What To Do If You Are Worried About Prostate Cancer
Talk to your GP if you’re worried about prostate cancer. Or if you have urinary symptoms such as difficulty passing urine. The symptoms don’t mean that you have prostate cancer, but it is important to get them checked.
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Adult screening programme Prostate cancerUK National Screening Committee, Last accessed March 20222
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Screening for prostate cancer. External review against programme appraisal criteria for the UK National Screening CommitteeUK National Screening Committee, October 2020
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Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow upC Parker and others
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:
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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What Is A Psa Test
A PSA Test is a type of blood test that can diagnose problems with your prostate, including prostate cancer.
As this test is monitoring the level of PSA in your blood. If you find an unusually high level and your doctor may then recommends you for further testing. This can lead to diagnosing before symptoms begin to show.
It is important to remember that this is not a conclusive test whether you do or dont have prostate cancer. It is not uncommon for men to naturally begin producing more PSA as they get older or from their prostate becoming enlarged.
What a PSA test provides is an indicator that there may be a problem with your prostate. With that information, you can see your GP for further testing.
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Prostate Cancer Risk Assessment
Prostate cancer represents a wide spectrum of disease. Some prostate cancers progress and need treatment, while others grow slowly, if at all, and can be managed conservatively with a system of careful monitoring called active surveillance. It is important to learn the characteristics of your cancer before making treatment decisions. There are many ways to determine prostate cancer risk, most of which incorporate information from several parameters, including the PSA, Gleason score and tumor extent .
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Is Going To The Bathroom Frequently A Sign Of Prostate Cancer
Thats one of the challenging things having urinary symptoms is very rarelyalmost nevera sign of prostate cancer. Having urinary symptoms means you should probably be evaluated for an enlarged prostate, also known as benign prostatic hyperplasia . We can treat your urinary symptoms and help you pee better.
If urinary symptoms bring men to the doctor, we can discuss screening for prostate cancer. Thats important because not all men will go to a doctor until theres something wrong with them. And prostate cancer screening really is the only way to detect prostate cancer, because its almost always asymptomatic.
Do You Need To Be Erect For A Clinical Exam
You dont, but it may happen unintentionally and thats completely normal.
Your penis is full of sensitive nerves and erogenous zones that are meant to help you get erect, so it isnt unusual for an erection to occur while your doctor is physically examining the area.
Your doctor has probably seen this happen hundreds or thousands of times, so they shouldnt be fazed.
If youre age 55 or older, you may already be getting annual prostate exams.
Otherwise, your doctor likely wont recommend this exam unless they observe unusual symptoms that could be related to your prostate.
A prostate exam is actually composed of two different tests: the digital rectal exam and the prostate-specific antigen exam. Heres how theyre done.
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What Other Screening Tests Are Used To Detect Prostate Cancer
Because a biopsy is an invasive procedure, your doctor may first use one or more of the following methods to screen for prostate cancer:
Medical history
When your doctor takes a detailed medical history, they may ask you about your symptoms, underlying health conditions and whether you consume alcohol or tobacco in any form. Your doctor may also ask you whether any of your close family members such as a father, uncle or brother were diagnosed with prostate cancer at a young age . You may also be asked other questions such as whether you have experienced weight loss or a change in sex drive.
Digital rectal examination
A thorough physical examination will also allow your doctor to assess your general health by looking for any signs of disease.
Your doctor may order a digital rectal examination . During a DRE, your doctor will insert a gloved, lubricated finger into your rectum and try to feel for any lumps, irregularities or hard areas on the prostate that could suggest cancer. This examination will also provide clues as to whether the cancer is in one or both sides of the prostate and whether it has spread to the nearby structures.
Prostate-specific antigen blood test
Your doctor may order blood tests to look for blood counts or inflammatory markers . One blood test may measure the levels of a type of protein called PSA, which is made by both normal and cancerous cells in the prostate.
