Is The Psa Test Recommended For Prostate Cancer Screening
Until about 2008, some doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50. Some organizations recommended that men who are at higher risk of prostate cancer, including African-American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45. However, as more was learned about both the benefits and harms of prostate cancer screening, a number of organizations began to caution against routine population screening. Most organizations recommend that men who are considering PSA screening first discuss the risks and benefits with their doctors.
Currently, Medicare provides coverage for an annual PSA test for all Medicare-eligible men age 50 and older. Many private insurers cover PSA screening as well.
Choosing Between A Prostate Mri Vs Biopsy
Whats worse than a false-positive PSA? A false-negative biopsy.
Research shows that 35% of biopsy results are false negatives. This means despite the invasive sampling of tissues, cancer can go undetected and continue to grow while symptoms persist.
Thats why having a prostate MRI before a biopsy is preferable. It shows the location of potential cancer, which helps direct the biopsy sampling.
Before you decide to get a prostate MRI vs. biopsy, here are a few things to know.
How Is A Digital Rectal Exam Performed
A DRE is a physical exam of the prostate. The health care provider will ask the patient to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies next to it. The DRE may be slightly uncomfortable, but it is brief. This exam reveals whether the prostate has any abnormalities that require more testing. If an infection is suspected, the health care provider might massage the prostate during the DRE to obtain fluid to examine with a microscope. This exam is usually done first. Many health care providers perform a DRE as part of a routine physical exam for men age 50 or older, some even at age 40, whether or not the man has urinary problems.
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Urologists Deal With Reproductive Health
Urologists specialize in urinary tract diseases and male reproductive health. Our training includes 5-6 years of residency and an optional 1-2 years of specialized fellowship training. Though primary care doctors have deep medical knowledge, urologists have special expertise in issues that impact male fertility and sexual health. We are equipped to not only diagnose urological conditions, but also to perform surgery to treat diseases that affect the bladder, kidneys, prostate, testes and other organs that are part of the urinary system.
A Better Way: The Pca3 Test
So, lets say your PSA levels have been rising during the past few years, and your doctor wants to find out if you have prostate cancer. While most physicians recommend a biopsy, I suggest my patients have a test known as the PCA3 first. This simple genetic test uses urine to look for the expression of genes that are only found in prostate cancer cells.
The PCA3 gene is over-expressed in 95 percent of all prostate cancer cases, so it is highly accurate. Even though it has been available since 2004, not many physicians use the PCA3 test yet, so you might have to educate your doctor about it.
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Why The Procedure Is Performed
An enlarged prostate can make it hard for you to urinate. You may also get urinary tract infections. Removing all, or part, of the prostate gland can make these symptoms better. Before you have surgery, your doctor may tell you changes you can make in how you eat or drink. You may also try some medicines.
Prostate removal may be recommended if you:
- Cannot completely empty your bladder
- Have repeat urinary tract infections
- Have bleeding from your prostate
- Have bladder stones with your enlarged prostate
- Urinate very slowly
- Took medicines, and they did not help your symptoms or you no longer want to take them
When To See A Urologist About Enlarged Prostate
The signs and symptoms of an enlarged prostate become more evident as a man ages. An enlargement of the prostate can signal Benign Prostatic Hyperplasia a noncancerous, but bothersome condition that affects more than half of men in their 50s and up to 90% of men in their 70s and 80s.1,2 However, the severity of these symptoms does not necessarily correlate with the severity of the enlargement of the prostate. In fact, many men who have serious enlargement of the prostate may only have mild symptoms and vice versa. That means that it is advisable for men who experience urinary symptoms to see their urologist early.
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Attention to these problems may help avoid serious interference in their lifestyle, such as the often embarrassing urgency and frequency of urination. A proactive physician visit may also allow for early diagnosis or even prevention of a more serious prostatic condition. LUTS can be a sign of prostatitis or even prostate cancer. Most men experiencing urinary symptoms or over the age of 50 will benefit from regular prostate exams.
