Screenings Can Lead To High Costs
The cost for a PSA test is fairly lowabout $40.
If your result is abnormal, the costs start adding up. Your doctor will usually refer you to a urologist for a biopsy. Costs may include:
- A consultation fee .
- An ultrasound fee .
- Additional professional fees .
- Biopsy fees .
If the biopsy causes problems, there are more costs. You might also have hospital costs.
Possible Harms From Diagnosis
Screening finds prostate cancer in some men who would never have had symptoms from their cancer in their lifetime. Treatment of men who would not have had symptoms or died from prostate cancer can cause them to have complications from treatment, but not benefit from treatment. This is called overdiagnosis.
Prostate cancer is diagnosed with a prostate biopsy. A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope to see if there are cancer cells. Older men are more likely to have a complication after a prostate biopsy.
A prostate biopsy can cause
- Pain.
- Blood in the semen or ejaculate.
- Infection.
The #1 Question On Your Mind And First One To Ask
Thefirst thing that you will hear is whether the prostate biopsy showed cancer or not. This is the answer to the question that we have been waiting for.
Your urologist will hopefully say that the biopsy is BENIGN. Benign means that there is no cancer tissue seen. HOORAY.
On the other hand, the urologist may say the biopsy showed a MALIGNANCY. This means that the results showed cancer .
Now, here is another confusing, but possible scenario. The urologist may say that the biopsy results was neither benign nor malignant. Huh? What could that mean?
There are two other possibilities that the biopsy could show. It can also potentially show HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA or ATYPICAL SMALL ACINAR HYPERPLASIA . Lets talk about these separately.
For HGPIN, it matters about the number of cores involved. If there was only one sample that showed this, then no worries, your prostate biopsy is the same as one that has no cancer. If there were multiple cores of HGPIN or if the biopsy showed ASAP, then the urologist will recommend a repeat biopsy as there is a possibility that there was cancer that was missed.
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How We Approach Prostate Biopsies And Prostate Cancer Diagnosis At Ctca
When you come to CTCA for a prostate biopsy or a second opinion, youll have access to tests that may help increase the accuracy of each biopsy. Our team has expertise with these tests and procedures, allowing us to work quickly and efficiently.
If youre diagnosed with prostate cancer, a multidisciplinary team of genitourinary experts, which may include a urologist, a urologic oncologist, a radiation oncologist and a medical oncologist, will review your case and develop a personalized plan based on your specific circumstances and needs.
We only treat cancer at CTCA, which means our cancer experts are skilled at assessing risk associated with each persons circumstances. We give you the pros and cons of the treatment options available to you, allowing you time to talk with your team of doctors and other experts about those options.
Our cancer experts are also vigilant about what patients need and when they need it. We know that when men are told they have slow-growing prostate cancer, some of them wont keep up with the necessary follow-ups, so we help keep them on track.
If you choose to receive treatment with us, you may benefit from our integrative approach to cancer treatment. Our multidisciplinary team works together to help prevent and manage the side effects of cancer and its treatment, providing supportive care services, such as:
How Is The Psa Test Used In Men Who Have Been Treated For Prostate Cancer
The PSA test is often used to monitor patients who have a history of 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 other clinical signs and symptoms of prostate cancer recurrence.
However, a single elevated PSA measurement in a patient who has a history of prostate cancer does not always mean that the cancer has come back. A man who has been treated for prostate cancer should discuss an elevated PSA level with his 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.
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What Does The Equipment Look Like
Ultrasound equipment:
Ultrasound scanners consist of an electronic console containing a computer, video monitor, and a handheld transducer . The transducer sends out inaudible high frequency sound waves into the body and listens for the returning echoes. The principle is similar to the sonar used by boats and submarines.
The computer displays the ultrasound image on a video monitor. This image is based on the amplitude and frequency of the signal. It is also based on signal travel time, tissue composition, and the type of body structure through which the sound travels.
The ultrasound probe for a prostate biopsy is about the size of a finger. Once the doctor inserts the probe into the rectum, they take tissue samples using a spring-driven needle core biopsy device . The handheld device includes a long but very thin needle. The needle opens inside the prostate, takes the sample, and then closes.
