What Happens During A Digital Rectal Exam
Your health care provider will insert a gloved finger into the rectum and feel the prostate for hard, lumpy, or abnormal areas. The test takes only a few minutes to complete.
You may feel slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate.
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When To Startand Stopscreening
The doctors and researchers who recommend screening argue that cases of prostate cancer found very early can be cured more quickly, with less chance of relapse or spread. Those who recommend against routine screening point to the slow-moving nature of prostate cancer and the side effects of surgical and medical treatment, which can be considerable.
The introduction of PSA screening in the US led to an initial increase in the number of prostate cancer cases diagnosed each year, even though many of these new cases were non-aggressive or low-risk prostate cancer. The issue was not that screening was harmful, it was that many of these low-risk cancers did not necessarily need immediate treatment. It seems strange to say that a patient might be better off leaving cancer untreated, but in some cases, it can be true. For a few years, the United States Preventative Services Task Force recommended against PSA screening. We are now seeing more cases of advanced prostate cancer diagnosed in recent years. This may be a long-tail effect of that USPSTF recommendation. It has now been changed to note that for men aged 55 to 69 years, the decision to undergo PSA screening is an individual one and should be discussed with your doctor. USPSTF continues to recommend against screening for men aged 70 and over.
How Is A Digital Rectal Exam Performed
A DRE is a physical exam of the prostate. The health care provider will ask the patient to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies next to it. The DRE may be slightly uncomfortable, but it is brief. This exam reveals whether the prostate has any abnormalities that require more testing. If an infection is suspected, the health care provider might massage the prostate during the DRE to obtain fluid to examine with a microscope. This exam is usually done first. Many health care providers perform a DRE as part of a routine physical exam for men age 50 or older, some even at age 40, whether or not the man has urinary problems.
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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.
How The Prostate Changes As You Age
Because the prostate gland tends to grow larger with age, it may squeeze the urethra and cause problems in passing urine. Sometimes men in their 30s and 40s may begin to have these urinary symptoms and need medical attention. For others, symptoms arenât noticed until much later in life. An infection or a tumor can also make the prostate larger. Be sure to tell your doctor if you have any of the urinary symptoms listed below.
Tell your doctor if you have these urinary symptoms:
- Are passing urine more during the day
- Have an urgent need to pass urine
- Have less urine flow
- Feel burning when you pass urine
- Need to get up many times during the night to pass urine
Growing older raises your risk of prostate problems. The three most common prostate problems are inflammation , enlarged prostate , and prostate cancer.
One change does not lead to another. For example, having prostatitis or an enlarged prostate does not increase your risk of prostate cancer. It is also possible for you to have more than one condition at the same time.
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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.
Why The Test Is Performed
Reasons for a PSA test:
- This test may be done to screen for prostate cancer.
- It is also used to follow people after prostate cancer treatment to see if the cancer has come back.
- If a provider feels the prostate gland is not normal during physical exam.
MORE ABOUT SCREENING FOR PROSTATE CANCER
Measuring the PSA level can increase the chance of finding prostate cancer when it is very early. But there is debate over the value of the PSA test for detecting prostate cancer. No single answer fits all men.
For some men 55 through 69 years old, screening may help reduce the chance of death from prostate cancer. However, for many men, screening and treatment could potentially be harmful instead of beneficial.
Before having the test, talk to your provider about the pros and cons of having a PSA test. Ask about:
- Whether screening decreases your chance of dying from prostate cancer
- Whether there is any harm from prostate cancer screening, such as side-effects from testing or overtreatment of cancer when discovered
Men younger than age 55 have a higher chance of developing prostate cancer and should talk with their provider about PSA screening if they:
- Have a family history of prostate cancer
- Are African American
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Does Normalizing Psa After Successful Treatment Of Chronic Prostatitis With High Psa Value Exclude Prostatic Biopsy
Sherif Azab1, Ayman Osama2, Mona Rafaat3
1 Urology Department, Faculty of medicine, October 6 University, 2 Radiology Department, October 6 University 3 Clinical Pathology Department, National research Center, Cairo, Egypt
Objective: Evaluate male patients with diagnosed chronic prostatitis, elevated serum prostate-specific antigen to find out whether medical treatment with antibiotics and anti-inflammatory drugs can lower serum PSA, and consequently decrease the prostate cancer detection rate in patients with post-treatment PSA< 4 ng/mL.
