Talk To Your Doctor First
In the past, doctors ordered PSA tests for all men over age 50. But in recent years, experts have questioned this practice. The American Urological Association recommends that you consider a PSA test only after talking with your doctor about your risk factors. Use this fact sheet to learn the questions you should ask your doctor.
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 Is A Digital Rectal Exam
The most common way for doctors to check on the health of your prostate is with a DRE. Its a fairly quick and simple procedure.
For the exam, youll bend at the waist while standing or lie on your side with your knees bent toward your chest.
Your doctor will lubricate a gloved finger and gently place it inside your rectum. Theyll press one hand on your prostate, and their other hand will feel your pelvic area. It should only take a few moments.
You may experience momentary discomfort. You may also feel the urge to urinate, especially if your prostate is enlarged or inflamed.
Your doctor will be able to tell you if your prostate seems to be a normal size and shape. In general, a DRE has no risks.
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What Are Normal Psa Levels
Thereâs no such thing as a normal PSA for any man at any given age, but most men with prostate cancer have a higher than normal level. In general:
If your PSA results are in the borderline range , the % free PSA can be useful in helping distinguish between prostate cancer or benign prostatic hyperplasia . The pattern is the opposite of that seen with PSA in that a high % free PSAâabove 20%âpoints to BPH, while a %- free PSA less than 10% indicates a greater likelihood of cancer.
Biopsy During Surgery To Treat Prostate Cancer
If there is more than a very small chance that the cancer might have spread , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy .
The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.
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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:
What Is Prostate Cancer
Check out this factsheet for a summary of the video.
Prostate cancer starts in the cells of the prostate. A cancerous tumour consists of cancer cells that can grow into nearby tissue and destroy it. The tumour can also spread to other parts of the body.
Prostate cancer is the most common cancer in Canadian men. It is most common in older men. It is more common in Black men than in white men and less common in Asian men. Trans women and non-binary people who were assigned male at birth can also get prostate cancer.
The prostate is part of the male reproductive and urinary systems. It makes some of the fluid that is part of semen. It is located below the bladder and in front of the rectum. The urethra goes through the prostate.
The prostate is usually about the size of a walnut in younger men but can change as you age and grow larger in older men.
Prostate cancer usually grows slowly and can often be completely removed or successfully managed when it is diagnosed before it has spread outside of the prostate. Older men with prostate cancer often die of other causes. Adenocarcinoma of the prostate is the most common type of prostate cancer. It accounts for 95% of all prostate cancers.
A Prostate Cancer Gene 3 Rna Test May Be Used For Certain Patients
If a man had a high PSA level and a biopsy of the prostate did not show cancer and the PSA level remains high after the biopsy, a prostate cancer gene 3 RNA test may be done. This test measures the amount of PCA3 RNA in the urine after a DRE. If the PCA3 RNA level is higher than normal, another biopsy may help diagnose prostate cancer.
When Should I Get A Psa Test
The guidelines below are adapted from the NCCN Clinical Practice Guidelines In Oncology for Prostate Cancer Early Detection. Please use these guidelines to have a discussion with your physician about your personal risk and make a plan for screening.
- If you are between ages 45 and 75:
- Discuss the risks and benefits of prostate cancer screening with your doctor, have a baseline PSA, and consider a baseline DRE
- If your PSA is below 1 ng/mL and your DRE is normal, repeat testing every 2-4 years
- If your PSA is between 1 and 3 ng/mL and your DRE is normal, repeat testing every 1-2 years
- If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
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What Tests Do I Need After A Biopsy
If you have a biopsy that shows that you have cancer cells in your prostate, then you’ll have more tests to work out where and how big the cancer is .
The tests you might have include a CT scan and a bone scan.;
The National Institute for Health and Care Excellence , 2019
The use of PI-RADSvs2 in pre-biopsy multi-parametric MRIThe Royal College of Radiologists, 2018
PI-RADS Prostate Imaging Reporting and Data System version 2American College of Radiology, 2015
The 2014 International Society of Urological Pathology Consensus Conference on Gleason Grading of Prostatic Carcinoma – Definition of Grading Patterns and Proposal for a New Grading SystemJ Epstein and others;American Journal of Surgical Pathology,;2016. Vol 40, Issue 2, Pages 244-252;
National implementation of multi-parametric magnetic resonance imaging for prostate cancer detection recommendations from a UK consensus meetingM;Appayya and others
What Are Clinical Trials And Are They Right For You
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.
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Discuss Prostate Cancer Testing With Your Doctor
Medical authorities do not recommend that all men should be tested for prostate cancer. In fact, most authorities suggest that men should make their own choice about whether or not to have a PSA test. If you decide to be tested, it is recommended that it should be done every two years from 50 to 69 years of age, and only if your health is such that you expect to live for at least another seven years.;
Men at high risk of prostate cancer, such as men with a family history of prostate cancer , or men who have previously had an elevated test result, can start two-yearly testing from age 45. Your doctor can help you decide whether this is necessary.
