Getting A Prostate Biopsy
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.
Clear Answers On Unclear Psa Results
Today, the initial step to diagnose prostate cancer is by testing PSA together with a digital rectal examination . The PSA test is a well-established prostate-specific marker that measures the concentration of PSA molecules in a blood sample. A high level of PSA can be a sign of prostate cancer. Therefore, clinical guidelines recommend a confirmatory prostate biopsy, if PSA > 3 ng/ml. But PSA levels can also be raised for many other reasons including infections, prostate stimulation, vigorous exercise or even certain medications. PSA results are confusing for many patients and even physicians. Patients are sent for time-consuming and anxiety-causing additional examinations, especially when a biopsy is being considered. Currently, over 50% of biopsies with elevated PSA are negative or clinically insignificant. This means overdiagnosis and overtreatment that impacts the physician’s routine, our healthcare system, and the quality of patient’s lives.
Strong health economic benefits thanks to early rule out of patients with no or non-significant cancerFewer complications
How Proclarix Clears The Grey Zone
Patients with a PSA level between 2 and 10 ng/ml are in a diagnostic grey zone. In these cases, the doctor faces an inconclusive situation without having sufficient information to decide whether to continue investigating or discharge the patient. Unclear results cause patients anxiety and require both additional time spent on health care procedures and unnecessary biopsies. Proclarix helps doctors and patients with PSA levels in the grey zone. Its Proclarix Risk Score delivers clear and immediate diagnostic support for further treatment decisions.
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What Are Some Of The Limitations And Potential Harms Of The Psa Test For Prostate Cancer Screening
Detecting prostate cancer early may not reduce the chance of dying from prostate cancer. When used in screening, the PSA test can help detect small tumors. Having a small tumor found and treated may not, however, reduce the chance of dying from prostate cancer. That is because many tumors found through PSA testing grow so slowly that they are unlikely to be life threatening. Detecting such tumors is called overdiagnosis, and treating them is called overtreatment.
Overtreatment exposes a person unnecessarily to the potential complications associated with prostate surgery and radiation therapy. These include urinary , gastrointestinal , and sexual side effects .
In addition, finding cancer early may not help someone who has a fast-growing or aggressive prostate tumor that may have spread to other parts of the body before being detected.
The PSA test may give false-positive results. A false-positive test result occurs when the PSA level is elevated but no cancer is actually present. A false-positive test result may create anxiety and lead to additional medical procedures, such as a prostate biopsy, that can be harmful. Possible side effects of biopsies include serious infections, pain, and bleeding.
False-positive test results are common with PSA screening only about 25% of people who have a prostate biopsy due to an elevated PSA level are found to have prostate cancer when a biopsy is done .
Ive Heard Of Ultrasensitive Psa What Is It
A test called “ultrasensitive PSA” may be useful in monitoring for persistence or recurrence of cancer after treatment. This test detects PSA at much lower levels than the traditional test. It has been suggested that increases in PSA due to the persistence or return of cancer can be identified much sooner with this test. However, results of this test must be interpreted with caution. Because the test is very sensitive, there can be small increases in PSA levels from one time to the next even when no cancer is present .
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Can I Take The Test At Home
Although testing for PSA at home is uncommon, several at-home PSA tests are available. At-home PSA tests typically involve collecting samples of blood at home through a fingerstick and sending the samples into a laboratory for testing. When considering at-home PSA testing, its important to understand the potential harms of this test.
At-home testing may be less accurate than testing a sample taken from a vein. PSA testing can also show a higher result when cancer isnt present and can lead to additional diagnostic procedures. Because the role of PSA testing is highly individualized, its important to seek testing only under the care and guidance of a doctor.
Who Should Get Tested For Prostate Cancer
A blood test for prostate cancer is recommended for men aged 50 and above. Once youve hit your golden year, its time to get serious with an annual physical exam that includes a blood test to check prostate cancer.
Also, if you have a family history of prostate cancer or other cancers, for that matter, you opt to get tested for the condition as well. Consult your doctor if youre in doubt about the proper cancer screening tests.
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Whats Wrong With Psa Testing
There are concerns about a PSA tests real ability to detect prostate cancer. About 3 out of 4 men with high PSA will not have cancer and about 1 in 7 prostate cancers can be missed.
Most men with high PSA tests will undergo a biopsy, which is a painful and invasive procedure. There are also concerns that many prostate cancers detected by PSA will never cause any problems, leading to unnecessary treatment and worry.
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.
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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. And other potential biomarkers of prostate cancer are being investigated. None of these tests has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include
Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. New England Journal of Medicine 2004 350:22392246.
What Happens If You Have A Likert Score Of 1 Or 2
Your doctor may not recommend a biopsy if you have a low Likert score. But you can still have one if you want to. Your doctor will explain the possible benefits and risks of having a biopsy.
When recommending whether you need a biopsy or not, your doctor also looks at other factors. These include:
- other test results such as PSA level and prostate examination
- the size of your prostate and the corrected PSA for its size. This is called the PSA density
- any other health conditions that you might have
- how well youd cope with prostate cancer treatment and whether it would benefit you
They might decide not to recommend a biopsy if you’re unwell or not likely to be able to have treatment.
If you don’t have a biopsy, your doctor may recommend monitoring your PSA level. They will recommend what your PSA level should be. You are usually discharged back to your GP to be monitored. Your GP can refer you back if the PSA levels go up.
