Why Is A Prostate
A PSA blood test is performed to detect or rule out prostate cancer. The amount of PSA in the blood is often higher in men who have prostate cancer. However, an elevated PSA level does not necessarily indicate prostate cancer. The U.S. Food and Drug Administration has approved the PSA blood test for use in conjunction with a DRE to help detect prostate cancer in men age 50 or older and for monitoring men with prostate cancer after treatment. However, much remains unknown about how to interpret a PSA blood test, its ability to discriminate between cancer and problems such as BPH and prostatitis, and the best course of action if the PSA level is high.
When done in addition to a DRE, a PSA blood test enhances detection of prostate cancer. However, the test is known to have relatively high false-positive rates. A PSA blood test also may identify a greater number of medically insignificant lumps or growths, called tumors, in the prostate. Health care providers and patients should weigh the benefits of PSA blood testing against the risks of follow-up diagnostic tests. The procedures used to diagnose prostate cancer may cause significant side effects, including bleeding and infection.
Advanced Genomic Testing For Prostate Cancer
The most common lab test for prostate cancer is advanced genomic testing, which examines a tumor to look for DNA alterations that may be driving the growth of the cancer. By identifying the mutations that occur in a cancer cells genome, doctors may get a clearer picture of the tumors behavior and be able to tailor a patients treatment based on the findings.
What Are The Symptoms Of Prostate Problems
The symptoms of prostate problems may include
- urinary retentionthe inability to empty the bladder completely
- urinary frequencyurination eight or more times a day
- urinary urgencythe inability to delay urination
- urinary incontinencethe accidental loss of urine
- nocturiafrequent urination at night
- trouble beginning a urine stream
- weak or interrupted urine stream
- blockage of urine
- urine that has an unusual color or odor
- pain after ejaculation or during urination
Different prostate problems may have similar symptoms. For example, one man with prostatitis and another with BPH may both experience urinary urgency. Sometimes symptoms for the same prostate problem differ among individuals. For example, one man with BPH may have trouble beginning a urine stream, while another may experience nocturia. A man in the early stages of prostate cancer may have no symptoms at all. Because of this confusing array of symptoms, a thorough medical exam and testing are vital.
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Are There Any New Developments In The Treatment Of Prostate Cancer
Doctors often successfully treat prostate cancer. Sometimes, however, the disease returns . An FDA-approved radiotracer for PET/CT called Axumin® helps detect and locate cancer that recurs following radiation therapy or surgery.
Conventional imaging, such as MRI or ultrasound, cannot locate recurring prostate cancer when it is small. PET/CT with Axumin® can detect recurring cancer when PSA levels are low and when the cancer is small.
Identifying the exact location and extent of the disease at an early state is vital. It allows doctors to specifically target the cancer and limit exposure to healthy tissues.
Prostate-specific membrane antigen is a protein that helps develop prostate cancer. A PSMA scan uses PET imaging and a radiotracer to locate recurrent cancer. Doctors are studying Lutetium-177 PSMA therapy in clinical trials for use in treating prostate cancer. Neither of these procedures has FDA approval yet. For more information about the clinical trials, visit .
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.
The Role Of Psa In Choosing The Best Treatment
If you have received a diagnosis of prostate cancer, your PSA levels can be used along with the results of other tests and physical exams and your tumors Gleason score to help determine which tests are needed for further evaluation and to decide on the best treatment plan. After treatment has begun, your PSA and other tests will be used to determine how well the treatment is working: The more successful the therapy, the lower the PSA.
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Prostate Cancer Is The Most Common Nonskin Cancer Among Men In The United States
Prostate cancer is found mainly in older men. Although the number of men with prostate cancer is large, most men diagnosed with this disease do not die from it. Prostate cancer causes more deaths in men than any other cancer except lung cancer. Prostate cancer occurs more often in African-American men than in white men. African-American men with prostate cancer are more likely to die from the disease than white men with prostate cancer.
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How Is Prostate Cancer Diagnosed And Evaluated
Your primary doctor will ask about your medical history, risk factors and symptoms. You will also undergo a physical exam.
Many patients undergo regular prostate cancer screening before symptoms appear. Screening may involve one or more of the following tests:
- Prostate-specific antigen : This test analyzes a blood sample for levels of PSA, a protein the prostate produces. Higher PSA levels could indicate cancer is present.
- Digital Rectal Exam :This test examines the lower rectum and the prostate gland to check for abnormalities in size, shape or texture. The term “digital” refers to the doctor’s use of a gloved, lubricated finger to conduct the exam.
If screening test results are abnormal, your doctor may perform the following imaging tests:
How Is The Psa Test Used In Men Who Have Been Treated For Prostate Cancer
The PSA test is often used to monitor patients who have a history of 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 other clinical signs and symptoms of prostate cancer recurrence.
However, a single elevated PSA measurement in a patient who has a history of prostate cancer does not always mean that the cancer has come back. A man who has been treated for prostate cancer should discuss an elevated PSA level with his 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.
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Different Factors Increase Or Decrease The Risk Of Developing Prostate Cancer
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.
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The Selectmdx Test: Genomic Prostate Cancer Testing Without A Biopsy
Filed in Testing & Diagnosis
In this article, Id like to discuss a new non-invasive test for prostate cancer that more and more of our patients are requesting. It promises to be much more accurate in highlighting the possibility of prostate cancer than a PSA test, and avoids some of the uncomfortable aspects of a prostate biopsy. It is called the SelectMDX test.
