What Is A Prostate
A prostate-specific antigen test measures the level of PSA in your blood. The prostate is a small gland that is part of a man’s reproductive system. It is located below the bladder and makes a fluid that is part of semen. PSA is a substance made by the prostate. Men normally have low PSA levels in their blood. A high PSA level may be a sign of prostate cancer, the most common non-skin cancer affecting American men. But high PSA levels can also mean noncancerous prostate conditions, such as infection or benign prostatic hyperplasia, a noncancerous enlargement of the prostate.
Other names: total PSA, free PSA
What Happens During The Test
Your doctor will start by giving you a digital rectal exam . They will insert a lubricated, gloved finger in your rectum and gently push on your prostate gland. This helps move the PCA3 into your urethra so it can be expelled in your urine. Following the DRE, youll be asked to provide a urine sample. The urine sample will be sent to a lab for testing and the results will then be sent to your doctor when they are available.
The PCA3 test results are more accurate when preceded by a DRE.
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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What Happens After The Prostate Tests
Urodynamic tests and cystoscopy may cause mild discomfort for a few hours after the procedures. Drinking an 8-ounce glass of water every half-hour for 2 hours may help reduce discomfort. The health care provider may recommend taking a warm bath or holding a warm, damp washcloth over the urethral opening to relieve discomfort. A prostate biopsy may produce pain in the area of the rectum and the perineum, which is between the rectum and the scrotum. A prostate biopsy may also produce blood in urine and semen.
An antibiotic may be prescribed for 1 or 2 days to prevent infection.
Patients with signs of infectionincluding pain, chills, or fevershould call their health care provider immediately.
Common Enlarged Prostate Symptoms
As men get older their prostate grows larger and may push up into the bladder and pinch the urethra, the urine tube that drains the bladder. These changes could lead to urinary problems, including having to urinate more often during the day, having an urgency to pass urine and getting up throughout the night to go to the bathroom.
Like many of our organs as we get older theres an accumulation of DNA damage from mutations over the years and sometimes that DNA damage can lead to a cancer in the prostate. Its actually very common to get prostate cancer, Dr. Scott Tyldesley, a radiation oncologist at the BC Cancer Agency, said in an interview with Yahoo Canada.
Tyldesley, who is also a clinical professor in the Division of Radiation Oncology at the University of British Columbia, says a symptom thats more rare, and potentially more sinister, occurs when prostate cancer spreads to the lymph nodes in the pelvis. If this happens men will experience swelling in their legs.
Prostate cancer can also spread to the bones, which can lead to new or unusual bone pain, particularly between the joints, the spine or pelvis.
If somebodys getting a lot of perineum or prostate pelvic pain particularly in combination with those urine symptoms that would be something you should get checked out sooner rather than later, Tyldesley advised.
One of the ways men can get screened is through a Prostate Specific Antigen test, which measures the amount of PSA in your blood.
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Tests To Diagnose And Stage Prostate Cancer
Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.
If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.
The actual diagnosis of prostate cancer can only be made with a prostate biopsy .
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What Is The Psa Screening Controversy
The goal of measuring PSA in men with no symptoms of cancer as a screening test for prostate cancer is to reduce the mortality caused by this cancer. Although the advent of prostate cancer screening is associated with decreased prostate cancer deaths, concerns exist regarding risks of overtreatment and the associated risks of such treatments.
A substantial number of the cancers detected by PSA screening are early stage and low-risk, and these patients will likely never die from this disease. PSA screening, due to its low specificity, does not allow differentiating between low-risk and high-risk prostate cancer. Hence PSA systematic screening is inevitably associated with over-diagnosis and potentially overtreatment. Therefore, not only do these patients not benefit from early detection but they also carry the burden of a cancer diagnosis. In addition, a subset of these patients may suffer the side effects of an unnecessary treatment.
Another trial conducted in the United States recently concluded that there is no evidence of an improvement in death rate from prostate cancer with annual PSA screening compared with usual medical care. After 13 years of follow-up, the cumulative mortality rates from prostate cancer in the intervention and control groups were 3.7 and 3.4 deaths per 10,000 person-years, respectively, meaning that there was no significant difference between the two groups.
