What Questions Should I Ask My Healthcare Provider
If you have prostate cancer, you may want to ask your healthcare provider:
- Why did I get prostate cancer?
- What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
- Has the cancer spread outside of the prostate gland?
- What is the best treatment for the stage of prostate cancer I have?
- If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
- What are the treatment risks and side effects?
- Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
- Am I at risk for other types of cancer?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.
Talk With Your Doctor
Prostate cancer is a risk for all men as they age, but if its caught and treated early, the outlook is generally very good. So as you get older, be sure to have open conversations with your doctor about your risk.
If you have any symptoms you think might be prostate cancer, talk to your doctor right away. And even if you dont have symptoms, consider adopting a healthy lifestyle to decrease your risk.
Psa Testing For Detection Of Prostate Cancer
The introduction of prostate-specific antigen testing into clinical practice has greatly increased the detection of localized prostate cancer and, by doing so, has decreased the diagnosis of regional and metastatic disease. PSA testing has had such a profound clinical effect that questions have arisen regarding the significance of the cancers that are being detected.
Stage, grade, tumor volume, and PSA testing are used to determine whether a prostate cancer is clinically significant or insignificant. However, there is no generally accepted precise definition for this distinction.
The goal of early detection of prostate cancer is to identify clinically significant cancers at a time when treatment is most likely to be effective. The risk of death from prostate cancer is significant in those with moderate- to high-grade tumors. This is especially true in younger men. Long-term survival is compromised when the cancer has spread beyond the confines of the prostate, into the regional lymph nodes, and to distant sites.
Several studies have shown that with a PSA cutoff of 4.0 ng/mL, clinically insignificant cancers are detected in fewer than 20% of men, but nearly 50% of all the cancers detected because of an elevated PSA level are localized, and these patients are candidates for potentially curative therapy. Only a small proportion of prostate cancers detected by PSA testing and treated with radical prostatectomy are low-volume and low-grade tumors.
Also Check: Prostate Disease Definition
Comfort With And Knowledge Of Prostate Cancer Screening
Baseline mean composite score for comfort with PCa screening was 3.5 outof 5. Higher baseline comfort with PCa screening was associated with femalegender , being personallycured of cancer , and having a previous discussion with a caregiverabout PCa screening . Compared to nothaving a close relative with a cancer history, having a relative alive with acancer diagnosis or deceased fromcancer were both associated with increasedbaseline comfort with screening. . Race did not affectcomfort.
After exposure to any DA, mean comfort score increased from 3.5 to 4.1out of 5 . Nospecific DA was superior in increasing comfort with screening compared to others. Mean pre-test score onknowledge questions was 9.6 out of 11 and increased to 10.0 following DAexposure . Each individual DA was associated with a similarincrease in correct knowledge based questions.
Psa Testing For The Pretreatment Staging And Posttreatment Management Of Prostate Cancer
Peter Carroll, MD, Chair Peter C. Albertsen, MD, Vice Chair Kirsten Greene, MD, Facilitator Richard J. Babaian, MD H. Ballentine Carter, MD Pater H. Gann, MD, ScD Misop Han, MD Deborah Ann Kuban, MD A. Oliver Sartor, MD Janet L. Stanford, MPH, PhD Anthony Zietman, MD
Don’t Miss: What Is Perineural Invasion In 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.
Production In Benign Hyperplasia
The majority of PSA is produced by the glands in the transitional zone of the prostate. This portion of the prostate is associated with benign prostatic hyperplasia . The peripheral zone, where 80% of prostate cancers originate, produces very little PSA.
The Hybritech monoclonal assay produced a measurement of 0.5 Â± 0.4 ng/mL. Using the monoclonal assay, Lee et al calculated a serum PSA elevation of 0.12 ng/mL per gram of benign prostatic tissue.
You May Like: What Happens If You Have Prostate Cancer
Benefits Of Mammographic Screening
The ACS systematic review also examined the effect of screening mammography on life expectancy. Although the review concluded that there was high-quality evidence that mammographic screening increases life expectancy by decreasing breast cancer mortality, the authors were not able to estimate the size of the increase 23.
What Is The Prognosis For People Who Have Prostate Cancer
Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.
