.0 ng/mL and lower were considered normal. However, some individuals with PSA levels below 4.0 ng/mL have prostate cancer and many with higher PSA levels between 4 and 10 ng/mL do not have prostate cancer .

In addition, various factors can cause someones PSA level to fluctuate. For example, the PSA level tends to increase with age, prostate gland size, and inflammation or infection. A recent prostate biopsy will also increase the PSA level, as can ejaculation or vigorous exercise in the 2 days before testing. Conversely, some drugsincluding finasteride and dutasteride, which are used to treat BPHlower the PSA level.

In general, however, the higher a mans PSA level, the more likely it is that he has prostate cancer.

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Permission To Use This Summary

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The best way to cite this PDQ summary is:

PDQ® Screening and Prevention Editorial Board. PDQ Prostate Cancer Screening. Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .

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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.

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.

National Cancer Institute Prostate Cancer Screening Study Indicates Qtscan Has Equal Or Better Sensitivity Than Mri

NOVATO, Calif., July 28, 2022 /PRNewswire/ — QT Imaging, Inc., a medical device company focused on the development and clinical adoption of novel products for body imaging, today announced results of a National Cancer Institute study comparing the QTscan with 7-Tesla MRI for prostate cancer screening. In an initial series of 10 patients, blinded QT Imaging interpretation demonstrated equal or better sensitivity for detection of cancer compared with multi-parametric 7-Tesla MRI. The study was done in collaboration with the Urologic Oncology Branch, Center for Interventional Oncology National Cancer Institute, Bethesda, MD and the Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD.

On blinded sector-based analysis, QT’s low frequency transmitted ultrasound volography had a sensitivity of 85.7% and specificity of 93.9%, while mpMRI had a sensitivity of 65.3% and specificity of 96.6%. These results demonstrate that QT’s imaging technology has significant potential as a low-cost, high resolution imaging modality for prostate cancer.

“These results demonstrate the clinical value of QT’s low frequency transmitted sound volography as a high-resolution imaging modality. We are encouraged by the continued high performance of QT imaging, especially in general anatomic and body imaging,” said John Klock, MD, CEO and CMO at QT Imaging.

These results were reported at three scientific meetings:

About QT Imaging, Inc.

Contacts

Prostate Cancer Is The Most Common Nonskin Cancer Among Men In The United States

Prostate cancer is found mainly in older men. In the U.S., about one out of every 8 men will be diagnosed with prostate cancer. 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.

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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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

Men Aged Less Than 55 Years

Avoid prostate biopsies with new cancer screening

For men aged less than 55 years of age, we recommend not screening for prostate cancer with the PSA test.

This recommendation is based on the low incidence of prostate cancer and prostate cancer mortality, and the lack of evidence for benefit of screening in this age group, as well as the evidence of harms.

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Repeating The Psa Test

A mans blood PSA level can vary over time , so some doctors recommend repeating the test after a month or so if the initial PSA result is abnormal. This is most likely to be a reasonable option if the PSA level is on the lower end of the borderline range . For higher PSA levels, doctors are more likely to recommend getting other tests, or going straight to a prostate biopsy.

Screening For Prostate Cancer In Men With A Family History

Burden

The introduction of PSA-based screening for prostate cancer has substantially altered the epidemiologic data for prostate cancer, greatly increasing the number of men with a diagnosis of prostate cancer and thus also the number of men with a father, brother, or son with a history of prostate cancer.

Available Evidence

It is generally accepted that men with a family history of prostate cancer are more likely to develop prostate cancer. A study of twins in Scandinavia estimated that genetic factors may account for up to 42% of prostate cancer risk.18 An analysis from the Finnish site of the ERSPC trial concluded that men with at least 1 first-degree relative with prostate cancer were 30% more likely to be diagnosed with prostate cancer than men without a family history.19 Men with 3 first-degree relatives with prostate cancer or 2 close relatives on the same side of the family with prostate cancer diagnosed before age 55 years may have an inheritable form of prostate cancer associated with genetic changes passed down from one generation to the next. This type of prostate cancer is thought to account for less than 10% of all prostate cancer cases.20

The USPSTF searched for evidence about the potential benefits and harms of PSA-based screening for prostate cancer in men with a family history of prostate cancer.

Potential Benefits

Potential Harms

Advising Men With a Family History of Prostate Cancer

What Is Cancer Screening

Screening means testing people for early stages of a cancer, or for early changes that could develop into cancer if left untreated. For screening to be useful the tests:

need to be reliable at picking up cancers that need treatment
overall must do more good than harm to people taking part
must be something that people are willing to do

Screening tests are not perfect and have some risks. The screening programme should also be good value for money for the NHS.

Why You Should Screen

Prostate cancer is the most common type of cancer found in men. The cause of prostate cancer is unknown. Research has found it is most common in men who:

are over age 50
have a family history of prostate cancer
are of African ancestry

If caught early, treatment is often successful. If you need treatment, your doctor will discuss the options with you.

The Prostate-specific antigen test is the best way to detect prostate cancer but may also produce false results.

Prostate Cancer Screening Patient Version

Scientists are trying to better understand whichpeople are more likely to get certain types of cancer. They also study the thingswe do and the things around us to see if they cause cancer. Thisinformation helps doctors recommend who should be screened for cancer, whichscreening tests should be used, and how often the tests should be done.

It is important to remember that your doctor does not necessarilythink you have cancer if he or she suggests a screening test. Screeningtests are given when you have no cancer symptoms. Screening tests may be repeated on a regular basis.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.

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