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.
Key Points To Remember
- PSA tests can help find some prostate cancers early, when the cancer may be easier to treat. The largest study of prostate cancer screening so far showed that PSA testing may prevent a small number of men from dying of prostate cancer.
- A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer. A high PSA can cause a lot of worry and lead to more tests. But most high PSA test results will not turn out to be from cancer.
- Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when they are found, they often get treated with surgery to remove the prostate or with radiation. These cancer treatments may not have been needed. And they can have serious side effects, such as urinary, bowel, and erection problems.
- Many prostate cancers grow slowly. This means that many men with prostate cancer will die of something else before their prostate cancer advances enough to cause any problems.
- With faster-growing prostate cancers, finding the cancer early may not help you live longer. Some prostate cancers will be fatal no matter when they are found or how they are treated.
What Is The Psa Test
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a mans blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.
The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the use of the PSA test in conjunction with a digital rectal exam to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing to help doctors determine the nature of the problem.
In addition to prostate cancer, a number of benign conditions can cause a mans PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis and benign prostatic hyperplasia . There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
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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 .
What Do My Test Results Mean
Your doctor will look at your test results to find out if the cancer has spread and how quickly it might be growing.
How far has my cancer spread?
The stage of your cancer tells you whether it has spread outside the prostate and how far it has spread. You might need scans, such as an MRI, CT or bone scan, to find out the stage of your cancer.
Depending on the results, your cancer may be treated as:
- localised prostate cancer it’s contained inside the prostate
- locally advanced prostate cancer its started to break out of the prostate or has spread to the area just outside it
- advanced prostate cancer its spread from the prostate to other parts of the body.
Is my cancer likely to spread?
Your doctor may talk to you about the risk of your cancer spreading outside the prostate or coming back after treatment.
Your prostate biopsy results will show how aggressive the cancer is in other words, how likely it is to spread outside the prostate. You might hear this called your Gleason grade, Gleason score, or grade group.
Your cancer may be low risk if:
- your PSA level is less than 10 ng/ml, and
- your Gleason score is 6 or less , and
- the stage of your cancer is T1 to T2a.
Your cancer may be medium risk if:
- your PSA level is between 10 and 20 ng/ml, or
- your Gleason score is 7 , or
- the stage of your cancer is T2b.
What happens next?
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Prostate Cancer: Advancements In Screenings
Dr. Christian Paul Pavlovich
You may know thatprostate canceris one of the most common cancer types in men. The good news is that thereare many treatment and management options, even if the cancer is caught ata later stage.
What you may not know: There are several options when it comes toprostate cancer screening. After considering multiple factors, your doctor may recommend theprostate-specific antigen test, and/or one of the newer screeningtests that are now available.
Johns Hopkins urologistChristian Pavlovich, M.D., explains what you should know.
Do I Need The Psa Test
The PSA test is not recommended for men who dont have symptoms of prostate cancer, as it can lead to unnecessary investigations and treatments that have serious side effects.
If you are at higher risk of developing prostate cancer, or if you have symptoms that may indicate cancer, PSA testing may be of more benefit.
Cancer Council Australia and the Royal Australian College of General Practitioners both recommend against routine screening in men without symptoms. That is because the PSA test is not very accurate for screening men without symptoms. High PSA levels can be due to many things, and cancer is just one of them. And a man with prostate cancer can have a normal PSA level.
As there is a range of risks and potential benefits of PSA testing, talk to your doctor to help make an informed decision.
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Thinking Of Joining The Trial
Research is vital to making progress. But theres a lot to consider when taking part in research, so wed encourage anyone who receives an invitation to the GRAIL Galleri trial to read the information and decide whats right for them.
If you do decide to take part, its really important that you still report any unusual changes in your health to a GP and consider invitations to NHS cancer screening as you would do normally.
This is because not everyone in the trial will have their blood samples analysed, and the test wont identify everyone who has cancer.
You can find out more on the NHS Digital website
In a different study, 25,000 people with possible cancer symptoms will also be offered the test once they have been referred to hospital. People taking part in the study will have their diagnostic test in the normal way, but will also give a blood sample and permission for the study team to check their health records later to see if they were diagnosed with cancer and what appointments and other tests they had.
At the end of the study, having tested the blood with the Galleri test, the team will understand more about how well it works in this group of people.
This will help them to design a trial where they can further explore if the test can be used to decide who needs rapid referral to look for a possible cancer and what diagnostic tests might be appropriate to use.