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When Is A Psa Test Needed
If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.
Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.
- You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
- Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
- If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
What Are Additional Tests For Detecting Prostate Problems
If the DRE or the PSA blood test indicates a problem may exist, the health care provider may order additional tests, including urinalysis, urodynamic tests, cystoscopy, abdominal ultrasound, transrectal ultrasound with prostate biopsy, and imaging studies such as magnetic resonance imaging or computerized tomography scan.
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What Is Prostate Cancer
Prostate cancer is a type of cancer that affects the prostate, the walnut sized gland in a biological male below the bladder, where the seminal fluid is produced. This fluid is responsible for providing food to and transporting sperm. Genetic testing for prostate cancer can play an important role in assessing risk and creating a treatment plan after diagnosis.
Prostate cancer is one of the most common types of cancer. According to the CDC, out of every 100 men in the United States, about 13 will get prostate cancer during their lifetime, and about 2 to 3 men will die from the disease. The greatest risk factor of developing the condition is older age. African American men and those with a family history may be at an increased risk.
The growth of prostate cancer is usually slow and is detected before it spreads beyond the prostate gland. Localized prostate cancer cases can remain benign for decades so it is possible to live with prostate cancer without realizing it. In this case, treatment may involve watching for changes.
However, some subtypes may grow fast and spread aggressively. Men with metastatic prostate cancer may require more involved therapies immediately to treat this type of cancer.
Normal Psa Levels By Age Chart
We mentioned earlier in this article that PSA levels increase with age due to age related growth of the prostate gland. A doctor will therefore take into account an age-adjusted PSA level when discussing your prostate health:
0 to 6.5
Although there are normal PSA levels by age range, it is still important to screen routinely to ensure these normal levels are not rising.
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Imaging Tests For Prostate Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. One or more imaging tests might be used:
- To look for cancer in the prostate
- To help the doctor see the prostate during certain procedures
- To look for spread of prostate cancer to other parts of the body
Which tests you might need will depend on the situation. For example, a prostate biopsy is typically done with transrectal ultrasound and/or MRI to help guide the biopsy. If you are found to have prostate cancer, you might need imaging tests of other parts of your body to look for possible cancer spread.
The imaging tests used most often to look for prostate cancer spread include:
Screening For Prostate Cancer
Prostate cancer is fairly common. Early detection of aggressive prostate cancer may allow timely treatment and can prevent the metastatic spread of cancer cells and death. Many men, especially those at high risk, choose to get screening for prostate cancer. It is important to discuss the risks and benefits of screening for prostate cancer with a urologist to make sure that screening is the right decision for you.
New York Urology Specialists, under the leadership of Dr. Alex Shteynshyuger, is the first practice in New York City and one of the first in the world to offer 4KScore and PHI test to their patients beginning in 2014.
We see patients from all parts of New York City , Long Island, Westchester and New Jersey as well as other parts of the USA. We also see from Canada, Japan, South America, Russia, Asia, Europe, Middle East, Africa, the Caribbean and other parts of the world.
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Worried About Having A Dre
Its natural to feel worried or embarrassed about having tests, but some men find the idea of having a DRE upsetting. For example, if youve been sexually abused as a child or an adult, you might feel very upset about having this test. Theres no right or wrong way to feel about this, and it is your choice whether or not you have tests for prostate cancer.
It might be helpful to talk to a counsellor about your experience, thoughts and fears. Or you could contact a charity for people whove been sexually abused, such as the National Association for People Abused in Childhood or SurvivorsUK. If you do decide to have a DRE, explain your situation to your doctor as they can talk through the test with you and help to reassure you.
When I had the DRE I thought, For a few seconds of discomfort, I can live with it. Yeah its uncomfortable, but it could save your life. A personal experience
Who Should Get A Digital Rectal Exam
Not all medical institutions agree on when men should begin screening for prostate cancer or even if a DRE should be part of the screening.
To help detect prostate cancer in its early stages, the American Cancer Society recommends that men talk to their doctors about the benefits, risks, and limitations of prostate cancer screening before deciding whether to be tested.
