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
Symptoms associated with advanced prostate cancer include:
- 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.
Does A High Psa Level Mean I Have Prostate Cancer
There is no set rule about what constitutes an abnormal PSA reading on a blood test. Since prostate cancer is not the only source of PSA, an elevated PSA may reflect an enlarged or inflamed benign prostate gland. High PSA levels are often the result of benign prostate hyperplasia, enlargement of the prostate that occurs in most men as they age. When interpreting the test results, doctors take a number of factors into consideration, including the patients age and ethnicity as well as rate of rise of PSA.
It is hard to detect the difference between PSA made by normal prostate tissue and PSA made by prostate cancer cells, says , a medical oncologist at Dana-Farber Cancer Institute. We know that as the PSA rises and gets higher and higher, the odds that that PSA is coming from a cancer than a normal prostate increases.
Still, most men considered tohave an elevated PSA do not have a detectable prostate cancer. About 25 percentof those who undergo a prostate biopsyin which a small section of the prostateis removed and examined for signs of cancerare found to have prostate cancer.
What Have Randomized Trials Of Prostate Cancer Screening Found
Several large, randomized trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and digital rectal exam were evaluated for their ability to decrease a mans chances of dying from prostate cancer.
The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but had about the same rate of deaths from the disease . Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment.
A second large trial, the European Randomized Study of Screening for Prostate Cancer , compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer .
The United States Preventive Services Task Force has estimated that, for every 1,000 men ages 55 to 69 years who are screened for 13 years :
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What Happens During The Test
Your doctor will start by giving you a digital rectal exam . They will insert a lubricated, gloved finger in your rectum and gently push on your prostate gland. This helps move the PCA3 into your urethra so it can be expelled in your urine. Following the DRE, youll be asked to provide a urine sample. The urine sample will be sent to a lab for testing and the results will then be sent to your doctor when they are available.
The PCA3 test results are more accurate when preceded by a DRE.
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 the 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 people with prostate cancer, and the PSA test was originally approved by the FDA in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the PSA test to be used in conjunction with a digital rectal exam to aid in the detection of prostate cancer in men 50 years and older. Until about 2008, many doctors and professional organizations had encouraged yearly PSA screening for prostate cancer beginning at age 50.
PSA testing is also often used by health care providers for individuals who report prostate symptoms to help determine the nature of the problem.
In addition to prostate cancer, several benign conditions can cause a persons PSA level to rise, particularly prostatitis and benign prostatic hyperplasia . There is no evidence that either condition leads to prostate cancer, but someone can have one or both of these conditions and develop prostate cancer as well.
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A Genetic Biomarker Test For Newly Diagnosed Prostate Cancer
Results from a study of a different genetic biomarker test suggest that it could one day help inform treatment decisions for men newly diagnosed with localized prostate cancer.
According to findings published February 24 in JCO Precision Oncology, a biomarker test called the Oncotype DX Genomic Prostate Score accurately predicted the long-term risk of metastasis and death from prostate cancer in men with localized disease. The test needs to be validated in larger forward-looking studies before it can be used to guide treatment, the study researchers noted.
How Do I Interpret My Test Results
With some laboratory tests, the results obtained for healthy people can vary somewhat from person to person. Factors that can cause person-to-person variation in laboratory test results include a person’s age, sex, race, medical history, and general health. In fact, the results obtained from a single person given the same test on different days can also vary. For these tests, therefore, the results are considered normal if they fall between certain lower and upper limits or values. This range of normal values is known as the “normal range,” the “reference range,” and the “reference interval.” When healthy people take such tests, it is expected that their results will fall within the normal range 95 percent of the time. Reference ranges are based on test results from large numbers of people who have been tested in the past.
Some test results can be affected by certain foods and medications. For this reason, people may be asked to not eat or drink for several hours before a laboratory test or to delay taking medications until after the test.
For many tests, it is possible for someone with cancer to have results that fall within the normal range. Likewise, it is possible for someone who doesn’t have cancer to have test results that fall outside the normal range. This is one reason that many laboratory tests alone cannot provide a definitive diagnosis of cancer or other diseases.
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What Are Some Questions To Ask The Doctor About Laboratory Tests
It can be helpful to take a list of questions to the doctorâs office. Questions about a laboratory test might include:
- What will this test measure?
- Why is this test being ordered?
- Does this test have any risks or side effects?
- How should I prepare for the test?
- When will the test results be available?
- How will the results be given ?
- Will this test need to be done more than once?
Complete Blood Count Test
A complete blood count test measures the number of blood cells circulating in the bloodstream. Specifically, this cancer blood test measures a blood sample for the level of red blood cells, which carry oxygen throughout the body white blood cells, which fight infection and platelets, which help with blood clotting. The test also measures hemoglobin, a protein in red blood cells that carries oxygen, and hematocrit, the ratio of red blood cells to plasma.
A CBC may be used to detect a variety of conditions, including leukemia, anemia and infection. Also, because some cancer treatments may temporarily lower blood counts, oncologists often use CBC tests throughout treatment to closely monitor a patients blood counts.
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Special Types Of Psa Tests
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.
In Men Over : Bph May Be The Cause Of High Psa
Benign prostatic hyperplasia is an enlargement of the prostate gland, but its not prostate cancer. âBPH means more cells, so that means more cells making PSA,â explains Dr. Castle.
BPH is the most common prostate problem in men over age 50. It may not need to be treated unless its causing frequent or difficult urination.
Your primary care doctor may be able to tell the difference between BPH and prostate cancer by doing a digital rectal exam, but commonly this will require evaluation by a urologist and further testing, such as a biopsy or imaging studies.
