Wednesday, June 15, 2022

What Is A High Psa Level For Prostate Cancer

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What Are The Limitations Of The Psa Test

What if my PSA levels are high? | Norton Cancer Institute

The level of PSA is a continuous parameter the higher the value, the higher the probability of having prostate cancer. On the other hand, men may have prostate cancer despite low levels of PSA. In a U.S. prevention study, 6.6% of the men whose PSA level was less than 0.5 ng/mL had prostate cancer. Thus, although age and ethnicity-based normal reference ranges exist, they have limitations. Furthermore, PSA does not allow one to predict the likelihood of clinically significant prostate cancer being present, thus subjecting men to potentially unnecessary biopsy and treatment and the morbidity associated with these.

What Research Has Been Done To Study Prostate Cancer Screening

Several randomized clinical trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and DRE were evaluated for their ability to decrease a mans chances of dying from prostate cancer.

The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but the same rate of deaths from the disease . Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment.

A second large trial, the European Randomized Study of Screening for Prostate Cancer , compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer .

Screening Tests For Prostate Cancer

Screening is testing to find cancer in people before they have symptoms. Its not clear, however, if the benefits of prostate cancer screening outweigh the risks for most men. Still, after discussing the pros and cons of screening with their doctors, some men might reasonably choose to be screened.

The screening tests discussed here are used to look for possible signs of prostate cancer. But these tests cant tell for sure if you have cancer. If the result of one of these tests is abnormal, you will probably need a prostate biopsy to know for sure if you have cancer.

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What Can Lower The Psa Test Results

Medications commonly taken to treat benign enlargement of the prostate such as finasteride , dutasteride , and a combination of dutasteride and tamsulosin can decrease the PSA by about 50% within six to 12 months of starting their use. Another medication used to treat fungal infections, ketoconazole, can also lower PSA levels. Lastly, herbal supplements such as saw palmetto and those containing phytoestrogens, which are plant-derived chemicals with estrogen-like effects, can also lower the PSA level. It is important to tell your health care provider all the medications, both prescription and nonprescription, as well as any herbal preparations or health supplements that you are taking.

Factors That Might Affect Psa Levels

David Samadi, MD

One reason its hard to use a set cutoff point with the PSA test when looking for prostate cancer is that a number of factors other than cancer can also affect PSA levels.

Factors that might raise PSA levels include:

  • An enlarged prostate: Conditions such as benign prostatic hyperplasia, a non-cancerous enlargement of the prostate that affects many men as they grow older, can raise PSA levels.
  • Older age: PSA levels normally go up slowly as you get older, even if you have no prostate abnormality.
  • Prostatitis: This is an infection or inflammation of the prostate gland, which can raise PSA levels.
  • Ejaculation: Thiscan make the PSA go up for a short time. This is why some doctors suggest that men abstain from ejaculation for a day or two before testing.
  • Riding a bicycle: Some studies have suggested that cycling may raise PSA levels for a short time , although not all studies have found this.
  • Certain urologic procedures: Some procedures done in a doctors office that affect the prostate, such as a prostate biopsy or cystoscopy, can raise PSA levels for a short time. Some studies have suggested that a digital rectal exam might raise PSA levels slightly, although other studies have not found this. Still, if both a PSA test and a DRE are being done during a doctor visit, some doctors advise having the blood drawn for the PSA before having the DRE, just in case.
  • Certain medicines: Taking male hormones like testosterone may cause a rise in PSA.

Some things might lower PSA levels :

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Causes Of High Psa Levels Without Prostate Cancer

PSA or prostatic specific antigen is a special protein that is secreted by prostate cells. The PSA test determines the serum levels of this protein in the blood. It has been observed that high PSA levels are usually suggestive of prostate disease but high levels of PSA doesnt always mean that the person is suffering from prostate cancer. High PSA levels that are caused by benign conditions returns to normal levels if inciting source is removed.

What Is Considered An Elevated Psa After Prostatectomy

After radical prostatectomy, the doctors will perform a PSA test in order to determine whether there are some prostate cells left in the body. This usually happens when the disease is advanced at the time of surgery and could have already spread to other parts of the body. It is considered elevated PSA after prostatectomy a PSA greater than 0.2 ng/ml. If the prostate cells are grown enough to generate detectable levels of PSA, this could be an alarming point both for the patient and the doctor.

