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.
What Tests Might I Have At The Hospital
If youre given an appointment with a hospital specialist, they may do some of the tests you had at the GP surgery again. You may also have other tests, including the following.
Symptom questionnaire
You might be asked to fill in a short questionnaire about your symptoms. This is called the International Prostate Symptom Score and is used to see how bad your symptoms are and how much they are bothering you.
Urine flow test
Youll be asked to urinate into a machine that measures the speed of your urine flow. Men with an enlarged prostate usually have a slower flow than other men. Youâll need a full bladder for the test. The doctor or nurse will tell you how much to drink before you have the test. They may also ask you not to urinate for two to three hours before the test.
Ultrasound scan
This shows how much urine your bladder can hold, and if it is emptying properly. You may have the scan straight after the urine flow test to see how much urine is left in your bladder after you urinate. You may also have an ultrasound scan to look at your kidneys.
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Transrectal Ultrasound With Prostate Biopsy
Transrectal ultrasound is most often used to examine the prostate. In a transrectal ultrasound, the health care provider inserts a transducer slightly larger than a pen into the mans rectum next to the prostate. The ultrasound image shows the size of the prostate and any abnormal-looking areas, such as tumors. Transrectal ultrasound cannot definitively identify prostate cancer.
To determine whether a tumor is cancerous, the health care provider uses the transducer and ultrasound images to guide a needle to the tumor. The needle is then used to remove a few pieces of prostate tissue for examination with a microscope. This process, called biopsy, can reveal whether prostate cancer is present. A transrectal ultrasound with prostate biopsy is usually performed by a doctor in a health care providers office, outpatient center, or hospital with light sedation and local anesthesia. The biopsied prostate tissue is examined in a laboratory by a pathologista doctor who specializes in diagnosing diseases.
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What Are The Prostate Cancer Symptoms I Need To Look Out For
In its early stages, prostate cancer may not show any symptoms. Symptoms of early prostate cancer can include:
- difficulty passing urine
- a slow, interrupted flow of urine
- frequent passing of urine, including at night
Symptoms associated with advanced prostate cancer include:
- pain during urination
- lower back or pelvic pain.
These symptoms are also found in men who may have benign prostatic hyperplasia , a common, non-cancerous enlargement of the prostate gland.
If you experience these symptoms, visit your doctor.
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.
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Living With Prostate Cancer
As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.
Nevertheless, it can affect your life. As well as the possible side effects of treatment, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.
You may find it beneficial to talk about the condition with your family, friends, a GP and other people with prostate cancer.
Financial support is also available if prostate cancer reduces your ability to work.
Genetic Testing For Some Men With Prostate Cancer
Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.
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Facts About Prostate Specific Antigen Tests
According to the American Cancer Society, 1 in 8 men will be diagnosed with prostate cancer during his lifetime, and prostate cancer is the second leading cause of cancer death in American men. Here are five things you should know about prostate cancer and prostate specific antigen tests.
1. Prostate cancer is silent for many men.
In most men, prostate cancer displays few early symptoms. Urinary symptoms, such as decreased force of urinary stream or nocturia , are common in aging men but, in general, these are not associated with prostate cancer. Symptoms such as bone pain, blood in urine or weight loss can be found if prostate cancer has spread.
2. Some men are at a greater risk for developing prostate cancer.
All men can develop prostate cancer. However, there are some risk factors that increase your likelihood. Older men are at increased risk. African American men and men with one or more close relatives who have had prostate cancer also are at increased risk. Your risk also will be higher if you have a close relative diagnosed with prostate cancer prior to age 55.
3. PSA tests do not diagnose prostate cancer.
There is no universally accepted threshold value above which total PSA is considered abnormal, as PSA values change depending on your age and race.
4. There are some downsides with a PSA test.
5. There are established screening guidelines for men of average risk of prostate cancer.
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 .
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Information For Well Men Aged 50 And Over
You can refer to the infographic above and direct patients to the information sheet for well men aged 50 and over for a summary of the potential benefits and risks of PSA testing.
The information sheet for well men includes the above infographic, which explains the PSA test. It also includes a list of the potential advantages and disadvantages of the PSA test for men to consider when making a decision.
The Office for Health Improvement and Disparities created this information on behalf of the NHS.
Is Psa The Same As Psma
The PSA test is different from the PSMA PET scan.
The PSA test is a blood test that measures the level of PSA in your blood. PSA is a protein produced by cells in your prostate gland. High levels of PSA are often a sign of prostate cancer.
The PSMA PET scan is used after PSA testing if your doctor isnt sure if or where prostate cancer has spread. It can more accurately pinpoint where prostate cancer cells are located throughout the body.
Your doctor may order a PSA blood test to:
- screen for prostate cancer if you dont have symptoms of the disease
- determine whether further tests are necessary to diagnose prostate cancer if you do have symptoms of the disease
- check for signs that prostate cancer has come back if youve received successful treatment for the disease
PSA blood test results are not enough to diagnose prostate cancer or learn whether it has spread or returned. If you have high levels of PSA, your doctor will order other follow-up tests to develop an accurate diagnosis.
