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.
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.
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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Early Detection Saves Lives
Prostate cancer is the most common cancer affecting Australian men .
Prostate cancer is the growth of abnormal cells in the prostate gland. This gland is only found in males and is about the size of a walnut.
The causes of prostate cancer are not understood and there is currently no clear prevention strategy.
Further Tests For Prostate Cancer
If results of the PSA test or the DRE are abnormal, a urologist will likely recommend a biopsy, where small samples of tissue are removed from the prostate and examined.
If cancer is diagnosed, other tests may be used to check the progression of the cancer, including:
- magnetic resonance imaging scan of the prostate – often done before a biopsy
- bone scan – to check whether or not cancer cells have spread to the bones
- computed tomography scan – a specialised x-ray
- pelvic lymph node dissection – a nearby lymph node is removed and examined to check whether or not cancer cells have entered the lymphatic system .
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Recent Advances Can Help Men With A Worrisome Psa Result Avoid Immediate Biopsy
Prostate-specific antigen blood testing receives high marks as an effective way to monitor disease activity in men diagnosed with prostate cancer. Yet, as a screening tool for prostate cancer, PSA testing is problematic.
PSA naturally tends to increase as men get older, but levels that get too high may suggest prostate cancer. A PSA level of less than 4 nanograms per milliliter is often reassuring, unless there has been a sudden jump from a much lower number. Many doctors consider a total PSA level higher than 10 ng/mL as the threshold for getting a biopsy to check for cancer.
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Whats The Difference Between The Pca3 Test And The Psa Test
The PCA3 test measures the levels of prostate cancer gene 3. This gene is found in high levels in prostate cancer cells. The test isnt affected by an enlarged prostate, prostatitis, or other conditions of the prostate gland.
PSA tests measure the levels of prostate-specific antigen in your blood. If your levels are high, or if they rise rapidly, you may have prostate cancer. But elevated PSA levels can be caused by many things besides prostate cancer, including:
- benign prostatic hyperplasia , often referred to as an enlarged prostate, which is a common, noncancerous condition
- prostatitis, or inflammation or infection of the prostate
- pressure on the prostate from a digital rectal exam or catheter
PSA tests used to be given annually to men older than 50 years, but theyre no longer recommended as a primary screening method by most medical experts. There are several reasons for this:
- There are a high number of false positives with PSA tests.
- Some men have prostate cancer even when their PSA levels are low, so the test may give false negatives.
- In many men, prostate cancer grows so slowly that watchful waiting is advised rather than treatment.
- Because the diagnosis of cancer can be alarming, some men have unnecessary biopsies or surgery.
- Incontinence and sexual problems can be common side effects of prostate cancer treatment.
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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.
Kscore: A Better Mousetrap
4KScore provides the key to what was missing with the PSA test alone. It allows us to separate men who are at high risk for high-risk, aggressive prostate cancer from those who may never experience symptoms of prostate cancer.
#4KScore is a simple blood test. 4KScore is actually a combination of PSA test with a hK2 and a few other related tests .
4KScore can be used in combination with PHI to gain a better understanding of the risks associated with prostate cancer.
In our practice, we recommend the 4KScore test to all our patients who are at risk for prostate cancer. New York Urology Specialists is the first practice in the New York Metro area to offer 4KScore tests to our patients.
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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What Are Other Tests Available For Men At Risk For Prostate Cancer
While traditionally, the options available to men at risk for prostate cancer were limited to PSA blood test and a prostate exam , a number of exciting, innovative options became available to men, and more exciting innovations are expected in the coming years.
PSA is still a useful test but is being supplanted by more informative tests such as 4KScore and PHI .
PHI is a new test that provides an incremental improvement over the PSA test alone when it comes to predicting the risk of prostate cancer. It can be used to reduce the need for unnecessary biopsies in some men.
Read more about the differences between PHI and 4KScore tests.
Use In Men Already Diagnosed With Prostate Cancer
The PSA test can also be useful if you have already been diagnosed with prostate cancer.
- In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
- The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
- PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .
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Prolaris Test For Prostate Cancer Risk Assessment
Am Fam Physician. 2019 Sep 1 100:311-312.