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Frequently Asked Questions About The Psa Blood Test
As we grow older, our risk of developing serious health issues, including cancer, also grows. For men, the risk of getting prostate cancer increases with age. Prostate cancer is rare in men under 40, and about 60% of cases are diagnosed in men aged 65 or older. But in the United States, nearly one of every nine men will be diagnosed with the disease. Thats why doctors recommend screening for prostate cancer beginning at age 45, with a yearly digital rectal exam and PSA blood test.
But what is exactly is a PSA test and what does it measure? When should you consider starting your screening for prostate cancer? Weve compiled answers to these and other frequently asked questions about PSA tests here.
Transrectal Ultrasound Scan Guided Biopsy
Your doctor takes a series of small tissue samples from the prostate to examine under a microscope. You have the biopsy through the back passage using a transrectal ultrasound scanner.
A TRUS guided biopsy can be uncomfortable. You usually have a local anaesthetic to numb the area and reduce any pain.
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Why Do I Need A Psa Test
It’s your choice whether to have a PSA test to screen for cancer. You and your prover may consider your risk for developing a serious cancer that could spread if you don’t catch it early. Your risk for serious prostate cancer may be higher depending on your:
- Age. The risk of prostate cancer increases after age 50.
- Your family health history. If members of your family have had prostate cancer, your risk may be higher.
- Your race. Prostate cancer is more common in African Americans. They also have a higher risk of developing prostate cancer at a younger age and having more serious disease.
You may also have a PSA test if:
- You have symptoms of a prostate condition, such as:
- Painful or frequent urination
- Pelvic and/or back pain
Discuss Prostate Cancer Testing With Your Doctor
Medical authorities do not recommend that all men should be tested for prostate cancer. In fact, most authorities suggest that men should make their own choice about whether or not to have a PSA test. If you decide to be tested, it is recommended that it should be done every two years from 50 to 69 years of age, and only if your health is such that you expect to live for at least another seven years.
Men at high risk of prostate cancer, such as men with a family history of prostate cancer , or men who have previously had an elevated test result, can start two-yearly testing from age 45. Your doctor can help you decide whether this is necessary.
While there is now some evidence that regular testing may prevent prostate cancer deaths, there are concerns that many men may be diagnosed and treated unnecessarily as a result of being screened, with a high cost to their health and quality of life .
However, the option of active surveillance, where a low-risk cancer is watched closely instead of being treated, helps to lower these risks. Active surveillance is now used quite commonly in Australia for men with low-risk prostate cancer.
If you are unsure whether or not to be tested after considering the benefits and uncertainties of testing and your own risk of prostate cancer, discuss it with your doctor.
In Australia, if you choose to be tested for prostate cancer the tests are covered by Medicare.
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Circulating Tumor Cell Test
Cellsearch circulating tumor cell tests may be used to monitor metastatic breast, metastatic colorectal and metastatic prostate cancers. This diagnostic test helps capture, identify and count circulating tumor cells in a blood sample. CTCs are cancer cells that detach from solid tumors and enter the bloodstream. This cancer blood test may be performed prior to the start of therapy or during the course of treatment.
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.
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How Soon Will Prostate Test Results Be Available
Results for simple medical tests such as some urodynamic tests, cystoscopy, and abdominal ultrasound are often available soon after the test. The results of other medical tests such as PSA blood test and prostate tissue biopsy may take several days to come back. A health care provider will talk with the patient about the results and possible treatments for the problem.
How Do Men Feel About The Rectal Exam
I think most men are willing to do it, but some men are exceptionally opposed to it. They might be happy to hear that there are studies ongoing in the United Kingdom looking at using magnetic resonance imaging as a screening tool to be able to avoid doing a digital rectal exam in the future. There is a large African immigrant population in London with a higher incidence of prostate cancerthey didnt want to have the prostate exam because they had a lot of opposition to it. They were uncomfortable with it.
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Should I Be Screened For Prostate Cancer
Since there are benefits and risks to prostate screening, you should talk with your provider to decide if screening is right for you. You and your provider should consider:
- Your age. The risk of prostate cancer increases after age 50.
- Your family health history. If members of your family have had prostate cancer, your risk may be higher.
- Your race. Prostate cancer is more common in African Americans. They also have a higher risk of developing prostate cancer at a younger age and having more serious disease.
- Your general health. Are you well enough to have treatment for prostate cancer if its found?
- What you prefer. How do you feel about the possible benefits and harms of screening, diagnosis, and treatment?
NIH: National Cancer Institute
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Use In Everyday Medical Care
Current guidelines from leading medical organizations don’t recommend routine use of the Decipher test. But the new study results should prompt these organizations to reconsider such guidelines on the basis of the strength of the evidence, Dr. McGuire wrote. The tests use in everyday medical practice should become commonplace, he added.
The question of whether hormone therapy should be added to radiation for patients with rising PSA after surgery is a question I see all the time in my practice, Dr. Feng said. My patients very much want to know if hormone therapy has a good chance of benefiting them. Tests like this are important because, if we can provide more information to patients and physicians, they can make better choices together.
There are still many questions about how to use the Decipher test in different groups of patients with prostate cancer, Dr. McGuire wrote. About 20 ongoing clinical studies are looking to provide some answers.
One area that needs further study is how well the test works in people of color, Dr. Feng noted. Recent evidence has shown that genetic-based tests can be less useful for people of color if there was a lack of diversity among participants in the studies that were done to develop and validate the test.
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