Your doctor will only order a PSMA PET scan if they think you may have prostate cancer that has spread beyond the prostate gland.
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What Other Test Are 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 are now available.
PSA is still a useful test but is being supplanted by more informative tests such as 4KScore and PHI , both of which incorporate the traditional PSA test as well. Thus, the report will list both the traditional PSA test and the 4KScore or PHI score respectively.
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.
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There Are Risks To Getting Prostate Cancer Tests And Treatments
If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.
Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.
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How Long Does A Psma Scan Take
The PSMA PET scan usually takes about 2 hours, although timing may vary.
To conduct a PSMA PET scan, a nurse or technician will inject a special dye with a radioactive tracer into one of your veins. They will ask you to wait approximately 30 to 60 minutes to allow the dye to travel throughout your body.
Next, they will ask you to lie down on a padded exam table. They will slide the table through a PET-CT or PET-MRI scanner to create images of your body. This scan may take 30 minutes or longer to complete.
After the scan is finished, a specialist will review the images and report the results to your doctor. Your doctor will share the results with you.
Ask your doctor how long it will take to receive the results of the scan.
What Can Be Done
If your prostate cancer has recurred, your healthcare provider will likely order some imaging tests to better determine where in your body the cancer has returned. Bone scans, CT scans, and MRIs are the most common tests ordered to find where in the body prostate cancer has recurred.
Many treatment options are available for prostate cancer that has returned. The one that you and your healthcare provider choose depends on individual factors such as what treatment you have already received, where in the body your prostate cancer has returned, how your cancer has spread, your general health, and your age.
If your prostate cancer is thought to have recurred in only a small area and has not spread to other areas of the body, then radiation therapy to that area may be an option.
If your prostate cancer has most likely spread to multiple areas of the body, then hormonal therapy would likely be an option. Chemotherapy can also be used when the cancer has spread to multiple sites.
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Screening For Prostate Cancer
Prostate cancer screening did not significantly decrease prostate cancer-specific mortality in a combined meta-analysis of five RCTs. Only one study reported a 21% significant reduction of prostate cancer-specific mortality in a pre-specified subgroup of men aged 55 to 69 years. Pooled data currently demonstrates no significant reduction in prostate cancer-specific and overall mortality. Harms associated with PSA-based screening and subsequent diagnostic evaluations are frequent, and moderate in severity. Overdiagnosis and overtreatment are common and are associated with treatment-related harms. Men should be informed of this and the demonstrated adverse effects when they are deciding whether or not to undertake screening for prostate cancer. Any reduction in prostate cancer-specific mortality may take up to 10 years to accrue therefore, men who have a life expectancy less than 10 to 15 years should be informed that screening for prostate cancer is unlikely to be beneficial. No studies examined the independent role of screening by DRE.
To determine whether screening for prostate cancer reduces prostate cancer-specific mortality or all-cause mortality and to assess its impact on quality of life and adverse events.
An updated search of electronic databases , MEDLINE, EMBASE, CANCERLIT, and the NHS EED) was performed, in addition to handsearching of specific journals and bibliographies, in an effort to identify both published and unpublished trials.
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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Early Detection Saves Lives
Prostate cancer is the most common cancer affecting Australian men .
Prostate cancer is the growth of abnormal cells in the prostate gland. This gland is only found in males and is about the size of a walnut.
The causes of prostate cancer are not understood and there is currently no clear prevention strategy.
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What Happens If You Have A Likert Score Of 1 Or 2
Your doctor may not recommend a biopsy if you have a low Likert score. But you can still have one if you want to. Your doctor will explain the possible benefits and risks of having a biopsy.
When recommending whether you need a biopsy or not, your doctor also looks at other factors. These include:
- other test results such as PSA level and prostate examination
- the size of your prostate and the corrected PSA for its size. This is called the PSA density
- any other health conditions that you might have
- how well youd cope with prostate cancer treatment and whether it would benefit you
They might decide not to recommend a biopsy if you’re unwell or not likely to be able to have treatment.
If you don’t have a biopsy, your doctor may recommend monitoring your PSA level. They will recommend what your PSA level should be. You are usually discharged back to your GP to be monitored. Your GP can refer you back if the PSA levels go up.
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Benefits Of Early Detection And Treatment
The goal of screening for prostate cancer is to identify high-risk, localized prostate cancer that can be successfully treated, thereby preventing the morbidity and mortality associated with advanced or metastatic prostate cancer.
Adequate evidence from randomized clinical trials shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened.3, 4 Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened.3 Current results from screening trials show no reductions in all-cause mortality from screening. There is inadequate evidence to assess whether the benefits for African American men and men with a family history of prostate cancer aged 55 to 69 years are different than the benefits for the average-risk population. There is also inadequate evidence to assess whether there are benefits to starting screening in these high-risk groups before age 55 years.
Adequate evidence from RCTs is consistent with no benefit of PSA-based screening for prostate cancer on prostate cancer mortality in men 70 years and older.