For most men at average risk, discussions about screening begin at age 50. However, some doctors recommend that men at higher risk of prostate cancer — African-American men or men with a family history of prostate cancer — start screening earlier.
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How Is Prostate Cancer Treated
Treatment options for prostate cancer include:
- Surgery to remove the prostate .
- High intensity focused ultrasound .
- Cryotherapy .
- Hormone treatment, also called androgen suppression therapy.
You may continue to have PSA level tests during and after prostate cancer treatment. These tests check that the treatment is working.
Medical Procedures Can Cause Psa To Rise
“Anything that traumatically interferes with the architecture around the prostate gland can make PSA go up,” says Dr. Milner. “One of the most common causes of significantly high PSA from this type of trauma is the placing of a catheter into the bladder.”
Another cause is a prostate or bladder exam that involves passing a scope or taking a biopsy.
“Since it takes about two to three days for PSA to go down by half, you should wait two to three weeks after this type of trauma to do a PSA test,” Milner says.
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What Should I Expect If Im Told I Have Elevated Psa
If your provider finds an elevated PSA level, youll have repeat tests to check your prostate. Many men with elevated PSA levels even those who have prostate cancer live long, healthy lives. Prostate cancer may not need treatment, depending on how slowly the tumor is growing. Keep up with your regular appointments and tests so your care team can keep tabs on your health.
How Are Prostate Problems Diagnosed
To diagnose prostate problems, the health care provider will perform a digital rectal exam . The health care provider will also ask the patient
- when the problem began and how often it occurs
- what symptoms are present
- whether he has a history of recurrent urinary tract infections
- what medications he takes, both prescription and those bought over the counter
- the amount of fluid he typically drinks each day
- whether he consumes caffeine and alcohol
- about his general medical history, including any major illnesses or surgeries
Answers to these questions will help the health care provider identify the problem or determine what medical tests are needed. Diagnosing BPH may require a series of medical exams and tests.
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What Is The Controversy Surrounding Psa Screening
In recent years, there has been some controversy surrounding the PSA test. In 2012, the U.S. Preventive Services Task Force assigned the PSA test a D rating. This meant that the USPSTF concluded the harms that resulted from PSA testing, such as unnecessary biopsies and negative treatment side effects, outweighed the benefits of finding and managing the disease early. This recommendation did not include exceptions for men at increased risk of developing the disease, such as African American men, those with a family history of the disease, and those with BRCA gene mutations. The USPSTF recommendation is important as it guides primary care physicians in preventive care and can impact insurance coverage and reimbursement for screening. Prior to its D rating, the PSA test had an I rating, meaning the USPSTF concluded there was insufficient evidence to assess the pros and cons of testing.
In May 2018, the USPSTF updated their recommendation on PSA screening. In response to new research demonstrating the benefits of PSA screening , an increase in the number of men choosing active surveillance, and advocacy efforts, the USPSTF released a draft recommendation in April 2017 that assigns the PSA test a C rating for men ages 55to 69 . This rating has now been certified official by the task force.
What Is A Psa Test
The PSA test is the leading method of screening for prostate cancer. PSA screening can help catch the disease at an early stage when treatment may be more effective and potentially have fewer side effects. The PSA test may be done along with a digital rectal exam , in which a physician inserts a gloved finger into the rectum to examine the prostate for irregularities.
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What If My Psa Is High
PSA screening is just the first step, alerting you and your doctor that more testing may be needed. If PSA is only slightly elevated, your doctor may recommend repeating the test a couple of weeks later. From there, other types of tests can help with the decision on whether you need a biopsy, including:
- Digital rectal exam , if not already done
- Free PSA test
- PSA velocity, or the rate of rise over time
- PSA density, or the PSA per volume of prostate
- PSA-based markers
- Other markers, a urinary PCA3 or SelectMDx test
- Magnetic resonance imaging of the prostate
Each time you see your doctor for a checkup, have a conversation about prostate health and prostate cancer screening. PCF recommends that you make a about PSA screening with your doctor, starting at age 45, or age 40 if you have a family history of prostate or other cancers or are Black.