What Do You Say To Patients Diagnosed With Prostate Cancer
Something I say to my patients a lot is that, in treating prostate cancer, we end up trying to extend your quantity of life at the cost of your quality of life. And so, at some point, if the quantity is extended a lot, and we can minimize the effect on quality, that makes sense, but the equation is different for every man. How much decrease in quality of life are you willing to accept if were going to extend your life?
Realistically, a lot of guys who are 70 dont have any sexual function anyway, so thats not a huge loss for them. As men get older theres definitely an increased chance of having erectile dysfunction the guys who have sexual function over 70 are very keen on preserving it. Even for the guys who dont have good sexual function, who are on Viagra, for them its often even more important to preserve what sexual function they have.
Psa Levels By Age Chart
The main difference between the PSA scores of prostatitis and an enlarged prostate, compared to prostate cancer, is the ratio of free vs bound PSA within your test sample.
- Prostate Cancer will have a higher bound PSA ratio.
- An enlarged prostate and prostatitis will have a higher free PSA ratio.
- If your free PSA results are less than 25%, your risk for developing prostate cancer is between 10% to 20%.
- If your free PSA results are less than 10%, your risk for developing prostate cancer jumps to around 50%.
Do All Men Who Are Treated For Prostate Cancer Lose Sexual And Urinary Function
Its definitely not true that all men are incontinent and impotent after treatment for prostate cancer. Urinary incontinence is usually temporary.
There can be a sexual impact for guys who have normal function. If the cancer is near their nerve bundle, theyre going to have a decrease in sexual function. If its not, and we can do bilateral nerve sparing surgery, studies show 70 percent can get back their normal sexual function. It all depends on where the cancer is. But the truth is that we cant predict very well who will be the 30 percent who will haveor still haveED some already do have ED because of age, diabetes, hypertension or renal failure.
What Does Prostate Cancer Screening Entail
There are two types of prostate cancer screening exams and both should be done in conjunction with the other: A digital rectal exam and a prostate-specific antigen blood test .
A DRE is a physical exam in which the physician lubricates a gloved finger to gently examine the patients rectum. If it is enlarged or irregular in shape, the doctor will be able to easily detect it. While it may be uncomfortable, the test brief and can be life-saving.
A PSA test is a blood test that measures the level of prostate-specific antigens in the blood. Rising levels of PSA can be one of the first signs of prostate cancer, allowing for early detection and treatment.
What Happens After The Exam
When abnormalities are found with the rectal exam, the doctor will order a PSA test. After the results for PSA testing are returned, the doctor will analyze the measurements of prostate-specific antigen in the patients blood.
The findings of the PSA test determine what the doctor will do next.
If the doctor suspects prostate cancer, other tests may be requested. A transrectal ultrasound is often requested. This gives the doctor a visual view of the patients prostate gland.
Cancerous growths can be observed through this type of ultrasound test. The test is also relatively quick to perform. Men may experience discomfort when an ultrasound is performed. The discomfort should not last long, however.
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Who Should Get A Prostate Exam
Starting at age 50, all men should discuss prostate cancer screening with their doctor. The American Cancer Society advises men at higher risk to have this conversation at age 45.
Youre considered to have an increased risk if youre African-American or if a first-degree relative had prostate cancer before age 65. If more than one first-degree relative had prostate cancer before age 65, you might want to consider beginning prostate cancer screening even earlier.
The ACS estimates there will be about 26,120 men will die from it.
Prostate cancer is easier to treat before it spreads. However, some prostate cancers are so slow-growing that they dont always require treatment. A lot depends on your age and other factors.
Discuss your risk factors with your doctor, and ask if you should have a prostate exam as part of your yearly checkup.
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 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. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:
What Are The Risks Of A Prostate Exam
In the medical community, there is some controversy regarding the risks and benefits of a prostate exam. When a DRE is performed and irregularity is detected, 50% of the time there is prostate cancer and 50% of the time there isnt. The risk, then, becomes over-treatment.
Although not a physical health risk, the possibility of further testing, such as a prostate biopsy or an MRI of the prostate, can be anxiety-provoking.
Overall, the benefits highly outweigh the risks. Patients should discuss the pros and cons of prostate cancer screening with their physician to make the best decision for their health.
As men age, they can face physical, sexual and medical health concerns that have an impact on their everyday lives. Making healthy lifestyle choices, like exercising regularly and eating a healthy diet, along with regular checkups and screening tests can help prevent or lead to early treatment of many men’s health threats.
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Noncancerous Causes Of A High Psa
The PSA test was originally approved by the U.S. Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men diagnosed with the disease. By 1994, it was clear that the test also had value in detecting prostatic inflammation in otherwise symptom-free men.
While prostate cancer is the main focus reason for this test, other noncancerous conditions can also cause the PSA to rise. The most common of these is prostatitis .
Prostatitis is, in fact, the most common cause of prostate problems in men under 50 and can take several forms:
- Acute bacterial prostatitis, most often caused when bacteria leaks from the urinary tract into the prostate gland
- Chronic bacterial prostatitis, characterized by persistent inflammation
- Chronic non-specific prostatitis, for which there may be symptoms but no known cause
- Chronic asymptomatic prostatitis, for which inflammation is present but with no symptoms
Another cause for elevated PSA levels is benign prostatic hyperplasia , a condition by which the gland itself becomes enlarged. BPH is primarily seen in older men and may cause uncomfortable urinary symptoms, including the impairment of the urinary flow. While it isn’t entirely clear what causes BPH, many believe it to be related to changes in sex hormones as men get older.
