What Is The Test For Prostate Cancer

How Soon Will Prostate Test Results Be Available

New Test to Detect Prostate Cancer Now 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.

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

Tests To Diagnose And Stage Prostate Cancer

Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.

If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.

The actual diagnosis of prostate cancer can only be made with a prostate biopsy .

Myriad Genetics Genetic Testing For Prostate Cancer

This genetic testing company offers genetic testing for prostate cancer. Myriad Genetics has been selling genetic testing services for over 25 years and is constantly making efforts to bring the significance of genetics in diseases to the attention of both patients and medical practitioners. Myriad Genetics has carried out various studies to link genetics with various diseases to improve the process of diagnosis and treatment of diseases.

Myriads gene testing procedure for prostate cancer is called Prolaris. Prolaris costs $2400 per test. The company notes that most insurance companies will cover the entire cost of the test. For those with out-of-pocket costs, the price is usually less than $60.

Prolaris offers both tumor testing for confirmed tumors and genetic testing to identify if you have inherited a genetic mutation that increases your risk of developing cancer.

Prolaris, in combination with other screening tests, can be used to assess the aggressiveness of prostate cancer and the chances it will spread to other parts of the body. This product is designed for men with untreated cancer. It can also be used to aid in treatment decisions, such as choosing active surveillance or a multi-model aggressive treatment.

The genetic testing portion of Prolaris is for men with prostate cancer, treated or untreated. It assesses whether an inherited mutation may have caused your cancer. It can impact early treatment decision making and qualify individuals for certain treatments.

Screening For Prostate Cancer In African American Men

Burden

In the United States, African American men are more likely to develop prostate cancer than white men . African American men are also more than twice as likely as white men to die of prostate cancer .1 The higher death rate is attributable in part to an earlier age at cancer onset, more advanced cancer stage at diagnosis, and higher rates of more aggressive cancer . These differences in death from prostate cancer may also reflect that African American men have lower rates of receiving high-quality care.

Available Evidence

The USPSTF searched for evidence about the potential benefits and harms of PSA-based screening for prostate cancer in African American men.

Potential Benefits

The PLCO trial enrolled 4% African American men, which is not enough to determine whether the overall trial results differed for African American men.17 The ERSPC trial did not record or report any race-specific subgroup information. The low proportion of persons of African descent in European countries during the study period makes it likely that these groups were not well represented.

Potential Harms

An analysis from the PLCO trial found that African American men were significantly more likely to have major infections after prostate biopsy than white men .13 Evidence is insufficient to compare the risk of false-positive results, potential for overdiagnosis, and magnitude of harms from prostate cancer treatment in African American vs other men.

Advising African American Men

Estimate Of Magnitude Of Net Benefit

Conclusions from decision analysis models, which are consistent with the findings of randomized trials and cohort studies, suggest that more aggressive screening strategies, particularly those that use a lower PSA threshold for biopsy than generally used in the United States, provide the greatest potential reduction in death from prostate cancer. However, these strategies are also associated with more false positives, more biopsies, and higher rates of overdiagnosis.24

Options for reducing the overdiagnosis rate include lowering the age at which to stop screening, extending the interval between screenings, and using higher PSA thresholds for biopsy. However, no strategy completely eliminates overdiagnosis. PSA-based screening for prostate cancer every 2 or 4 years instead of annually appears to provide a good trade-off between a reduction in overdiagnosis and a small reduction in mortality benefit.24

Although active surveillance may reduce exposure to the potential harms of active treatment, it may not be viewed favorably by some men who value definitive action, are concerned about repeat biopsies, or want to avoid a potential increase in metastatic cancer.

Research Needs And Gaps

There are many areas in need of research to improve screening for and treatment of prostate cancer, including

Comparing different screening strategies, including different screening intervals, to fully understand the effects on benefits and harms
Developing, validating, and providing longer-term follow-up of screening and diagnostic techniques, including risk stratification tools, use of baseline PSA level as a risk factor, and use of nonâPSA-based adjunctive tests that can distinguish nonprogressive and slowly progressive cancer from cancer that is likely to become symptomatic and affect quality or length of life, to reduce overdiagnosis and overtreatment
Screening for and treatment of prostate cancer in African American men, including understanding the potential benefits and harms of different starting ages and screening intervals and the use of active surveillance given the large disparities in prostate cancer mortality in African American men, this should be a national priority
How to better inform men with a family history of prostate cancer about the benefits and harms of PSA-based screening for prostate cancer, including the potential differences in outcomes between men with relatives who died of prostate cancer and men with relatives diagnosed with prostate cancer who died of other causes
How to refine active prostate cancer treatments to minimize harms

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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.

Why Test For Prostate Cancer

A new test for prostate cancer

Prostate cancer affects 1 in 7 men. Certain men are at higher risk for prostate cancer because of their family history breast cancer and ovarian cancer in mothers and sisters can also put men at increased risk for prostate cancer.

It is important that all men over age 40 who have symptoms that can be caused by prostate cancer are tested for prostate cancer. These symptoms can be caused by many other conditions but it is important to test for prostate cancer in order not to miss it.