Study: New Prostate Cancer Test Could Avoid Unnecessary Biopsies
Urine test found to be extremely accurate at detecting aggressive prostate cancer with few false negatives.
A urine test based on University of Michigan Rogel Cancer Center research could have avoided one third of unnecessary prostate cancer biopsies while failing to detect only a small number of cancers, according to a validation study that included more than 1,500 patients. The findings appear in the March issue of the Journal of Urology.
The MyProstateScore test, which is being commercialized by LynxDX, a U-M startup company, measures levels of cancer-specific genes in a patients urine. It is based on U-M research that discovered that half of all prostate tumors harbor a certain genetic anomaly in which the genes TMPRSS2 and ERG relocate on a chromosome and fuse together creating an on-switch for prostate cancer development.
Currently, one of doctors best methods for detecting prostate cancer is a blood test for prostate-specific antigen, commonly known as the PSA test. Elevated PSA levels may indicate cancer, but the majority of men with an elevated PSA do not actually have prostate cancer.
Our ultimate goal was to determine whether the MyProstateScore test could be a practical, reliable test that could rule out the need for more costly or invasive testing in men referred for a prostate biopsy, says study lead author Jeffrey Tosoian, M.D., M.P.H., a clinical lecturer in urology at Michigan Medicine.
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If Screening Test Results Arent Normal
If you are screened for prostate cancer and your initial blood PSA level is higher than normal, it doesnt always mean that you have prostate cancer. Many men with higher than normal PSA levels do not have cancer. Still, further testing will be needed to help find out what is going on. Your doctor may advise one of these options:
- Waiting a while and having a second PSA test
- Getting another type of test to get a better idea of if you might have cancer
- Getting a prostate biopsy to find out if you have cancer
Its important to discuss your options, including their possible pros and cons, with your doctor to help you choose one you are comfortable with. Factors that might affect which option is best for you include:
- Your age and overall health
- The likelihood that you have prostate cancer
- Your own comfort level with waiting or getting further tests
If your initial PSA test was ordered by your primary care provider, you may be referred to a urologist for this discussion or for further testing.
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What Do Psa Numbers Mean In Prostate Cancer
PSA stands for prostate-specific antigen and not prostate cancer-specific antigen. Therefore, the number needs to be taken in combination with other variables such as the size and feel of the prostate, the age of the man, and other risk factors. Very high PSA numbers, such as greater than 20, are an increased indication of prostate cancer.
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How Is The Psa Test Used In Men Who Have Been Treated For Prostate Cancer
The PSA test is used to monitor men after surgery or radiation therapy for 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 the recurrence causes symptoms.
However, a single elevated PSA measurement in someone who has a history of prostate cancer does not always mean that the cancer has come back. Someone who has been treated for prostate cancer should discuss an elevated PSA level with their 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.
A rising trend in PSA level over time in combination with other findings, such as an abnormal result on imaging tests, may lead the doctor to recommend further cancer treatment.
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.
If you decide to get screening for prostate cancer, it is important to decide whether you should have a traditional PSA test or improved modern tests for prostate cancer such as 4Kscore test or PHI .
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.
If youre interested in testing for prostate cancer or prostate cancer screening, please contact New York Urology Specialists for an appointment.
If you have any questions, to schedule a consultation or if you need a second opinion, pleasecontact us or call:
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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Getting The Results Of The Biopsy
Your biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. Getting the results usually takes at least 1 to 3 days, but it can sometimes take longer. The results might be reported as:
- Positive for cancer: Cancer cells were seen in the biopsy samples.
- Negative for cancer: No cancer cells were seen in the biopsy samples.
- Suspicious: Something abnormal was seen, but it might not be cancer.
If the biopsy is negative
If the prostate biopsy results are negative , and the chance that you have prostate cancer isnt very high based on your PSA level and other tests, you might not need any more tests, other than repeat PSA tests sometime later.