Are There Other Options Besides Treatment
If its cancer, consider active surveillance. Active surveillance means that you and your doctor keep a careful watch on your condition. There are frequent checks to make sure its not fast growing. With this approach, you have regular PSA tests to check if the cancer is growing quickly. You may also have MRI or ultrasound tests.
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.
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Circulating Tumor Cell Test
A circulating tumor cell test can check for blood biomarkers that show whether normal cells are transforming into cancer cells. CTC tests can help diagnose and screen patients who have a risk of developing cancer, such as a family history of the disease.
CTC tests are helpful in the early detection of cancer as well as monitoring treatment effectiveness over time. The only test currently approved for this purpose is called CellSearch CTC, which offers different prostate, colorectal, and breast cancer assays.
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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How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:
Men At Higher Risk Of Prostate Cancer
Some men are at higher risk of prostate cancer than others. These are:
- black men
- men who have a family history of prostate cancer
The risk of prostate cancer also increases as men get older.
The evidence so far doesnt suggest that routinely screening these men would help prevent deaths from prostate cancer. In fact, it might lead to men having treatment for prostate cancer even though that cancer wouldnt have caused any problems or symptoms.
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What Do We Know So Far
Results from studies into Galleri have so far been promising.
GRAIL reports that the test can detect 50 different types of cancer with a false positive rate of 0.5%. This means that in approximately 200 people tested, 1 person would be expected to receive a positive result when they do not have cancer.
In a study involving people who had already been diagnosed with cancer, the test accurately detected cancer in 51.5% of people. This gives an indication of the tests sensitivity. The Galleri test was able to correctly predict the location of the tumour 89% of the time, which is important for knowing which follow-up diagnostic tests the patient needs to confirm their diagnosis.
A key challenge that this type of test faces is the difficulty in detecting very small quantities of abnormal DNA circulating in the blood.
Because the amount of tumour-derived cfDNA tends to increase as a cancer becomes more advanced, these types of blood tests tend to be better at picking up later stage disease. Based on the results reported so far, the test is not currently that good at picking up stage 1 cancer, where the cancer is small and hasnt spread to other parts of the body.
Whats more, the number of cancers that have been analysed, particularly for some rarer cancer types, has been very small.
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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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.
Both Tests Are Better Than One
Using these tests together is better than using either test alone. PSA testing together with a DRE may help find a dangerous cancer early when it is easier to treat.
If a problem is found, more tests will be done to find out whether you have prostate cancer or another health problem. Further tests can include:
- a follow-up PSA test
- a transrectal ultrasound a test that uses sound waves to make a picture of the rectum and nearby organs, including the prostate
- a biopsy of the prostate tissue samples of the prostate are looked at under a microscope
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What Is Prostate Cancer
Prostate cancer is the abnormal growth of cells in the tissues of the prostate gland. It is the second most common cancer in men. Most men who get it are older than 65.
Early prostate cancer usually doesn’t cause symptoms. When prostate cancer is found before it has spread outside the prostate gland, a man’s options include active surveillance, surgery to remove the prostate, or radiation. If a prostate cancer grows or spreads, symptoms may develop, including urinary problems and bone pain.
Many prostate cancers grow slowly. This means that many men with prostate cancer will die of something else before their prostate cancer advances enough to cause any problems. With faster-growing prostate cancers, finding the cancer early may not help you live longer. Some prostate cancers will be fatal no matter when they’re found or how they are treated.
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 .
Personal Stories About Having A Prostate
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I have two children who are in high school right now, and both plan to go to university. It’s important to me to provide for them and ensure that they have the money they need to finish their education. If I found out I had cancer, I would try any treatment that might offer me a chance to live longer, even if it has side effects. I’m going to have the PSA test.
Eric, age 56
For me, there is still too much uncertainty about how helpful the PSA test is and how accurate it is. I’ve read that high PSAs can be caused by things other than cancer. But the only way to know it’s not cancer is to have a biopsy. I don’t want to have to go through that if I don’t have to. And the fact that I might be treated for a cancer that wouldn’t have caused a problem is troublesome. So for now, I’m not going to have the PSA test.
Mike, age 62
My health is great. I still run, play tennis, and travel a lot. At my age, you start to see friends getting sick and dying of one thing or another, and it makes you start to think about your own health more. I know that the PSA test isn’t perfect, but I want to have every chance I can to treat cancer early if I have it.
Jacob, age 68
Pieter, age 67