What To Do If You Have Symptoms
Talk to your GP if you’re worried about symptoms or have noticed any unusual or persistent changes.
Screening for prostate cancer 2013Cochrane Database of Systematic Reviews D Ilic, MM Neuberger, M Djulbegovic, P Dahm
Effect of a low-intensity PSA-based screening intervention on prostate cancer mortality: the CAP randomized clinical trial Richard M Martin PhD and othersJAMA, 2018. Volume 319, Pages 883-895
Mortality Results from a Randomized Prostate-Cancer Screening TrialGL Andriole and othersThe New England Journal of Medicine, 2009. Vol 360, Issue 13
Randomised prostate cancer screening trial: 20 year follow-upG Sandblom and othersBritish Medical Journal, 2011. Vol 342, Issue 1539
Prostate cancer risk management programme : benefits and risks of PSA testingPublic Health England, 2016
Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer at 13 years of follow-upFH Schroder and others
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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.
Average Psa Test Doubling Time
Another red flag. This calculation denotes the time it takes your PSA values to double.
Therefore it may signify the aggressiveness of any prostate abnormalities, whether it’s an enlarged prostate, prostatitis, or prostate cancer.
If your average PSA readings double in less than three years your doctor will most likely order a biopsy, to look in to the problem further and discuss possible prostate cancer treatment options.
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.
What To Expect During Your Prostate Exam
If you’ve been avoiding a prostate exam, you could be putting your health at risk. Knowing the facts about the procedure will help put any fears, concerns, or squeamishness to rest.
If you’re a man older than 40 and have not yet had a prostate exam, it’s a good time to talk to your doctor. If you’re also African American or have a family history of prostate cancer, it’s a really good time. One of six men eventually gets a prostate cancer diagnosis. And even though most men have a slow-growing type, prostate cancer is still the leading cause of cancer deaths in men older than 75. So if you’re afraid of a prostate exam, it’s time get over it and protect your prostate health.
“Start talking about your prostate care plan at age 40, and if you and your doctor think the time is right, get a digital rectal exam and a PSA blood test during your annual physical,” suggests Dan Zenka, senior vice president of the Prostate Cancer Foundation and a prostate cancer survivor who was diagnosed at age 51 in 2010.
What to Expect During a Primary Care Prostate Health Exam
Your doctor will probably start by asking you if you have any prostate health symptoms like a weak urine stream, dribbling, straining to urinate, or blood in your sperm or urine. Your doctor may also ask if you have a father or a brother with prostate cancer – and if the doctor doesn’t ask, volunteer the information.
Here are the two tests that will be done:
What to Expect if You Need a Prostate Cancer Exam
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What Are Some Common Prostate Problems
The most common prostate problem in men younger than age 50 is inflammation, called prostatitis. Prostate enlargement, or benign prostatic hyperplasia , is another common problem. Because the prostate continues to grow as a man ages, BPH is the most common prostate problem for men older than age 50. Older men are at risk for prostate cancer as well, but it is much less common than BPH.
Men At Higher Risk Of Prostate Cancer
Some men are at higher risk of prostate cancer than others. These are:
- black men
- men who have a family history of prostate cancer
The risk of prostate cancer also increases as men get older.
The evidence so far doesnt suggest that routinely screening these men would help prevent deaths from prostate cancer. In fact, it might lead to men having treatment for prostate cancer even though that cancer wouldnt have caused any problems or symptoms.
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What Is Screening For Prostate Cancer
Some men get a PSA test to screen for prostate cancer. Talk to your doctor, learn what is involved, and decide if a PSA test is right for you.
Cancer screeningexternal icon means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.
There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.
Are You Seeing Prostate Cancer Becoming More Prevalent In Younger Patients
Its pretty rare. Its less common that men in their 40s have prostate cancer, but, we also are very rarely screening them. The young men who come in to be screened tend to have one of those high-risk features. They most likely had a father who had prostate cancer, so theyre nervous about it. Or theyre African-American, and theyve been flagged by their health care providers.
If youre young, your quality of life is even more important to you right now. We know that, if diagnosed with low-grade prostate cancer, a person will need treatment at some time in life. If we can delay treatmentwhich could negatively impact urinary or sexual functionby several years, then we should do that and obviously discuss that there is a low but possible chance of metastasis developing during that time.
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The Test Is Often Not Needed
Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:
- An enlarged prostate gland.
- Recent sexual activity.
- A recent, long bike ride.
Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.
Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.
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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Should I Have A Psa Test
If you have no symptoms of prostate cancer and are thinking about having a PSA test, you should ask your doctor about the risks and benefits.
While some studies suggest PSA reduces mortality on a population basis, the test picks up large numbers of cancers that would have caused no symptoms or harm in the patient. This is known as overdiagnosis. Overdiagnosis of prostate cancer can lead to unnecessary treatments that have side effects such as sexual impotence, urinary incontinence and bowel problems.
It is important to balance the potential benefit of detecting a prostate cancer early against the risk that detection and treatment may not be necessary. Treatment may affect your lifestyle but it may also save your life.
Make your own decision about whether to be tested after a discussion with your doctor. Ensure you get good quality information to make an informed decision.
Screening tests for breast, bowel and cervical cancer can save lives, but there is still confusion around PSA testing for prostate cancer. Find more information here.
Remember, if you have any concerns or questions, please contact your doctor.