To start with, and to help new patients who are unaccustomed to the prostate cancer diagnosis process, lets discuss the PSA blood test. This is usually the very first test that patients have that leads them down the path of diagnosis. Contrary to what you might have read in your newspaper, doctors never use the PSA blood test to actually diagnose prostate cancer as it is not entirely specific or sensitive . It is, however, extremely useful in identifying men who need further investigation and the largest screening study done to date has shown that a man aged 55-69 years who undergoes PSA testing will have his risk of dying from prostate cancer reduced by 29%. This is important when you consider how common and important prostate cancer is: 35,000 new cases and 11,000 deaths each year in the UK.
Biopsy sometimes unnecessary?
Introducing the SelectMDx urine test
SelectMDx outperforms existing established biomarkers
Below are some example, anonymised reports for you to see how clear the test reporting is:
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What does the future hold for SelectMDx?
Other Factors That Influence Psa Levels
The PSA blood test alone cannot diagnose prostate cancer. It is possible, although rare, to have prostate cancer without raised PSA levels in the blood. A higher-than-normal PSA level doesnt automatically indicate prostate cancer either. A high PSA level is due to cancer in around one in three cases.
PSA levels can be raised by other factors, including:
- , also known as benign prostatic enlargement .
For this reason, the PSA blood test isnt used in isolation when checking for prostate cancer.
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Kscore Test For Prostate Cancer Screening: Early Detection Of Prostate Cancer
Screening for prostate cancer detects prostate cancer early, which allows for timely treatment. Screening with PSA test has a number of limitations as elevated PSA can occur in the absence of prostate cancer.
Many men undergo biopsy with attended inconvenience, risks, and costs which do not have prostate cancer because with PSA test, there is a degree of uncertainty of who has prostate cancer and who does not.
What we need is a better test for predicting who has prostate cancer. Then we need to know who among the men with prostate cancer is at risk of having an aggressive disease. We know that many men with prostate cancer have a very slow-growing disease that may not cause any problems for many years. Some have a disease that is on fire. We need to tell which is which.
An ideal test would be easy to administer, inexpensive, and will tell us with a great degree of certainty if a man has prostate cancer. Just as important, a good test will also tell us with a great degree of certainty that someone does not have prostate cancer.
How Common Is Prostate Cancer
About one in nine men will receive a prostate cancer diagnosis during his lifetime. Prostate cancer is second only to skin cancer as the most common cancer affecting males. Close to 200,000 American men receive a diagnosis of prostate cancer every year. There are many successful treatments and some men dont need treatment at all. Still, approximately 33,000 men die from the disease every year.
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New Prostate Cancer Tests Using Urine Samples
The urine samples give information not only on gene fragments of prostate cancer but also on the risk factors. The University of Michigan developed another urine-based test that can reduce the number of negative biopsies by 50%.
This same new test was found to be 97% accurate in identifying cancers later found to be aggressive in biopsies. This means that the urine test can identify prostate cancer earlier than other tests and also divide people into different risk groups, allowing the doctor to accurately determine the treatment path watchful waiting, active surveillance, biopsy or immediate treatment.
In the following video, Dr. David Samadi discusses the benefits of this new prostate cancer test:
Prostate Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Prostate
The prostate is agland in the malereproductive system located just below the bladder and in front of the rectum . It is about the size of a walnut and surrounds part of the urethra . The prostate gland produces fluid that makes up part of semen.
As men age, the prostate may get bigger. A bigger prostate may block the flow of urine from the bladder and cause problems with sexual function. This condition is called benign prostatic hyperplasia , and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms of prostate cancer.
See the following PDQ summaries for more information about prostate cancer:
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Detecting And Diagnosing Prostate Cancer
Prostate cancer is often detected during the course of a routine prostate exam and/or the PSA blood test, but diagnosing it may require other procedures.
PSA test: PSA is a protein found in prostate cells that helps to keep semen liquified. Most cases of prostate cancer develop in these cells, so an elevated PSA count may be a sign of prostate cancer. However, PSA results are more of an indicator than a firm diagnostic tooltheres not a certain PSA score that means a man has prostate cancer. Instead, there are various ranges that are considered average for different age groups. If the PSA score is elevated for your age, further testing may be recommended.
PSA levels are measured as ng/mL. According to the ACS:
- Men with a PSA level between 4 and 10 have about a 25 percent chance of having prostate cancer.
- Men with a PSA level higher than 10 have more than a 50 percent chance of having prostate cancer.
Not all men with high PSA levels have prostate cancer. High levels may also be caused by a urinary tract infection, prostatitis or benign prostatic hyperplasia, all of which are noncancerous conditions. Conversely, men with a low PSA level may still develop prostate cancer.
PSA tests are not an indication of how aggressive the prostate cancer may be. Many prostate cancers are slow-growing and dont require immediate treatment.
The National Comprehensive Cancer Network suggests these screening guidelines and recommendations for men older than 45:
Lymph Node Biopsy As A Separate Procedure
A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.
Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.
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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.
What Are The Stages Of Prostate Cancer
Your healthcare provider uses the Gleason score and Grade Groups to stage prostate cancer based on its projected aggressiveness. To get this information, the pathologist:
- Assigns a grade to each type of cell in your sample. Cells are graded on a scale of three to five . Samples that test in the one to two range are considered normal tissue.
- Adds together the two most common grades to get your Gleason score .
- Uses the Gleason score to place you into a Grade Group ranging from one to five. A Gleason score of six puts you in Grade Group 1 . A score of nine or higher puts you in Grade Group five . Samples with a higher portion of more aggressive cells receive a higher Grade Group.
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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.