While there is now some evidence that regular testing may prevent prostate cancer deaths, there are concerns that many men may be diagnosed and treated unnecessarily as a result of being screened, with a high cost to their health and quality of life .;
However, the option of active surveillance, where a low-risk cancer is watched closely instead of being treated, helps to lower these risks. Active surveillance is now used quite commonly in Australia for men with low-risk prostate cancer.
If you are unsure whether or not to be tested after considering the benefits and uncertainties of testing and your own risk of prostate cancer, discuss it with your doctor.
In Australia, if you choose to be tested for prostate cancer the tests are covered by Medicare.
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.
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Stages Of Prostate Cancer
Staging describes or classifies a cancer based on how muchcancer there is in the body and where it is when first diagnosed. This is oftencalled the extent of the cancer. Informationfrom tests is used to find out the size of the tumour, which parts of the organhave cancer, whether the cancer has spread from where it first started andwhere the cancer has spread. Your healthcare team uses the stage to plantreatment and estimate the outcome . The following staginginformation is for adenocarcinoma, which makes up 95% of all prostate cancers.Other types of prostate cancer are staged differently.
The most common staging system for prostate cancer is the AJCC/UICCTNM system. Doctors often also use a simple staging system that describeswhether the cancer has spread and if so, where it has spread. Doctors furtherclassify prostate cancers into risk groups based on whether they are likely to comeback .
What Clinical Trials Are Open
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Steven A. Kaplan, M.D., Weill Cornell Medical College; Michel A. Pontari, M.D., Temple University School of Medicine
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Prostate Cancer Screening Guidelines
Specialists in the Prostate and Urologic Cancer Program encourage all men at risk for prostate cancer to consider appropriate screening. Men considering prostate cancer screening should first talk with their personal physicians so they may make an informed decision about the risks and benefits, and whether screening is right for them.
The following guidelines are based on American Cancer Society recommendations about prostate cancer screening. Men should not be tested without first learning about the risks and possible benefits of testing and treatment. They should have a conversation with their doctor about whether, when and how often prostate cancer screening is appropriate, given individual health factors.;
After having a discussion with their doctor, men who want to be screened should be tested with the prostate-specific antigen blood test. The digital rectal exam may also be done as a part of screening. The discussion about screening and your risk factors should take place at:
- Age 50: Men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- Age 45: Men at high risk of developing prostate cancer. This includes African Americans; the rate at which African American men are diagnosed with cancer is 76% higher than for white men. All men who have a first-degree relative diagnosed with prostate cancer at an early age are considered to be at high risk.
- Age 40: Men at even higher risk .
Understanding Your Biopsy Results
You might have a negative biopsy. This means that no cancer cells were found. Your doctor might;arrange another biopsy even if the first biopsy was negative. They’ll discuss this with you. This is because in some cases biopsies can miss cancer.;
If they find cancer cells, a pathologist grades each sample of prostate cancer cells from 3;to 5 based on how quickly they are likely to grow or how aggressive;the cells look. You may hear this being called the;Gleason grade, Gleason score or Grade Group.
Gleason score or Grade Group
The pathologist works out an overall Gleason score by adding together the 2 most common Gleason grades.;This combined score is also now called the Grade Group.;
There are 5 Grade Groups. Grade Group 1 is the least aggressive and Grade Group 5 is the most aggressive.;
It can be difficult to understand what the Gleason score and Grade Group mean in your situation. We have more information about the Gleason score and Grade Groups. And you can ask your doctor and specialist nurse if you have any questions about this.;
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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.
Risks Of Prostate Cancer Screening
Screening tests have risks.
The risks of prostate screening include the following:
Finding prostate cancer may not improve health or help a man live longer.
Screening may not improve your health or help you live longer if you have cancer that has already spread to the area outside of the prostate or to other places in your body.
Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. Finding these cancers is called overdiagnosis. It is not known if treatment of these cancers would help you live longer than if no treatment were given, and treatments for cancer, such as surgery and radiation therapy, may have serious side effects.
Some studies of patients with prostate cancer showed these patients had a higher risk of death from cardiovascular disease or suicide. The risk was greatest the first year after diagnosis.
Follow-up tests, such as a biopsy, may be done to diagnose cancer.
If a PSA test is higher than normal, a biopsy of the prostate may be done. Complications from a biopsy of the prostate may include fever, pain, blood in the urine or semen, and urinary tractinfection. Even if a biopsy shows that a patient does not have prostate cancer, he may worry more about developing prostate cancer in the future.
False-negative test results can occur.
False-positive test results can occur.
Your doctor can advise you about your risk for prostate cancer and your need for screening tests.
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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 .