It is important to note that a level of PSA that is not alarming when first diagnosed with prostate cancer is a reason for concern when being tested after surgery. The reason is that usually, the prostate generates a certain level of PSA. But after being removed, the level of PSA is expected to be zero unless the prostate cells had already spread to other parts of the body.

According to the Prostate Cancer Foundation, about 20-30% of men have PSA recurrence after five years of initial prostate cancer treatment . As a patient, the prospect of PSA recurrence can be very worrisome. What many patients do not know is that not all modified levels of PSA after prostate cancer treatment indicate the same diagnosis. Some types of levels are much more troublesome than others and treatment approaches can vary tremendously case by case. Not all changes in the PSA mean a recurrence of prostate cancer after robotic surgery or other forms of treatment.

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What Is Free/total Psa Ratio

Although prostate cancer cells do not produce more PSA than benign prostate tissue, the PSA produced from cancerous cells appears to escape an enzymatic processing that cleaves the bond between PSA and the protein that binds to it. Therefore, men with prostate cancer have a greater fraction of complexed, or bound, serum PSA and a lower amount of unbound PSA compared with men without prostate cancer. Therefore, the free/total PSA ratio can be additionally used in clinical practice to discriminate between PSA elevation secondary to benign prostatic disease and prostate cancers. This is particularly useful for patients with a total PSA level between 4.0 and 10.0 ng/mL and a negative normal rectal exam to help the health care provider to decide if a biopsy is necessary. In one study, prostate cancer was found in 56% of men with a free/total PSA less than 0.10 but in only 8% of men with free/total PSA greater than 0.25 . Nevertheless, the concept of free PSA must be used with caution as several factors may influence the free/total PSA ratio such as temperature and prostate size. Furthermore, the free PSA measurement is not clinically useful for patients with total serum PSA values less than 10.0 ng/mL or in the follow-up of patients with known prostate cancer.

My Psa Is Elevated What Happens Next

Prostate Cancer 101: So Your PSA Is High, What Now?

Men who have undergone a prostate-specific antigen test that resulted in a high PSA number may have questions: What could an elevated PSA indicate? and, What can I do next for my health?

Herbert Ruckle, MD, FACS, chair of Loma Linda University Healths Urology Department, answers your top questions about receiving and interpreting an elevated PSA result and what to expect thereafter. It is important for men to know their PSA number and understand what it means, so they can engage in shared decision making with their doctor and decide what is best for their care moving forward, he says.

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Prostatitis: A Common Problem In Men Under 50

“The PSA test is a good screening tool for prostate cancer, but it is not very specific,” says Erik P. Castle, MD, a urologist and researcher at the Mayo Clinic in Phoenix, Arizona. “Common causes of inflammation in the gland, called prostatitis, can cause high PSA levels.”

Prostatitis is the most common prostate problem for men younger than 50.

Prostatitis caused by bacteria can be treated with antibiotics. Another, more common type of prostatitis, called nonbacterial prostatitis, can be harder to treat and may last a long time.

What Is Prostate Intraepithelial Neoplasia Or Atypical Or Suspicious Cells On Biopsy

In about 10% of prostate needle biopsy reports, the pathologist will tell us that the final diagnosis is neither benign nor malignant. They describe this condition as

  • High Grade Intraepithelial Neoplasia
  • A premalignant condition
  • Biopsy should be repeated soon
  • 25% risk of cancer on repeat biopsy
  • Low Grade Intraepithelial Neoplasia
  • Repeat biopsy is not indicated unless there is a rise in PSA
  • Atypia

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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.

What Psa Level Indicates Prostate Cancer

Prostate

    Prostate-specific antigen is a protein produced by both healthy and cancerous cells in the prostate gland. While a small amount of this protein is normally found in the blood, PSA blood levels are usually elevated in men who have prostate cancer.

    As with all cancers, early detection of prostate cancer is important to ensure timely and appropriate treatment. Additionally, this type of cancer, which is very common, tends to progress gradually over the course of many years and may not show symptoms in its earliest stages. To screen men for early signs of prostate cancer, a relatively simple blood test known as a PSA test may be recommended. This test, which measures the level of PSA in the blood, is often performed along with a digital rectal exam.

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    What Secondary Tests Are Available To Me

    Various secondary testing methods are at your disposal should you need more information before engaging in shared decision-making with your physician about further prostate cancer screening. It could also be helpful if your PSA test or rectal exam results place you in a “gray area” of risk for prostate cancer.

