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How To Test For Prostate Cancer

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Positron Emission Tomography Scan

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

A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.

However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.

Other newer tracers, such as Ga 68 PSMA-11 and 18F-DCFPyl , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.

These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body.

The pictures from a PET scan arent as detailed as MRI or CT scan images, but they can often show areas of cancer anywhere in the body. Some machines can do a PET scan and either an MRI or a CT scan at the same time, which can give more detail about areas that show up on the PET scan.

What Is The Psa Test

Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a mans blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.

The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the use of the PSA test in conjunction with a digital rectal exam to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing to help doctors determine the nature of the problem.

In addition to prostate cancer, a number of benign conditions can cause a mans PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis and benign prostatic hyperplasia . There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.

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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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.

Special Types Of Psa Tests

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The PSA level from a screening test is sometimes referred to as total PSA, because it includes the different forms of PSA . If you decide to get a PSA screening test and the result isnt normal, some doctors might consider using different types of PSA tests to help decide if you need a prostate biopsy, although not all doctors agree on how to use these tests. If your PSA test result isnt normal, ask your doctor to discuss your cancer risk and your need for further tests.

Percent-free PSA: PSA occurs in 2 major forms in the blood. One form is attached to blood proteins, while the other circulates free . The percent-free PSA is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not.

If your PSA test result is in the borderline range , the percent-free PSA might be used to help decide if you should have a prostate biopsy. A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy.

Many doctors recommend a prostate biopsy for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. Using these cutoffs detects most cancers and helps some men avoid unnecessary biopsies. This test is widely used, but not all doctors agree that 25% is the best cutoff point to decide on a biopsy, and the cutoff may change depending on the overall PSA level.

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Both Tests Are Better Than One

Using these tests together is better than using either test alone. PSA testing together with a DRE may help find a dangerous cancer early when it is easier to treat.

Follow-up tests

If a problem is found, more tests will be done to find out whether you have prostate cancer or another health problem. Further tests can include:

  • a follow-up PSA test
  • a transrectal ultrasound a test that uses sound waves to make a picture of the rectum and nearby organs, including the prostate
  • a biopsy of the prostate tissue samples of the prostate are looked at under a microscope

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.

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Prostate Specific Antigen Test

A blood test called a prostate specific antigen test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.

As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.

PSA levels also can be affected by

  • Certain medical procedures.

Preparing For A Prostate Exam

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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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Is Psa The Same As Psma

The PSA test is different from the PSMA PET scan.

The PSA test is a blood test that measures the level of PSA in your blood. PSA is a protein produced by cells in your prostate gland. High levels of PSA are often a sign of prostate cancer.

The PSMA PET scan is used after PSA testing if your doctor isnt sure if or where prostate cancer has spread. It can more accurately pinpoint where prostate cancer cells are located throughout the body.

Your doctor may order a PSA blood test to:

  • screen for prostate cancer if you dont have symptoms of the disease
  • determine whether further tests are necessary to diagnose prostate cancer if you do have symptoms of the disease
  • check for signs that prostate cancer has come back if youve received successful treatment for the disease

PSA blood test results are not enough to diagnose prostate cancer or learn whether it has spread or returned. If you have high levels of PSA, your doctor will order other follow-up tests to develop an accurate diagnosis.

Your doctor will only order a PSMA PET scan if they think you may have prostate cancer that has spread beyond the prostate gland.

When Is A Psa Test Needed

If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.

Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.

  • You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
  • Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
  • If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

04/2014

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Prostate Cancer Screening Guidelines

Specialists in the Prostate and Urologic Cancer Program encourage all men at risk for prostate cancer to consider appropriate screening. Men considering prostate cancer screening should first talk with their personal physicians so they may make an informed decision about the risks and benefits, and whether screening is right for them.

The following guidelines are based on American Cancer Society recommendations about prostate cancer screening. Men should not be tested without first learning about the risks and possible benefits of testing and treatment. They should have a conversation with their doctor about whether, when and how often prostate cancer screening is appropriate, given individual health factors.

After having a discussion with their doctor, men who want to be screened should be tested with the prostate-specific antigen blood test. The digital rectal exam may also be done as a part of screening. The discussion about screening and your risk factors should take place at:

  • Age 50: Men who are at average risk of prostate cancer and are expected to live at least 10 more years.
  • Age 45: Men at high risk of developing prostate cancer. This includes African Americans the rate at which African American men are diagnosed with cancer is 76% higher than for white men. All men who have a first-degree relative diagnosed with prostate cancer at an early age are considered to be at high risk.
  • Age 40: Men at even higher risk .

Screenings Can Lead To High Costs

Why a one

The cost for a PSA test is fairly lowabout $40.

If your result is abnormal, the costs start adding up. Your doctor will usually refer you to a urologist for a biopsy. Costs may include:

  • A consultation fee .
  • An ultrasound fee .
  • Additional professional fees .
  • Biopsy fees .

If the biopsy causes problems, there are more costs. You might also have hospital costs.

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Benefits And Harms Of Screening

The benefit of screening is that the disease is often curable with early detection . Common treatments like surgery or radiation aim to remove or kill all cancerous cells in the prostate. If the cancer spreads beyond the prostate before it is treated, it is often fatal. However, the cancer usually grows so slowly that it is often equally safe to wait until there are symptoms before attempting to diagnose prostate cancer. Symptoms of prostate cancer might include urinary problems, difficulty having an erection, or blood in the urine or semen.

The harms of screening include 1) inaccurate results leading to unnecessary biopsies and complications, and 2) complications from unnecessary treatment. Even if a man has prostate cancer, if he does not have symptoms he may not need to be treated. Experts estimate that between 18% and 85% of prostate cancers detected by these screening tests would never become advanced enough to harm the patient. This wide range of uncertainty, however just adds to the confusion.

Unnecessary treatment costs a lot of money, but the main concern is the complications, which include serious and long-lasting problems, such as urinary incontinence and impotence.15

When Is The Psma Pet Test Used

Your doctor might order a PSMA PET scan if youve recently received a new diagnosis of prostate cancer and they think it may have spread to other parts of your body. Or your doctor may use it to get a better idea of where prostate cancer has spread.

Prostate cancer is usually diagnosed in its early stages, before it has spread. However, some people are at heightened risk of metastatic prostate cancer.

Your doctor might order PSMA PET-CT at the time you are diagnosed with prostate cancer if you have any risk factors for metastatic disease, Dr. Michael Feuerstein, a urologist at Lenox Hill Hospital in New York City, tells Healthline.

According to Feuerstein, doctors use the following measurements to assess the risk of metastatic prostate cancer:

  • Prostate-specific antigen . PSA is a protein made by the prostate thats found in the semen and blood. It tends to be elevated in people with prostate cancer. A PSA blood test is one of the first tests doctors order to diagnose prostate cancer. Youre considered at risk of metastatic prostate cancer if you have a PSA blood level of 20 or higher.
  • Gleason grade. This system assigns a score to classify how many abnormal prostate cancer cells are found in a tissue biopsy. A Gleason grade of 7 or higher puts you at higher risk of metastatic prostate cancer.

Your doctor might also order the PSMA PET test if you still have detectable prostate cancer after undergoing surgery to treat it, says Feuerstein.

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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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