Transrectal Ultrasound With Prostate Biopsy
Transrectal ultrasound is most often used to examine the prostate. In a transrectal ultrasound, the health care provider inserts a transducer slightly larger than a pen into the mans rectum next to the prostate. The ultrasound image shows the size of the prostate and any abnormal-looking areas, such as tumors. Transrectal ultrasound cannot definitively identify prostate cancer.
To determine whether a tumor is cancerous, the health care provider uses the transducer and ultrasound images to guide a needle to the tumor. The needle is then used to remove a few pieces of prostate tissue for examination with a microscope. This process, called biopsy, can reveal whether prostate cancer is present. A transrectal ultrasound with prostate biopsy is usually performed by a doctor in a health care providers office, outpatient center, or hospital with light sedation and local anesthesia. The biopsied prostate tissue is examined in a laboratory by a pathologista doctor who specializes in diagnosing diseases.
Specialist Referral And Biopsy
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.
What If My Test Results Are Abnormal
If the results of early detection tests like the PSA screening or the digital rectal exam suggest that you might have prostate cancer, your doctor will conduct further testing. The PSA may be repeated, or you may be sent to a specialist for more tests such as a transrectal ultrasound and a prostate biopsy.
In a prostate biopsy, a tissue sample is taken from your prostate. Cancer can only be diagnosed with a tissue sample.
Recent research has yielded additional tests that in addition to the PSA and subsequent DRE and Biopsy that can give a doctor more information on to determine the probability of both finding cancer during a biopsy and determining how aggressive that cancer is likely to be. Read more on those tests.
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Early Detection Saves Lives
Prostate cancer is the most common cancer affecting Australian men .
Prostate cancer is the growth of abnormal cells in the prostate gland. This gland is only found in males and is about the size of a walnut.
The causes of prostate cancer are not understood and there is currently no clear prevention strategy.
What Does A High Psa Level Mean
High PSA levels could be a sign of prostate cancer or a different condition like prostatitis or an enlarged prostate.
Other things can affect your PSA level:
- Age. Your PSA will normally go up slowly as you get older, even if you have no prostate problems.
- Medications. Some drugs may affect blood PSA levels. Tell your doctor if youÃ¢re taking dutasteride or finasteride . These drugs may falsely lower PSA levels by half of what they should be.
If your PSA level is high, your doctor may suggest that you get a prostate biopsy to test for cancer.
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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 .
New Tests For Prostate Colon Cancer Show Promise
One test examines a person’s blood for four biomarkers linked to inflammation. In a small study, it outperformed the fecal blood test now used in colon cancer screening, said lead researcher Dr. Mona Eldeeb, of Alexandria University Medical Research Institute in Egypt.
“These combined blood base markers could detect early cancer colon, especially if applied in a screening program,” she said.
The other test uses a man’s saliva to look for genetic material linked to prostate tumor growth, according to the Iranian researchers who developed it.
If approved in the United States, the tests could make screening and diagnosis for these cancers easier on patients, without the need for needle biopsy or colonoscopy, experts said.
“The exciting part of this study is that the test truly is noninvasive, requiring no need for needles as it relies on saliva that can be easily and repeatedly obtained,” said Dr. Corey Speers, a radiation oncologist at the University of Michigan’s Rogel Cancer Center in Ann Arbor.
The colon cancer test uses microscopic, color-coded beads to capture four inflammatory proteins from a blood sample. Laser technology then provides a count of the beads.
Eldeeb and her team tried the test with 35 patients with colon cancer and 52 people who were cancer-free.
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How Is The Psa Test Used In Men Who Have Been Treated For Prostate Cancer
The PSA test is used to monitor men after surgery or radiation therapy for prostate cancer to see if their cancer has recurred . If a mans PSA level begins to rise after prostate cancer treatment, it may be the first sign of a recurrence. Such a biochemical relapse typically appears months or years before the recurrence causes symptoms.
However, a single elevated PSA measurement in someone who has a history of prostate cancer does not always mean that the cancer has come back. Someone who has been treated for prostate cancer should discuss an elevated PSA level with their doctor. The doctor may recommend repeating the PSA test or performing other tests to check for evidence of a recurrence. The doctor may look for a trend of rising PSA level over time rather than a single elevated PSA level.
A rising trend in PSA level over time in combination with other findings, such as an abnormal result on imaging tests, may lead the doctor to recommend further cancer treatment.
New Blood Test Improves Prostate Cancer Diagnosis
The IsoPSA assay, a blood test for prostate cancer, improved diagnostic accuracy of disease presence and grade of disease compared with concentration-based assays, according to the findings of a preliminary study.
IsoPSA is a structure-based assay that agnostically interrogates the entire spectrum of structural changes of complex , the researcher wrote.____________________________________________________________________________________________________________________________________________USPSTF Releases Draft Recommendation on Prostate Cancer Screening____________________________________________________________________________________________________________________________________________
The multicenter prospective study included 261 men scheduled for prostate biopsy between August 2015 and December 2016 at 5 academic and community center clinics. The performance of IsoPSA at detecting the presence of prostate cancer verses no cancer, and detecting the presence of high-grade disease verses the presence of low-grade or benign disease were assessed as the main outcomes.
Overall, 139 patients out of 261 had prostate cancer, and 88 had high-grade prostate cancer.
False-positive biopsies were reduced by 48% and the rate of false-positives for identifying men with high-grade verses men with low-grade or benign disease risk was reduced by 45%.