MRI equipment:
The traditional MRI unit is a large cylinder-shaped tube surrounded by a circular magnet. You will lie on a table that slides into a tunnel towards the center of the magnet.
What Are The Symptoms Of Prostate Dysfunction
Not all prostate cancer patients experience prostate symptoms. However, according to the National Institute on Aging, the most common symptoms of prostate problems include:
- Increased frequency of urination
- Sexual dysfunction
- Painful back, hips, pelvis, or rectum
If you are experiencing these symptoms, please seek medical care as soon as possible. They may indicate inflammatory conditions like BPH , prostatitis , an infection of the prostate, bladder, or other organs, or other diseases like STDs and cancer.
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Before Your Prostate Mri
Your doctor and his team should be able to reassure you that MRI is radiation-free, make you comfortable with going through the scan, and explain what is meant by significant prostate cancer and why MRI excels at identifying it.
- What do I need to do to prepare?
- How long will the scan last?
- What if Im claustrophobic?
- Is there any radiation or side effects from MRI?
- Do you use an endorectal coil?
- Will I need an IV injection of a contrast agent?
- Can the MRI tell me if I have prostate cancer?
- Whats the difference between insignificant and significant prostate cancer?
- Why is MRI better at finding significant prostate cancer?
- What else can it tell me about my prostate gland?
Further Testing For Advanced Cancer
If there’s a significant chance the cancer has spread from your prostate to other parts of the body, further tests may be recommended.
These include:
- an MRI scan, CT scan or PET scan these scans build a detailed picture of the inside of your body
- an isotope bone scan, which can tell if the cancer has spread to your bones a small amount of radiation dye is injected into the vein and then collects in parts of the bone where there are any abnormalities
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Controversies And Misconceptions Surrounding Prostate Biopsies
The PSA test measures the levels of PSA proteins in the body, and when it was first developed, it was quickly implemented by many physicians as a screening test for prostate cancer. The thought was that since PSA proteins are only produced by the prostate, elevated levels could be an indication of prostate cancer. As a result, most men with an abnormal PSA test underwent a prostate biopsy.
The increase in biopsies resulted in the number of advanced, untreatable prostate cancers decreasing significantly because more prostate cancers were caught earlier, when the disease is easier to treat. But the problem with many patients being diagnosed sooner was that some patients were being aggressively treated when they should have been monitored instead.
Though many in the field of urology believe it was flawed, a controversial study attempted to assess the benefits of the PSA test as a screening tool for prostate cancer, and its results led to the recommendation that most men shouldn’t get the test because it didnt appear to improve mortality rates from prostate cancer. This, combined with growing awareness that many cases of prostate cancer were being treated unnecessarily or prematurely, led to a reduction in prostate biopsies. This controversy led to a reduction in prostate cancer screening and an increase in the number of diagnoses of advanced prostate cancer.
What Kind Of Treatment Will I Need
There are many ways to treat prostate cancer. The main kinds of treatment are observation, active surveillance, surgery, radiation, hormone therapy, and chemo. Sometimes more than one kind of treatment is used.
The treatment thats best for you will depend on:
- Your age
- Any other health problems you might have
- The stage and grade of the cancer
- Your feelings about the need to treat the cancer
- The chance that treatment will cure the cancer or help in some way
- Your feelings about the side effects that might come with treatment
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What If A Screening Test Shows An Elevated Psa Level
If a man 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 man continue with PSA tests and DREs at regular intervals to watch for any changes over time.
If a mans PSA level continues to rise or if a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. A urine test may be recommended to check for a urinary tract infection. The doctor may also recommend imaging tests, such as a transrectal ultrasound, x-rays, or cystoscopy.
If prostate cancer is suspected, the doctor will 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. Most often, the needles are inserted through the wall of the rectum . A pathologist then examines the collected tissue under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to diagnose prostate cancer.
Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11 and 18F-DCFPyl , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body.
The pictures from a PET scan arent as detailed as MRI or CT scan images, but they can often show areas of cancer anywhere in the body. Some machines can do a PET scan and either an MRI or a CT scan at the same time, which can give more detail about areas that show up on the PET scan.
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Study: New Prostate Cancer Test Could Avoid Unnecessary Biopsies
Urine test found to be extremely accurate at detecting aggressive prostate cancer with few false negatives.