Materials and methods: This prospective study evaluated 142 male patients aged 40-73 years whose presented with elevated serum PSA> 4 ng/mL and were consequently diagnosed with chronic prostatitis as expressed prostatic excretions examination revealed more than 10 white blood cells per high power field. The Patients underwent treatment with antibiotics and nonsteroidal anti-inflammatory agents for 6-weeks. Subsequently, all patients are Followed-up by serum PSA and performed transrectal ultrasonography-guided prostate biopsy within 2 months of treatment.
Chronic prostatitis is one of the causes that elevate serum PSA levels. Treatment of chronic prostatitis with elevated PSA by antibiotics and anti-inflammatory agents can decrease the elevated PSA to the normal levels. Nevertheless, the opportunities of potential prostate cancer still exist in patients with a decreased PSA level even also if PSA< 2.5 ng/mL.
What Are Some Other Prostate Tests
Elevated PSA levels require further testing. Initially, many doctors may order another PSA test to confirm findings from the initial test. Another test that may be ordered is a digital rectal exam . The doctor conducts an exam using a gloved hand and lubricated finger and inserts the finger into the rectum to feel the prostate gland to determine if it is enlarged. DREs may be recommended at regular intervals to monitor changes.
Other tests may also be recommended initially or after monitoring reveals further abnormalities. Tests include checking for infections and other imaging like ultrasound, x-rays and cystoscopy. If a physical exam or imaging detects a lump, a biopsy may be recommended. During a biopsy the doctor inserts a hollow needle into the prostate and withdraws samples of tissue to detect cancer.
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Questions To Think About Before Having A Psa Test
To help you make your decision, you could think about the following questions:
- What would you do if your PSA level is high?
- What would you do if further tests find that you have an early prostate cancer?
- What difference will it make for you to know about an early prostate cancer?
Before you decide whether to have the PSA test, you may want to talk to your GP about it. You can also call our cancer support specialists on 0808 808 00 00. They can discuss the options with you and send you more information.
The Test Is Often Not Needed
Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:
- An enlarged prostate gland.
- Recent sexual activity.
- A recent, long bike ride.
Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.
Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.
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What If My Biopsy Results Are Negative
A negative biopsy does not definitively exclude the presence of cancer. After a negative result, you will have a PSA test every three to six months. If the PSA remains elevated, the physician will recommend a second biopsy.
The closer you follow the patients with negative biopsies, the less likely you are to miss a clinically significant cancer.Dr. Herb Ruckle
For a second biopsy, MRI imaging is typically performed. An MRI-guided prostate biopsy uses advanced, more accurate imaging to take a biopsy and detect a cancer missed in the first ultrasound-guided biopsy. If this second biopsy comes back as negative, the physician will continue to keep a close eye on your PSA levels with the variety of tests, and you may need to undergo additional biopsies. The closer you follow the patients with negative biopsies, the less likely you are to miss a clinically significant cancer, Ruckle says.
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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 If My Psa Level Is Elevated
If you have a high PSA level, you will need ongoing PSA tests and DREs so your provider can look for any changes. If the PSA level continues to increase or if your healthcare provider finds a lump during a DRE, you may need other tests, including:
- Transrectal ultrasound and prostate biopsies.
- Prostate MRI.
- Iso PSA or 4Kscore® .
A biopsy can tell you definitively if you have prostate cancer. The biopsy results also affect your treatment. For example, if the biopsy shows a lot of cancer cells, you might need more aggressive treatment.
Noncancerous Causes Of A High Psa
The PSA test was originally approved by the U.S. Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men diagnosed with the disease. By 1994, it was clear that the test also had value in detecting prostatic inflammation in otherwise symptom-free men.