Visiting a urologist at the earliest stages of enlargement has the following benefits:
1 National Institute of Diabetes and Digestive and Kidney Diseases. Prostate enlargement: benign prostatic hyperplasia. NIH Publication No. 07-3012. June 2006.
2 Carter HB. Prostate Disorders: The Johns Hopkins White Papers. Baltimore, MD: Johns Hopkins Medicine 2013:1-25.
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What Is Prostate Cancer Screening
The diagnosis of prostate cancer usually follows a biopsy prompted by a significantly elevated initial PSA level, an increase in PSA levels over time, or an abnormal digital rectal examination. According to JAMA, patients with a prostate cancer history benefit from extended PSA monitoring. Elevated PSA levels may help determine when to go in for a prostate MRI and hopefully avoid unnecessary or repeat prostate biopsies.
The American Journal of Mens Health reports that prostate cancer diagnosis occurs most often in men older than 50. Other factors influencing the rate of prostate cancer are ethnicity and family history. Screening is vital because localized prostate cancer sometimes causes no symptoms or warning signs.
What To Expect During A Urology Visit
You can see a urologist at any age, but most often, urinary problems arise after age 50. When you come into the office, your doctor will talk with you about your symptoms and concerns. The exam may include specific tests based on your symptoms. Your doctor will want to ensure the kidneys are working well and that the bladder is emptying properly. For men, your doctor may want to make sure a proper cancer screening is done.
Depending on the cause of your symptoms, treatment may include medicine, surgery or even specific exercises to strengthen muscles.
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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.
When Should I See A Urologist
Until a few years ago, 27-year-old Valerie*, a third-grade teacher from New York, had never thought about her urologic health. “I didn’t see urology as something that affected me,” she said. “Then suddenly, it became a huge part of my life.”
Valerie* was one month into her first year of teaching when she started feeling strong bursts of pelvic pain. In addition to the pain, she felt a strong “gotta go” feeling. She felt this urge to urinate all the time. “It was terrible,” she remembered. “The pain was too much to handle. I had an urge to urinate all the time, even right after I left the bathroom. That’s very hard to deal with if you’re a third-grade teacher. You’re with the kids almost all day long going to the bathroom all the time is not an option,” Valerie explained. “Not to mention dealing with the pain while trying to keep up with the kids. Third-graders are pretty active, so that’s not easy to do.”
The pain, pressure and urinary frequency became so bad that Valerie had to stay home from work. She went to her primary care doctor, who told her she had a urinary tract infection . A UTI is a bacterial infection in the urinary tract. UTIs are fairly common, affecting about 40 percent of women and 12 percent of men.
“I was amazed!” said Valerie. “I thought urologists only treated men. Then I found out that, not only do urologists treat men, women and children, but some urologists focus on treating women specifically.”
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What Is The Prostate
The prostate gland is a part of the male reproductive system. Its main role is to produce semen, the fluid that carries and protects sperm. It is about the size of a walnut and sits just below the bladder in men.
The prostate is surrounded by the upper part of the urethra, the thin tube that carries urine from the bladder to the penis. It also carries semen from the prostate and sperm from the testicles to penis during ejaculation.
What Is The Urolift System
Treatment with the UroLift® System is typically a one-time, in-office solution that provides rapid relief and recovery of BPH symptoms.1 It can break the cycle of medications and how they make a person feel, all without the risks of more invasive surgery. The goal of the UroLift System treatment is to relieve symptoms so you can get back to your life and resume your daily activities.
The UroLift System treatment has demonstrated a significant improvement in quality of life for patients compared to medications.2,3 The UroLift System is the only BPH procedure shown not to cause new and lasting erectile or ejaculatory dysfunction*, while being a safe and effective treatment of lower urinary tract symptoms due to BPH.1,3-6
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Treatment In Any Hospital Using Private Health Insurance
If you use private health insurance to be treated in either in a public hospital or a private hospital or clinic, you will be charged by the urologist and by the hospital. You might also be charged for pathology tests, x-rays and other forms of imaging, and by other doctors you see, such as an anaesthetist. Your private health insurance will cover some of these costs.
