What Are Normal Psa Levels By Age
The definition of physiological PSA levels remains an active debate. 2.5 ng/mL is safe. 2.6 to 4 ng/mL is safe in most men but talk with your doctor about other risk factors. 4.0 to 10.0 ng/mL is suspicious. Although this is not always the case. Men with high PSAs do not always have prostate cancer, while men with very low PSAs sometimes DO have prostate cancer. The prostate gland increases in size and produces more PSA as you get older.
Note that the American Urological Association recommends against routine PSA screening in men aged less than 54 years . If your PSA test result is high for your age or persistently increasing, a prostate biopsy may be recommended.
Your health care provider should consider conditions that can elevate PSA levels before recommending a prostate biopsy.
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What Does An Elevated Psa Level Mean If Ive Had Prostate Cancer In The Past
If youve ever had treatment for prostate cancer, youll have regular PSA screenings for the rest of your life. An increasing PSA level may mean the cancer has returned. Your care team may use other tests, including imaging scans and biopsies, to check for signs of cancer. If cancer returns, your team will discuss your treatment options with you.
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What Happens During A Digital Rectal Exam
Your health care provider will insert a gloved finger into the rectum and feel the prostate for hard, lumpy, or abnormal areas. The test takes only a few minutes to complete.
You may feel slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate.
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Does My Psa Level Determine Whether I Have Prostate Cancer
Your provider looks at two factors related to your PSA:
- Your PSA level: A higher level means a higher risk of prostate cancer.
- A continuous rise: PSA levels that continue to rise after two or more tests may mean you have cancer.
But the PSA level alone doesnt determine if you have cancer or not. Two men can even have the same PSA levels but different risks of prostate cancer. And a high PSA level may reflect prostate problems that arent cancer.
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When Should I Have My Psa Levels Tested
The first thing to do is talk to your doctor about the pros and cons of prostate cancer screening before you decide whether to be tested. Donât get tested until you have that talk. Opinions differ about when you should do that.
The American Cancer Society says to get tested at age:
- 40 or 45 if youâre at high risk
- 50 if youâre at average risk
The American Urological Association suggests:
- Under 40: No screening
- 40 to 54: No screening if youâre at average risk. If youâre at a high risk, you and your doctor can decide.
- 55 to 69: Screening if your doctor suggests
- Over 70 or less than a 10-15 year life expectancy: No screening
The U.S. Preventive Services Task Force says:
- 55 to 69: Men with prostate cancer risks may need testing.
If your doctor thinks you might have prostate cancer based on either a PSA level or a rectal exam, a biopsy is the next step. This is a test where the doctor takes a small amount of tissue from your prostate and sends it to a lab for tests. Itâs the only way to be sure you have cancer.
Lymph Node Biopsy As A Separate Procedure
A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.
Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.
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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.
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.
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What Is Done If A Screening Test Shows An Elevated Psa Level
If someone who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to have an elevated PSA level, the doctor may recommend another PSA test to confirm the original finding. If the PSA level is still high, the doctor may recommend that the person continue with PSA tests and digital rectal exams at regular intervals to watch for any changes over time .
If the PSA level continues to rise or a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. These may include imaging tests, such as magnetic resonance imaging or high-resolution micro-ultrasound.
Alternatively, the doctor may recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. The biopsy needle may be inserted through the wall of the rectum or through the perineum . A pathologist then examines the collected tissue under a microscope. Although both biopsy techniques are guided by ultrasound imaging so the doctor can view the prostate during the biopsy procedure, ultrasound cannot be used alone to diagnose prostate cancer. An MRI-guided biopsy may be performed for patients with suspicious areas seen on MRI.
Advising Men Without Symptoms Of Prostate Disease Who Ask About The Psa Test
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Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
This publication is available at https://www.gov.uk/government/publications/prostate-specific-antigen-testing-explanation-and-implementation/advising-well-men-about-the-psa-test-for-prostate-cancer-information-for-gps
This prostate cancer risk management programme information helps GPs give clear and balanced information to asymptomatic men who ask about prostate specific antigen testing. The PSA test is available free to any man aged 50 and over who requests it.