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How Are Prostate Problems Diagnosed

To diagnose prostate problems, the health care provider will perform a digital rectal exam . The health care provider will also ask the patient

when the problem began and how often it occurs
what symptoms are present
whether he has a history of recurrent urinary tract infections
what medications he takes, both prescription and those bought over the counter
the amount of fluid he typically drinks each day
whether he consumes caffeine and alcohol
about his general medical history, including any major illnesses or surgeries

Answers to these questions will help the health care provider identify the problem or determine what medical tests are needed. Diagnosing BPH may require a series of medical exams and tests.

Use In Men Already Diagnosed With Prostate Cancer

The PSA test can also be useful if you have already been diagnosed with prostate cancer.

In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .

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.

Potential Harms Of Screening And Treatment

Potential Harms of Screening and Diagnosis

In addition to the ERSPC and PLCO trials, the USPSTF examined the results of a good-quality cohort study embedded within the ProtecT trial , a fair-quality cohort study conducted in the US Department of Veterans Affairs health system, as well as a report on complications of prostate biopsy from the ERSPC Rotterdam site to understand the potential harms of screening and diagnosis.3

In the large RCTs, one-fourth to one-third of men offered PSA-based screening had at least 1 positive screening test result. In the PLCO trial, 13% of men had undergone at least 1 biopsy. In the ERSPC trial, nearly 28 biopsies were performed for every 100 men randomized to screening.3 In the ProbE trial, 7.3% of men reported moderate or greater pain, 5.5% reported moderate to severe fever, and 26.6% reported troublesome hematospermia within the 35 days after biopsy.28 Complications from transrectal prostate biopsy resulted in 1.3% of men in the UK cohort, 1.6% of men in the VA cohort, and 0.5% of men in the Rotterdam cohort requiring hospitalization.30-32 In these studies, two-thirds to three-fourths of biopsies demonstrated that the PSA screening test was a false positive.3

Potential Harms of Treatment

In several studies, men older than 70 years had a significantly increased risk of medical complications and perioperative mortality after radical prostatectomy compared with younger men.3

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How Do You Know If You Have Prostate Cancer

Because so many men dont experience any symptoms of prostate cancer, its even more important you see your doctor and regularly have your prostate checked.

You cant check your prostate yourself, it must be done by a doctor.

Prostate Cancer UK says you are at increased risk of developing prostate cancer if youre over the age of 50, if you have a family history of prostate cancer or if you are black.

You can use their risk checker online tool here.

What Are The Different Types Of Psa Tests

PSA Test:A PSA test is a simple blood test that measures the amount of PSA protein in the blood. For the reasons listed in the What is PSA? section, measuring PSA levels can be a useful tool in screening for prostate cancer as well as monitoring the progression of the disease in someone who has already been diagnosed with prostate cancer. Discussing the risks and benefits of prostate cancer screening with a doctor, having a baseline PSA taken, and considering a baseline DRE are all important steps in early detection.

Free PSA Test:To help manage patients with a borderline or moderately elevated PSA level, a doctor may follow up with another test called a free PSA test. When circulating in the bloodstream, PSA is either attached to other proteins or it is not attached . By measuring free PSA in addition to total PSA a free-to-total PSA ratio can be calculated. When combined with a complete clinical assessment, it can help determine whether follow-up procedures, like a prostate biopsy, are necessary.

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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.

What Is A Normal Psa Test Result

Testing for Prostate Cancer | Prostate PSA Test

There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.

However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer . In addition, various factors can cause a mans PSA level to fluctuate. For example, a mans PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugsincluding finasteride and dutasteride , which are used to treat BPHlower a mans PSA level. PSA level may also vary somewhat across testing laboratories.

Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of White men. Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group.

In general, however, the higher a mans PSA level, the more likely it is that he has prostate cancer. Moreover, a continuous rise in a mans PSA level over time may also be a sign of prostate cancer.

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A Note On Suspicious Results

A suspicious result indicates that the biopsy sample contained some abnormalities but no cancer was found. There are a couple of potential explanations for a suspicious prostate biopsy result, including:

Prostatic intraepithelial neoplasia refers to changes within prostate cells that are abnormal, but not indicative of cancer. This condition is low-grade or high-grade, depending on how abnormal the cells are. Low-grade PIN is very common and isn’t associated with prostate cancer. High-grade PIN, however, is associated with a higher risk of prostate cancer. If you have high-grade PIN after a prostate biopsy, your doctor may recommend that biomarker tests be performed on the sample to learn more about the cells. Alternatively, another prostate biopsy may be suggested.
Atypical small acinar proliferation indicates that the biopsy sample contains some cells that appear to be cancerous, but not enough to confirm the diagnosis. In most cases, this finding suggests that another prostate biopsy is needed.
Proliferative inflammatory atrophy describes a prostate biopsy that reveals inflammation in the prostate and abnormally small prostate cells. While these cells arent cancerous, having PIA may be associated with an increased risk of developing prostate cancer.

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