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 that do not cause symptoms. Finding a small tumor, however, may not necessarily reduce a mans chance of dying from prostate cancer. Many tumors found through PSA testing grow so slowly that they are unlikely to threaten a mans life. Detecting tumors that are not life-threatening
that requires treatment.
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How Do You Test For It
Early detection is the goal of testing. Treatment is most likely to be effective when finding the disease is its early stages. There are two widely used tests to aid in the early detection. They are:
PSA – This simple blood test measures the level of a protein called prostate-specific antigen . Normally, PSA is found in the blood at very low levels. Elevated PSA readings can be a sign of prostate cancer.
DRE – The digital rectal exam involves the physician inserting a lubricated, gloved finger into the rectum to feel the prostate for signs of cancer. This test is simple, safe and only slightly uncomfortable.
Using both tests together will give your doctor the most accurate information.
Although an abnormal DRE or an elevated PSA may suggest the presence of prostate cancer, a diagnosis of cancer can only be confirmed by a prostate biopsy. A biopsy would be performed only after a thorough discussion with your urologist.
Biopsies are minimally invasive procedures. A small amount of prostate tissue is removed by a needle inserted through the rectum. An ultrasound probe is used to guide the needle. Usually this procedure is performed as an outpatient procedure without anesthesia.
What Is A Normal Psa Test Result
There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.
However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer . In addition, various factors can cause a mans PSA level to fluctuate. For example, a mans PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugsincluding finasteride and dutasteride , which are used to treat BPHlower a mans PSA level. PSA level may also vary somewhat across testing laboratories.
Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of White men. Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group.
In general, however, the higher a mans PSA level, the more likely it is that he has prostate cancer. Moreover, a continuous rise in a mans PSA level over time may also be a sign of prostate cancer.
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Treatment Of Prostate Cancer
Men with prostate cancer have many treatment options. The treatment thats best for one man may not be best for another. Your doctor will make recommendations that are best for each individual. The options include active surveillance , surgery, radiation therapy, cryotherapy, hormone therapy, and chemotherapy. You may have a combination of treatments. The treatment thats right for you depends mainly on your age, the grade of the tumor , the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, your symptoms, and your general health. Your doctor can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.
Prostate Cancer Vs Prostate Nodule
People tend to use terms nodule and tumor or cancer interchangeably, but theyre not the same. Knowing the difference can help you stay calm until your doctor diagnoses the problem.
Essentially, a nodule is any lump or mass of cells, while the tumor is a larger growth. In most cases, doctors use a term tumor to describe cancerous growth on the prostate.
Feel free to ask the doctor to explain if youre not sure whether he or she is talking about nodule or tumor.
Prostate nodules can be benign or harmless and malignant or cancerous.
Cancerous nodules are the masses of abnormal cells that can spread to surrounding tissues and lymph nodes. Timely diagnosis is vital for successful management and recovery.
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What Is An Mri
What makes an MRI different from other medical imaging techniques like X-rays and CT scans? X-rays take projection images of hard tissues like bones, while CT scans take images of both hard bony tissues and soft tissue. Both systems use ionizing radiation, which passes through the body to create images that are transferred to photographic film or to a video monitor.
An MRI works differently. Magnetic resonance imaging uses a magnetic field to create sound waves that are received, digitized, and displayed in real-time. When tissue is abnormal, its composition changes, so the images reflect damaged areas.
How To Prepare For The Prostate Exam
The best way to prepare for an annual prostate exam is by making sure you are hydrated, so your bladder isnt full when you go in for the appointment! You should also make sure theres enough time between urination before going in to get checked out. Finally, empty your bowels before the prostate exam!
If you have hemorrhoids, anal tears, or other problems with your anus before a PSA test, it will be easier to relax and breathe normally. Speak to your doctor about any medications/supplements that may affect the results of this exam, as well as recent ejaculation, beforehand so they can provide advice on how best to prepare for the procedure.
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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.
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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