A urine test based on University of Michigan Rogel Cancer Center research could have avoided one third of unnecessary prostate cancer biopsies while failing to detect only a small number of cancers, according to a validation study that included more than 1,500 patients. The findings appear in the March issue of the Journal of Urology.
The MyProstateScore test, which is being commercialized by LynxDX, a U-M startup company, measures levels of cancer-specific genes in a patients urine. It is based on U-M research that discovered that half of all prostate tumors harbor a certain genetic anomaly in which the genes TMPRSS2 and ERG relocate on a chromosome and fuse together creating an on-switch for prostate cancer development.
Currently, one of doctors best methods for detecting prostate cancer is a blood test for prostate-specific antigen, commonly known as the PSA test. Elevated PSA levels may indicate cancer, but the majority of men with an elevated PSA do not actually have prostate cancer.
Our ultimate goal was to determine whether the MyProstateScore test could be a practical, reliable test that could rule out the need for more costly or invasive testing in men referred for a prostate biopsy, says study lead author Jeffrey Tosoian, M.D., M.P.H., a clinical lecturer in urology at Michigan Medicine.
What Happens After A Biopsy
A negative biopsy indicates that none of the biopsy samples found any evidence of prostate cancer. This is usually good newshowever, this does not necessarily mean that there is no prostate cancer present. Your doctor may want to continue to monitor your PSA levels or do a repeat biopsy at some point in the future.
A positive biopsy indicates that there is evidence of prostate cancer. This would be considered a diagnosis of prostate cancer. At this point, you should also have some idea of the approximate location, size, and aggressiveness of the cancer. What happens next is a decision between you and your doctor. There are some additional tests you can take to give you a better idea of your diagnosis. For example, genomic tests can help provide information on how likely your cancer is to spread, or how aggressive it is likely to be.
In addition, there are additional new tests that can be performed with a biopsy to help make diagnosis and determine the aggressiveness of the cancer:
- ERG Protein Marker
- A marker used on prostate tissue after a biopsy, which measures ERG protein assays. This helps doctors identify patients who have the disease or have pre-cancerous lesions that indicate a patient is more likely to develop prostate cancer over time.
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What Is A Trus Biopsy
This is the most common type of biopsy in the UK. The doctor or nurse uses a thin needle to take small samples of tissue from the prostate.
Youll lie on your side on an examination table, with your knees brought up towards your chest. The doctor or nurse will put an ultrasound probe into your back passage , using a gel to make it more comfortable. The ultrasound probe scans the prostate and an image appears on a screen. The doctor or nurse uses this image to guide where they take the cells from. If youve had an MRI scan, the doctor or nurse may use the images to decide which areas of the prostate to take biopsy samples from.
You will have an injection of local anaesthetic to numb the area around your prostate and reduce any discomfort. The doctor or nurse then puts a needle next to the probe in your back passage and inserts it through the wall of the back passage into the prostate. They usually take 10 to 12 small pieces of tissue from different areas of the prostate. But, if the doctor is using the images from your MRI scan to guide the needle, they may take fewer samples.
The biopsy takes 5 to 10 minutes. After your biopsy, your doctor may ask you to wait until you’ve urinated before you go home. This is because the biopsy can cause the prostate to swell, so they’ll want to make sure you can urinate properly before you leave.
What Are The Side Effects Of A Prostate Biopsy
- Infection. The most common risk associated with a prostate biopsy is infection. Rarely, men who have a prostate biopsy develop an infection of the urinary tract or prostate that requires treatment with antibiotics.
- Bleeding at the biopsy site. Rectal bleeding is common after a prostate biopsy. If taking blood thinners, talk to the doctor about how to manage them before and after the treatment.
- Blood in your semen. Its common to notice red or rust coloring in semen after a prostate biopsy. This indicates blood, and its not a cause for concern. Blood in semen may persist for a few weeks after the biopsy.
- Difficulty urinating. In some men, prostate biopsy can cause difficulty passing urine after the procedure. Rarely, a temporary urinary catheter must be inserted.
Because of these side effects, it can be a good idea to try to eliminate other possible causes of an elevated PSA or abnormal DRE before undergoing a biopsy.
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