Response To Public Comment
A draft version of this recommendation statement was posted for public comment on the USPSTF website from April 11 to May 8, 2017. A number of comments suggested that because men are now living longer, they should be screened beyond 70 years of age. However, the USPSTF considered other evidence in addition to data on life expectancy when recommending against screening in men older than 70 years, including results from large screening trials that did not report a mortality benefit for men older than 70 years and evidence on the increased likelihood of harm from screening, diagnostic evaluation, treatment, overdiagnosis, and overtreatment. Several comments requested a recommendation for younger men and for baseline PSA-based screening in men 40 years and older or 50 years and older. The USPSTF found inadequate evidence that screening younger men or performing baseline PSA-based screening provides benefit.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Authors followed the policy regarding conflicts of interest described at . All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.
Prostate Cancer Caregiver Podcast Series
We are proud to announce a new podcast series geared toward helping give support, hope and guidance to prostate cancer caregivers. The goal of this Prostate Cancer Caregiver Podcast Series is to help others connect with a diverse group of people who have felt the impact of prostate cancer in their lives and empower them on their journey.
You May Like: What Is Perineural Invasion In Prostate Cancer
Improving Sensitivity Of Psa Testing
Prostate-specific antigen testing with a cutoff of 4.0 ng/mL has a sensitivity of 67.5-80%, which implies that 20-30% of cancers are missed when only the PSA level is obtained. Sensitivity can be improved by lowering the cutoff or by monitoring PSA values so that a rise in PSA level of more than 20-25% per year or an increase of 0.75 ng/mL in 1 year would trigger performance of a biopsy regardless of the PSA value.
The specificity of PSA at levels higher than 4.0 ng/mL is 60-70%. Specificity can be improved by using age-adjusted values, PSA velocity , and the ratio of free PSA to total PSA . Another method is to adjust the PSA according to the size of the prostate or volume determinations of the transitional zone, which produces most of the PSA, and the peripheral zone, which produces less PSA but a majority of prostate cancers.
In the European Randomized Study of Screening for Prostate Cancer, Schroder et al studied a strategy for the early detection of prostate cancer that excluded digital rectal examination results and used a PSA cutoff of 3.0 ng/mL as the only indication for a biopsy. This protocol was compared with one in which a PSA level of 4.0 ng/mL or higher or the presence of a positive DRE or transrectal ultrasound was the indication for a biopsy. In a follow-up study, Schroder et al confirmed a substantial reduction in mortality from prostate cancer as a result of PSA testing.
S Used In Best Practice Statement Development
The AUA convened a multidisciplinary panel for the purpose of developing a resource about PSA testing for urologists and primary care physicians. Panel membership included six urologists, one radiation oncologist, two medical oncologists, one internist and one epidemiologist. Funding in support of panel activities was provided by the AUA. Panel members received no remuneration for their efforts, and each member provided conflict of interest disclosure.
The Panel formulated its policy statements and recommendations by consensus, based on a review of the literature and the Panel members’ own expert opinions. The current policy was based on a reassessment of the previous policy published in 2000. After Panel members agreed on the general areas to be covered, each member took on the task of conceptualizing and writing and/or revising a section of the document in an area where he/she had specific expertise. Every part of the document was thoroughly critiqued by Panel members, both in written comments and in verbal discussions in a series of conference calls. Over the course of successive manuscript revisions, the Panel scrutinized and modified the conceptual framework, reworked the wording of key statements, and reexamined supporting evidence reported in the literature until Panel members reached consensus.
Read Also: How To Find The Prostate Gland Externally
Who Is At Risk For Prostate Cancer
All men are at risk for prostate cancer, but African-American men are more likely to get prostate cancer than other men.
All men are at risk for prostate cancer. Out of every 100 American men, about 13 will get prostate cancer during their lifetime, and about 2 to 3 men will die from prostate cancer.
The most common risk factor is age. The older a man is, the greater the chance of getting prostate cancer.
Some men are at increased risk for prostate cancer. You are at increased risk for getting or dying from prostate cancer if you are African-American or have a family history of prostate cancer.
Psa Transition Zone Density
Kalish introduced PSA density of the transition zone as a refinement to the original PSAD. This refinement is predicated on the following 2 assumptions:
That measuring transition zone volume with TRUS is more accurate than measuring the entire prostate volume because of the difficulty in measuring the true border of the apex in the longitudinal view
That most of the PSA entering the circulation arises from the transition zone
Zisman et al have offered a new index using the peripheral zone fraction of PSA to predict the presence of prostate cancer in men with PSA levels of 4-10 ng/mL. They point out that the PZ contributes little to tPSA. The PZ fraction can be calculated by using the following formula:
tPSA Ã /total prostate volume
PZ volume is measured by subtracting TZ volume from total prostate volume while neglecting the central zone.