    • PSA free-to-total-ratio, or prostate health index : can help improve the accuracy of the standard PSA test by discerning whether your risk of having prostate cancer is as low as 10% or as high as 50%.
    • PSA velocity: If you’ve had previous PSA tests, your physician will look at them to determine how quickly your PSA levels have changed over time. A steep PSA level increase over a short period often correlates with a prostate cancer diagnosis, Ruckle says.
    • Urine tests: One of which detects PCA3, a noncoding RNA gene that is only in your prostate. Too many copies of PCA3 in the urine indicate a greater chance of having prostate cancer.
    • MRI of the prostate to image for biopsy targets.

    Based on any of these results, the doctor will recommend a prostate biopsy if they suspect cancer.

    In Men Over : Bph May Be The Cause Of High Psa

    Benign prostatic hyperplasia is an enlargement of the prostate gland, but its not prostate cancer. “BPH means more cells, so that means more cells making PSA,” explains Dr. Castle.

    BPH is the most common prostate problem in men over age 50. It may not need to be treated unless its causing frequent or difficult urination.

    Your primary care doctor may be able to tell the difference between BPH and prostate cancer by doing a digital rectal exam, but commonly this will require evaluation by a urologist and further testing, such as a biopsy or imaging studies.

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    What Else Can Cause An Elevated Psa Besides Prostate Cancer

    If you are a man in your 50s or older, you likely have a PSA drawn with your routine annual blood work. For men who receive an elevated PSA result, prostate cancer may be an immediate concern. However, prostate cancer is not the only condition that can cause the PSA to become elevated. Board-certified urologists Drs. Ahmad and Ali Kasraeian and the expert team at Kasraeian Urology in Jacksonville, FL have a deep understanding of the complex behavior of the PSA and carefully monitor patients PSA levels to identify any cause for concern. Learn more about PSA elevations here, including why other than prostate cancer your PSA may be high.

    How Fusion Guided Biopsy Works

    PSA Levels After Prostate Cancer Treatment

    First, a patient will have a prostate MRI. The MRI will image the prostate and any abnormalities in much greater detail than the ultrasound used for traditional biopsies. This allows the radiologist to better distinguish between abnormal and regular tissue.

    Next, the patient will have an ultrasound-guided biopsy. A special machine attaches to the ultrasound probe and overlays the MRI image onto the ultrasound image. So when the doctor moves the ultrasound probe, the detailed MRI image moves with it in real time.

    The doctor then biopsies the prostate with fine needles, using the MRI image to guide the needles directly to the areas with tumors or abnormal tissue. Because the MRI images are so detailed, doctors can more precisely target exactly where they need to biopsy. This means that far fewer clinically significant tumors are missed. This strategy also helps reduce the number of biopsies a patient might need by giving the doctor better information the first time.

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    Psa And Prostate Cancer: What Do My Numbers Mean

    The prostateis a walnut-sized gland that sits below the bladder in men. It is responsible for creating semen, the milky liquid that carries sperm out of the body when a man ejaculates.

    A PSA test is a blood test used to screen for prostate cancers. PSA is a protein produced in the prostate by both cancerous and noncancerous tissue. Elevated PSA levels can indicate the presence of cancer, but high PSA levels can also be a result of non-cancerous conditions like benign prostatic hyperplasia , or an infection. PSA levels also rise naturally as you age.

    Elevated PSA levels do not necessarily mean that you have prostate cancer. PSA tests arent always accurate: many men who have prostate cancer have normal PSA levels. Alternatively, some men have high PSAs but dont have cancer. Or they have a slow growing form of cancer that would never have had symptoms or caused them any harm.

    At What Age Should You Get Screened For Prostate Cancer

    The following prostate cancer screening guidelines apply to men expected to live at least ten years.

    Men ages 45 to 49 should have a baseline PSA test.

    • If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
    • If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
    • If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test between the ages of 51 and 55.

    Men ages 50 to 59 should have their PSA level checked.

    • If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
    • If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
    • If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test at age 60.

    Men ages 60 to 70 should have their PSA level checked.

    • If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
    • If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
    • If the PSA level is less than 1 ng / mL, no further screening is recommended.

    Men ages 71 to 75 should talk with their doctor about whether to have a PSA test. This decision should be based on past PSA levels and the health of the man.

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