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Finding Out If The Cancer Has Spread
To find out if cancer has spread outside of the prostate, doctors may perform the imaging tests listed below. Doctors are able to estimate the risk of spread, called metastasis, based on PSA levels, tumor grade, and other factors, but an imaging test can confirm and provide information about the cancers location.
Imaging tests may not always be needed. A CT scan or bone scan may not be necessary for those with no symptoms and low-risk, early-stage prostate cancer, as determined with information from the PSA test and biopsy. Learn more about when these tests are recommended to find out if the cancer has spread.
For people with advanced prostate cancer, ASCO recommends that 1 or more of the imaging tests below be done to provide more information about the disease and help plan the best treatment. This includes when there is a newly diagnosed, high-risk cancer if metastasis is suspected or confirmed if the cancer has returned following treatment or when the cancer grows during the treatment period. Learn more about this guideline on the ASCO website.
Magnetic resonance imaging . An MRI scan uses magnetic fields, not x-rays, to produce detailed images of the body. An MRI can be used to measure the tumors size, and a scan can focus specifically on the area of the prostate or on the whole body. A special dye called contrast medium is given before the scan to create a clearer picture, which is injected into a patients vein.
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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Understanding Your Mri Results
A doctor who specialises in imaging scans gives the MRI scan a score based on the results. This score helps your doctor decide on the next step and whether you need to have a biopsy. This is where your doctor takes a sample of your prostate gland.
This score is called the Likert or PI-RAD system. It estimates the risk that an area seen on the MRI scan may be a cancer or not. The score is from 1 to 5.
|Its highly unlikely that you have prostate cancer|
|2||Its unlikely that you have prostate cancer|
|3||Its difficult to tell from the scan if a prostate cancer is present or not|
|4||Its likely that you have prostate cancer|
|5||Its very likely that you have prostate cancer|
Where Digital Pathology Is Working
Pathology laboratories that have transitioned to digital are leading the way. Currently Philips has assisted laboratories worldwide in the move to a fully digital workflow, representing more than 14 million scanned slides.* In fact, Philips partnered with LABPON in the Netherlands to realize the worlds first digital pathology diagnostic laboratory workflows. LABPON has been able to transition its entire workflow to digital processes, demonstrating its commitment to ensuring its patients and clinical colleagues receive the fastest and best-informed diagnoses possible.
19 hours saved/day through increased lab efficiency2
Easier collaboration across sites, reduction in costs
Simplified preparationfor MDT discussions
Ability to offer remote consultation as external services
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Pros And Cons Of The Psa Test
- it may reassure you if the test result is normal
- it can find early signs of cancer, meaning you can get treated early
- PSA testing may reduce your risk of dying if you do have cancer
- it can miss cancer and provide false reassurance
- it may lead to unnecessary worry and medical tests when there’s no cancer
- it cannot tell the difference between slow-growing and fast-growing cancers
- it may make you worry by finding a slow-growing cancer that may never cause any problems
What Are Additional Tests For Detecting Prostate Problems
If the DRE or the PSA blood test indicates a problem may exist, the health care provider may order additional tests, including urinalysis, urodynamic tests, cystoscopy, abdominal ultrasound, transrectal ultrasound with prostate biopsy, and imaging studies such as magnetic resonance imaging or computerized tomography scan.
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Taking Care Of Yourself As A Caregiver
Caring for someone who is sick, taking on new responsibilities, and worrying about the future can be exhausting at the very least. Here you can find tips on making sure you also take care of yourself. You’ll also find checklists that can help caregivers spot signs of anxiety or depression in yourself or others.
What Is The First Test For Detecting Prostate Problems
The first test for detecting prostate problems is a blood test to measure prostate-specific antigen , a protein made only by the prostate gland. This test is often included in routine physical exams for men older than age 50. Because African American men have higher rates of getting, and dying from, prostate cancer than men of other racial or ethnic groups in the United States, medical organizations recommend a PSA blood test be given starting at age 40 for African American men. Medical organizations also recommend a PSA blood test be given starting at age 40 for men with a family history of prostate cancer. Some medical organizations even recommend a PSA blood test be given to all men starting at age 40.
If urination problems are present or if a PSA blood test indicates a problem, additional tests may be ordered. These tests may require a patient to change his diet or fluid intake or to stop taking medications. If the tests involve inserting instruments into the urethra or rectum, antibiotics may be given before and after the test to prevent infection.
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Imaging Tests For Prostate Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. One or more imaging tests might be used:
- To look for cancer in the prostate
- To help the doctor see the prostate during certain procedures
- To look for spread of prostate cancer to other parts of the body
Which tests you might need will depend on the situation. For example, a prostate biopsy is typically done with transrectal ultrasound and/or MRI to help guide the biopsy. If you are found to have prostate cancer, you might need imaging tests of other parts of your body to look for possible cancer spread.
The imaging tests used most often to look for prostate cancer spread include:
Types Of Prostate Cancer
Almost all prostate cancers are adenocarcinomas. These cancers develop from the gland cells .
Other types of cancer that can start in the prostate include:
- Small cell carcinomas
- Neuroendocrine tumors
- Transitional cell carcinomas
These other types of prostate cancer are rare. If you are told you have prostate cancer, it is almost certain to be an adenocarcinoma.
Some prostate cancers grow and spread quickly, but most grow slowly. In fact, autopsy studies show that many older men who died of other causes also had prostate cancer that never affected them during their lives. In many cases, neither they nor their doctors even knew they had it.
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