Zisman et al compared the positive and negative predictive values using tPSA, PSAD, PSA-TZ, and PSA peripheral zone density . The efficacy rates of PSA and PSA-TZ were similar, at 60% PSA-PZ had a 70% efficacy rate, PSAD an 80% rate. The negative predictive values were superior to the positive predictive values, ranging from 78% to 83% for PSA, from 78% to 88% for PSAD, from 87% to 92% for PSA-TZ, and from 81% to 100% for PSA-PZ.
You May Like: Chemo Pill For Prostate Cancer
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.
Figure 1 Staging Once Prostate Cancer Is Diagnosed
1. Pretreatment serum PSA predicts the response of prostate cancer to local therapy.
Accurate pretreatment staging is crucial in prostate cancer management. Serum PSA levels correlate with the risk of extra-prostatic extension, seminal vesicle invasion, and lymph node involvement. Patients with serum PSA levels of less than 10.0 ng/mL are most likely to respond to local therapy.
Pretreatment serum PSA is an independent predictor of response to all forms of therapy. Nomograms incorporating pretreatment PSA are statistical models that use important variables to calculate the probability of clinical endpoints, and have been useful in predicting outcomes of prostate cancer treatment.5, 6
Pretreatment PSAV is an independent predictor of prostate cancer-specific and overall mortality following therapy. For example, men with localized prostate cancer and a pretreatment PSAV greater than 2.0 ng/mL/year may experience a significantly higher risk of cancer recurrence and prostate cancer-specific mortality following surgery or external beam radiotherapy.7,8
2. Routine use of a bone scan is not required for staging asymptomatic men with clinically localized prostate cancer when their PSA level is equal to or less than 20.0 ng/mL.
4. Pelvic lymph node dissection for clinically localized prostate cancer may not be necessary if the PSA is less than 10.0 ng/mL and the Gleason score is less than or equal to 6.
Also Check: Perineural Invasion Prostate
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.
Factors Influencing Psa Levels
For clinical purposes, prostate-specific antigen is considered specific for the prostate gland but not specific for prostate cancer. A major limitation of PSA as a prostate cancer marker is the overlap in values between benign prostatic hyperplasia and prostate cancer. Normal, hyperplastic, and neoplastic epithelial cells all make PSA, but the amount of PSA produced by cancer cells is 10 times higher per gram of tissue than the amount produced by normal or hyperplastic tissue.
Don’t Miss: Does Enlarged Prostate Affect Ejaculation
Effectiveness Of Early Detection
Potential Benefits of Screening
To understand the potential benefits of PSA-based screening for prostate cancer, the USPSTF examined the results of the ERSPC, PLCO, and CAP trials and site-specific reports from 4 ERSPC trial sites. To understand the effectiveness of treatment of screen-detected, early-stage prostate cancer, the USPSTF also examined the results of 3 randomized trials and 9 cohort studies.3
The ERSPC trial randomly assigned a core group of more than 160,000 men aged 55 to 69 years from 7 European countries to PSA-based screening vs usual care.8 Four ERSPC sites reported on the cumulative incidence of metastatic prostate cancer. After a median follow-up of 12 years, the risk of developing metastatic prostate cancer was 30% lower among men randomized to screening compared with usual care . The absolute reduction in long-term risk of metastatic prostate cancer associated with screening was 3.1 cases per 1000 men.11 After a median follow-up of 13 years, the prostate cancer mortality rate among men aged 55 to 69 years was 4.3 deaths per 10,000 person-years in the screening group and 5.4 deaths per 10,000 person-years in the usual care group .8 The ERSPC trial did not find a reduction in all-cause mortality.8
Neither the ERSPC, PLCO, or CAP trials, nor any of the ERSPC site-specific analyses, found an overall all-cause mortality benefit from screening for prostate cancer.
Potential Benefits of Treatment
Ethnic Differences In Awareness Of Prostate Cancer
The responses of the non-information group were analysed to determine if there were underlying differences between White and Black respondents. Fifty-three percent of the sample in the non-information group described themselves as White and 47% as Black. The response rate was similar for White and Black participants. The mean age was 51 years most were in full-time employment and married or with a partner . Demographics were similar for the two ethnic groups, although White men were more likely to have undergone higher or university-based education .
Table 1 Demographic characteristics of sample
You May Like: How Are Fiducial Markers Placed In The Prostate