GPs should use their clinical judgement to manage asymptomatic men and those aged under 50 who they consider to be at increased risk of prostate cancer.
GPs should follow National Institute for Health and Care Excellence guideline NG12 for the management of men who have symptoms of prostate disease.
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There Are Risks To Getting Prostate Cancer Tests And Treatments
If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.
Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.
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How To Prepare For An Accurate Psa Test
One of the most important factors in determining the accuracy and reliability of a medical test is how you, the patient, prepare for it. From fasting before certain blood tests to refraining from certain foods or medications, these criteria are vital for getting the most precise results possible.
A prostate specific antigen test for detecting elevated PSA levels possibly indicating prostate cancer, is one such procedure that relies on men preparing for and avoiding certain activities days before the actual test.
Since the PSA value can change by 15-20% depending on how and when the test is administered, to improve the accuracy, there are certain things a man should avoid to get the most accurate reading possible. Here is a list of what men should not do before a PSA test:
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.
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What Is The Test To See If I Have Elevated Psa
Healthcare providers use a blood test to measure PSA levels.
You may have a digital rectal exam together with a PSA test to check for signs of prostate cancer. During a DRE, your provider inserts a gloved finger into the rectum to check for bumps or other irregularities.
Depending on the results of your initial test, your provider may want you to repeat the test. PSA levels can change. A second test gives your provider more details about your prostate health.
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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What Is It Used For
A PSA test is used to screen for prostate cancer. Cancer screening means looking for signs of cancer before it causes symptoms. But screening tests can’t diagnose cancer. If a screening test finds signs of cancer, you’ll need other tests to find out if you have cancer and how serious it may be.
Most types of prostate cancer grow very slowly. They don’t spread beyond the prostate and may never cause health problems. In fact, you can live a long life with prostate cancer and never know you have it. The goal of prostate cancer screening is to help find cancers that may be more likely to spread so they can be treated early. But there are challenges and possible harms from using a PSA test to screen for prostate cancer:
- A PSA test can’t tell the different between abnormal PSA levels from prostate cancer and noncancerous conditions. If your PSA level is high, a prostate biopsy is the only way to find out if the cause is cancer. And prostate biopsies have possible harms.
- A PSA test may lead to finding and treating prostate cancer that would never have affected your health. If prostate cancer is found:
- It can be difficult to tell the difference between slow-growing cancers and those that are likely to grow faster and spread in your body.
- You could have prostate cancer treatment that you never really needed. And cancer treatment may cause serious harms, such as:
- Problems controlling your bowels
PSA testing may also be used to:
Use In Men Already Diagnosed With Prostate Cancer
The PSA test can also be useful if you have already been diagnosed with prostate cancer.
- In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
- The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
- PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .
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To Test Or Not To Test For Psa Levels The Question Remains In Prostate Cancer
As PSA testing recommendations change and the debate surrounding testing continues, people with a high-risk of prostate cancer and their families need to stay informed.
John Salata says he is grateful his prostate-specific antigen was tested when it was, even if it was by accident.
When Salata was 48, his primary care doctor mistakenly checked the box for a PSA test when ordering his panel of bloodwork. When Salatas score came back high, she referred him to a urologist who gave him an antibiotic.
A few months later, his PSA tested even higher. He had a biopsy and received a diagnosis of cancer. He had a radical prostatectomy in January 2011.
When the pathology came back, it was 60% cancerous and it had spread beyond the surgical margins, Salata recalls. If we hadnt found it, then it probably would have spread outside the prostate within a few years. It would have spread throughout the body. Even at that point in time there are usually no symptoms, so there wouldve been no need for me to see a doctor. Because the guidelines didnt recommend testing until 55 or 60, it would have gone unnoticed for some time. Then once youre at stage 4, the care is generally palliative.
Changes in recommendations for PSA testing as a screen for prostate cancer are a frequent occurrence. Why is it so difficult to decide whether or when it should be done? And what do the changes mean for men over the age of 50 as they enter the risk zone for this cancer type?
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.
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