While prostate cancer is the main focus reason for this test, other noncancerous conditions can also cause the PSA to rise. The most common of these is prostatitis .
Prostatitis is, in fact, the most common cause of prostate problems in men under 50 and can take several forms:
- Acute bacterial prostatitis, most often caused when bacteria leaks from the urinary tract into the prostate gland
- Chronic bacterial prostatitis, characterized by persistent inflammation
- Chronic non-specific prostatitis, for which there may be symptoms but no known cause
- Chronic asymptomatic prostatitis, for which inflammation is present but with no symptoms
Another cause for elevated PSA levels is benign prostatic hyperplasia , a condition by which the gland itself becomes enlarged. BPH is primarily seen in older men and may cause uncomfortable urinary symptoms, including the impairment of the urinary flow. While it isn’t entirely clear what causes BPH, many believe it to be related to changes in sex hormones as men get older.
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High Psa May Call For More Testing
All men are at risk for prostate cancer. Out of every 100 American men, about 10 will get prostate cancer during their lifetime, and two to three men will die from prostate cancer. Almost all prostate cancers occur in men older than age 55 years, and half of the men who die from prostate cancer are over age 80 years. African-American men and men with a family history of prostate cancer have the highest risk.
Testing for prostate cancer includes both a PSA blood test and a digital rectal exam . A DRE allows the doctor to manually inspect the prostate for size and condition. In up to one-half of patients with an enlarged prostate found on DRE, the PSA level is above normal.
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.
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Positive Psa Score Association With Other Conditions
The amount of PSA in your blood test may increase with other prostate conditions such prostatitis, enlarged prostate , or within two days after ejaculation.
Rest assured, even though your results may be high, it doesnt necessarily mean you have prostate cancer. Just a greater risk of developing it.
Diagnosis And Treatment Of Female Prostate Cancer
Due to the challenges of diagnosis, the signs of female prostate cancer are often mistakenly attributed to underlying conditions in the urinary tract or reproductive system.
Unfortunately, the initial stage of cancer in the Skene glands is asymptomatic. Once your menstrual cycle is disrupted, sex becomes painful, or youre always feeling sick, the disease is quite advanced.
Treatment of female prostate cancer follows a similar strategy to that of other reproductive cancers. If chemical and radiation therapies arent successful in eradicating tumors, then surgery will likely be required to excise them. Frequently, the surgical removal of larger tumors and the chemical destruction of smaller tumors happen simultaneously.
In more severe cases, the organ or organs containing the cancerous growths must be removed as well. This could include your Skene glands, uterus, ovaries, or your entire reproductive system . Whenever cancer in the Skene glands goes undiagnosed and untreated, bladder cancer may follow.
Medical experts have theorized that female prostate cancer could be linked to a history of sexually transmitted infections. The Skene glands, like the male prostate, act as guardians against infections that travel throughout the reproductive system.
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When To See A Doctor
Some of the first symptoms of patients who have an elevated PSA level is difficult or painful urination, pain in the abdomen or pelvic area, and a frequent urge to urinate. These symptoms can be signs of BPH, prostatitis, prostate cancer, and kidney stonesall of which require different treatment. If you are experiencing any of these symptoms, it is important to talk with your doctor. Your doctor will be able to help determine the cause of your problems and provide an individualized treatment plan.
If I Have Elevated Psa Levels What Should I Ask My Healthcare Provider
If you have any symptoms of prostate cancer, or if it runs in your family, ask your provider:
- Should I have regular tests to check my PSA level?
- What can I do to lower my risk for prostate cancer?
- What other tests or monitoring do I need?
- What are my treatment options if I get prostate cancer?
- What other signs or symptoms should I look out for?
A note from Cleveland Clinic
An elevated PSA level can be a sign of prostate cancer, but it doesnt always mean you have cancer. Your healthcare provider will watch you and do more tests to arrive at a diagnosis. Prostate cancer is often slow-growing and may never become life-threatening. If you have symptoms of prostate problems, such as difficulty urinating, don’t hesitate to let your provider know.
Last reviewed by a Cleveland Clinic medical professional on 04/06/2021.
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