But even if many samples are taken, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer , your doctor might suggest:
- Getting other lab tests to help get a better idea of whether or not you might have prostate cancer. Examples of such tests include the Prostate Health Index , 4Kscore test, PCA3 tests , and ConfirmMDx. These tests are discussed in Whats New in Prostate Cancer Research?
- Getting a repeat prostate biopsy. This might include getting additional samples of parts of the prostate not biopsied the first time, or using imaging tests such as MRI to look more closely for abnormal areas to target.
Prostate cancer grade
Gleason score
Us Studies On Phi In Prostate Cancer Screening
In 2011, Catalona and colleagues published the results of a large multicenter trial of PHI for prostate cancer detection in 892 men with total PSA levels from 2 to 10 ng/ml and normal digital rectal examination who were undergoing prostate biopsy . The mean PHI scores were 34 and 49 for men with negative and positive biopsies, respectively. Setting the sensitivity at 8095%, PHI had greater specificity for distinguishing prostate cancer on biopsy compared with PSA or percentage free PSA . On receiver operating characteristic analysis, PHI had an area under the curve of 0.70, compared with 0.65 for %fPSA and 0.53 for PSA. Although the PHI test has been approved by the US Food and Drug Administration only in the 4 -10 ng/ml PSA range, this study showed that PHI performed well in the 2-10 ng/ml PSA range. .
Since the aforementioned results came from a large multicenter trial, it is important to note that PHI has also been examined in a grassroots population with consistent findings. Specifically, Le and colleagues compared PHI with to its individual components in men undergoing a prostate biopsy with PSA levels from 2.5 to 10 ng/ml and negative DRE from a prospective screening population of 2034 men . On ROC analysis, PHI had the highest AUC compared with p2PSA , %fPSA and PSA for prostate cancer detection.
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Complementary And Alternative Medicine
There is an important distinction between complementary therapies and alternative therapies.
- Complementary therapies, such as exercise and diet changes, are undertaken in addition to conventional medical treatments. Health care providers are often supportive of complementary therapies, depending on your particular situation.
- Alternative therapies are undertaken instead of conventional medical treatments. Some of these may be helpful for some people, but most are not well-studied and none are well-regulated. Misleading websites and false advertising abound. You should be extremely careful about choosing nonstandard treatments instead of treatments that have been evaluated in clinical trials with published results.
Many therapies can fall into either category. Some interfere with standard medical treatment or cause serious side effects, so be sure to inform your doctor if you are considering any of these therapies. Lifestyle changes are likely to be helpful in both reducing the risk of getting prostate cancer and controlling its progression. UCSF is a leader in coordinating clinical trials of diet, exercise and stress in patients with prostate cancer. In addition, every prostate cancer patient treated at UCSF receives access to a nutritionist or dietitian to help in planning a healthy diet and to address dietary issues that may arise during treatment.
Prostate Specific Antigen Test
A blood test called a prostate specific antigen test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.
As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.
PSA levels also can be affected by
- Certain medical procedures.
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A Different Way To Detect Metastases
Most men diagnosed with prostate cancer have localized disease, meaning the cancer appears to be confined to the prostate gland. However, certain factors have been linked to a higher risk of the cancer eventually spreading .
Currently, in the United States and many other countries, most men diagnosed with high-risk localized prostate cancer undergo additional testing to see if there is evidence of metastatic cancer. For many years, that has been done with a conventional CT scan and a bone scan , the latter because prostate cancer often spreads to the bones.
But both imaging technologies have limitations. Neither is particularly good at finding individual prostate cancer cells, and thus can miss very small tumors. And bone scans can detect bone damage or abnormalities that were caused by something other than cancer , resulting in false-positive findings that can lead to unnecessary additional testing.
So, researchers have been developing and testing other imaging agents that can find prostate cancer cells specifically in the body, Dr. Shankar explained.
As their name implies, PET-CT scans combine a CT scan with a PET scan, another type of nuclear imaging test that requires patients to receive intravenous injections of a radioactive tracer that can be detected on the scan.