Prolaris is a genomic test that analyzes changes in 46 genes in prostate biopsy tissue. It generates a risk score to help predict the likelihood of disease progression in men with localized prostate cancer. Prolaris is intended to guide the decision regarding active surveillance without surgery or radiation for low- or intermediate-grade cancers vs. active treatment with immediate surgery or radiation therapy. The National Comprehensive Cancer Network guidelines recommend that physicians consider this test for patients with low-risk and favorable intermediate-risk disease and at least a 10-year life expectancy.1
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.
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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.
Whats The Best Method Of Screening For Prostate Cancer
This article was published more than 5 years ago. Some information may no longer be current.
A doctor does a prostate cancer surgery at the University of Chicago Medical Center in Chicago on Sept. 13, 2011.Bruce Powell/The Associated Press
There’s a popular saying: men are more likely to die with prostate cancer than from it.
But it’s a loaded statement with which many don’t agree. The result is a debate a very heated one over the best way to screen for prostate cancer, and once it’s found, whether to treat it aggressively with surgery or radiation, or leave it alone.
On one side of the screening debate are experts who argue the prostate-specific antigen test, long the most common test used to look for suspected cancer, is one of the best ways to catch the disease early and help men get successful treatment.
On the other side are those who suggest the usefulness of the PSA test is wildly overblown, considering it leads to false positives, overdiagnosis and overtreatment of a disease that, if left alone and monitored closely, would never pose a real health threat to many men.
The Canadian Cancer Society estimates suggest that 24,000 men were diagnosed with prostate cancer in 2015, while 4,100 died from the disease about 10 per cent of all cancer deaths among men. Men with the disease are 96 per cent as likely to survive five years after diagnosis as the general population, according to the society.
What men need to know
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.
Determining Whether Prostate Cancer Is Aggressive
If a biopsy sample is found to contain cancer, the pathologist analyzing the specimen takes a deeper look at the cancer cells to determine how aggressive the disease is likely to be.
If the cancer cells appear significantly abnormal and dissimilar from healthy cells under a microscope, the cancer is considered more aggressive and expected to advance quickly. Conversely, cancer cells that look relatively similar to healthy cells indicate that its less aggressive and may not spread as fast.
Prostate cancers are assigned a Gleason score depending on how abnormal the cells look..
Gleason score: Gleason scores range from 2 to 10, going from least to most aggressive prostate cancers.
There are different types of cancer cells in a prostate tumor, so the final Gleason score is determined by adding the scores of the two main areas of the tumor.
First, the primary part of the tumor is assigned a number between 1 and 5. Lower numbers indicate that the cells appear relatively similar to healthy cells, while higher numbers show that the cells are abnormal-looking. Then, another number between 1 and 5 is assigned to describe the second most prevalent area of the tumor.
Finally, the two numbers assigned to the different parts of the prostate tumor are added. So, if most of the tumor is given a 4, and some of the tumor is more aggressive and given a 5, the final Gleason score would be 9.
There are many biomarker tests, including:
- Oncotype DX® Genomic Prostate Score
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What Is The Best Test For Prostate Cancer
In the past, digital rectal exam in combination with PSA was the recommended tests for prostate cancer.
In 2016, while PSA can still be used as a test for prostate cancer, newer tests that provide better information became available. As of 2016, Dr. Alex Shteynshlyuger recommends that men with symptoms suggestive of prostate cancer consider more specific tests that include the 4KScore test that includes genetic profile and PHI test.
Living With Prostate Cancer
As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.
You may find it beneficial to talk about the condition with your family, friends, a family doctor and other men with prostate cancer.
Financial support is also available if prostate cancer reduces your ability to work.
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Why Test For Prostate Cancer
Prostate cancer affects 1 in 7 men. Certain men are at higher risk for prostate cancer because of their family history breast cancer and ovarian cancer in mothers and sisters can also put men at increased risk for prostate cancer.
It is important that all men over age 40 who have symptoms that can be caused by prostate cancer are tested for prostate cancer. These symptoms can be caused by many other conditions but it is important to test for prostate cancer in order not to miss it.
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.
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Who Should Have The Test
Having a PCA3 test done in addition to a PSA test and digital rectal exam can more accurately assess your need for a biopsy of your prostate gland. The decision to have the PCA3 test is up to you and your doctor.
Generally, the test is given if you have elevated PSA levels but a biopsy found no cancer. Its also given if you and your doctor have decided that watchful waiting is the best strategy, but you want another method of monitoring your status.