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Need For A Test Better Than Psa And Biopsy
The current method of diagnosing prostate cancer by combining the PSA test with a biopsy leads to many pointless biopsies, over-diagnoses, and unnecessary treatments.
Such a method can cause harm to individuals and waste precious time and resources in the healthcare system.
There is clearly a need for better selection of patients to undergo the biopsy procedure, Prof. Lu urges.
For the study, he and his colleagues carried out the new blood test in 98 males who had not yet had a biopsy and 155 others who had just received a diagnosis of prostate cancer but not yet undergone treatment. All the participants were attending St Bartholomews Hospital in London.
The researchers saw that the presence of circulating tumor cells in the prebiopsy blood samples was predictive of aggressive prostate cancer that subsequent biopsies detected.
In addition, from the level of circulating tumor cells, the team was able to assess the aggressiveness of the cancer.
When combined with the PSA test, the circulating tumor cell test was able to predict with 90% accuracy, which men would receive an aggressive prostate cancer diagnosis from biopsy results.
Normal Psa Levels By Age Chart
We mentioned earlier in this article that PSA levels increase with age due to age related growth of the prostate gland. A doctor will therefore take into account an age-adjusted PSA level when discussing your prostate health:
0 to 6.5
Although there are normal PSA levels by age range, it is still important to screen routinely to ensure these normal levels are not rising.
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Prostate Cancer: Advancements In Screenings
You may know thatprostate canceris one of the most common cancer types in men. The good news is that thereare many treatment and management options, even if the cancer is caught ata later stage.
What you may not know: There are several options when it comes toprostate cancer screening. After considering multiple factors, your doctor may recommend theprostate-specific antigen test, and/or one of the newer screeningtests that are now available.
Johns Hopkins urologistChristian Pavlovich, M.D., explains what you should know.
Prostate Cancer Urine Test
This test detects the gene PCA3 in your urine and can also help your doctorbetter assess your prostate cancer risk.
PCA3 is a prostate-specific noncoding RNA. Its a gene thats only in yourprostate. If the gene is overexpressed , then theres a greater chance you have prostate cancer.
Like PSA and PHI tests, this isnt definitive, either. But data suggestthat when cancer is present, the PCA3 will be positive 80 percent of thetime. This test can also help your doctor determine whether a biopsy isnecessary.
Both of these new tests are more accurate than the PSA test. Your doctormay recommend one or more than one, based on the specifics of your case.
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What Are Normal Psa Levels
ThereÃ¢s no such thing as a normal PSA for any man at any given age, but most men with prostate cancer have a higher than normal level. In general:
If your PSA results are in the borderline range , the % free PSA can be useful in helping distinguish between prostate cancer or benign prostatic hyperplasia . The pattern is the opposite of that seen with PSA in that a high % free PSAÃ¢above 20%Ã¢points to BPH, while a %- free PSA less than 10% indicates a greater likelihood of cancer.
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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:
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New Blood Test For Prostate Cancer
Experimental Test Detects Prostate Cancer, Tells Whether It Is Spreading
The new test looks for a protein called EPCA-2 — or early prostate cancer antigen 2. Unlike the PSA protein on which the current PSA test is based, this protein isn’t found in normal prostate cells. Instead, EPCA-2 occurs in relatively large amounts only in prostate cancer cells.
The test is being developed by Robert H. Getzenberg, PhD, director of urology research at Johns Hopkins University’s Brady Urological Institute. Getzenberg began the work while still at the University of Pittsburgh the test has been licensed to the Seattle biotech firm Onconome Inc.
“We wanted to find something that really identified people with prostate cancer and not people with enlarged or infected prostates,” Getzenberg tells WebMD. “This is as close to cancer specific as we could find. We found it is very unique. It is 97% specific, meaning that if you test positive there’s only a 3% chance you don’t have prostate cancer.”
Getzenberg has a financial interest in the test. But experts who do not stand to gain from the test agree that it has enormous potential.
Otis Brawley, MD, chief of the solid tumor service at Emory University’s Winship Cancer Institute, calls the test “important” and predicts it will be widely used.
Whats A Raised Psa Level
The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood .
If youre aged 50 to 69, raised PSA is 3ng/ml or higher.
A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of another condition thats not cancer, such as:
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What Is A Normal Psa Test Result
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 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.
Why The Test Is Performed
Reasons for a PSA test:
- This test may be done to screen for prostate cancer.
- It is also used to follow people after prostate cancer treatment to see if the cancer has come back.
- If a provider feels the prostate gland is not normal during physical exam.
MORE ABOUT SCREENING FOR PROSTATE CANCER
Measuring the PSA level can increase the chance of finding prostate cancer when it is very early. But there is debate over the value of the PSA test for detecting prostate cancer. No single answer fits all men.
For some men 55 through 69 years old, screening may help reduce the chance of death from prostate cancer. However, for many men, screening and treatment could potentially be harmful instead of beneficial.
Before having the test, talk to your provider about the pros and cons of having a PSA test. Ask about:
- Whether screening decreases your chance of dying from prostate cancer
- Whether there is any harm from prostate cancer screening, such as side-effects from testing or overtreatment of cancer when discovered
Men younger than age 55 have a higher chance of developing prostate cancer and should talk with their provider about PSA screening if they:
- Have a family history of prostate cancer
- Are African American
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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.