PSA Test and Signs of Prostate Cancer
The PSA test, a blood test for prostate cancer, is a helpful test in detecting prostate cancer early, especially since there usually aren’t any warning signs of prostate cancer. PSA testing, along with regular physician exams and in combination with new prostate cancer molecular markers, can help detect prostate cancer at its earliest stages and provide important information on whether the prostate cancer is likely to grow and whether the prostate cancer should be treated.
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For the past decade, controversy has swirled around when and how men should be screened for prostate cancer with PSA testing. Prostate cancer is the second most common type of cancer in men—and the second leading cause of cancer deaths. Yet there usually aren’t any warning signs of prostate cancer, and that is why prostate cancer screening is important.
The standard screening tests for prostate cancer are a digital rectal exam (DRE), in which a physician manually feels for irregularities in the prostate, and a PSA test, which is a blood test for prostate cancer that looks for prostate-specific antigens (PSA) in the blood.
In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against using the PSA test as a routine prostate cancer screening for all men. The Task Force made this recommendation after concluding that harm resulting from PSA testing, such as unnecessary biopsies and negative side effects from treatment, outweighed the benefits of finding and managing the disease early.
However, the Task Force is now reconsidering its recommendations based on further research into the effectiveness of PSA testing. We agree with USPSTF and their concerns around over-diagnosis and over-treatment, but also believe in the importance of early prostate cancer detection efforts. New tests for biomarkers for prostate cancer as well as more sophisticated prostate cancer biopsies, such as our 3D prostate biopsy, have allowed healthcare practitioners to obtain additional information that reduces the need for unnecessary testing and treatment.
At Precision Prostate Cancer Care, we believe that routine PSA testing should be selectively offered in the same manner as cholesterol or blood pressure screenings. We also believe that any PSA test result above 1.5 ng/ML—vs. the standard 4.0 ng/ML level—warrants further evaluation.
PSA levels are just one factor in a comprehensive evaluation of a man’s prostate health. Other factors include family history, race, overall health, diet, activity levels, age, and physical exam. Based on this thorough evaluation, we may recommend additional non-invasive testing using biomarkers and magnetic resonance imaging (MRI). Once we conduct a thorough workup of your condition, we may recommend an advanced 3D prostate biopsy or continued active surveillance for me who we deem are very low risk.
An elevated PSA level doesn’t always signal prostate cancer, nor does a low PSA level necessarily mean all is clear.
Elevated PSA levels can indicate prostatitis (inflammation of the prostate) or benign prostatic hyperplasia (BPH), both conditions common in men over age 50. In addition, men with normal PSA levels can have prostate cancer. This is known as a false-negative test result, and it can create a false sense of security when further diagnostic testing should be conducted. About 15 percent of men with a PSA level below 4 will have prostate cancer on a biopsy, according to the American Cancer Institute.
The PSA test is an unreliable determination of prostate cancer on its own. According to the National Cancer Institute, only about 25 percent of men who have had a prostate biopsy in the past due to an elevated PSA level actually have prostate cancer. It’s unknown how many cases of prostate cancer are missed due to false-negative PSA test results.
It is for these reasons, clearly supported by peer-reviewed medical research, that we recommend that every man receive a customized evaluation if they have a PSA level above 1.5 ng/ML. With the availability today of advanced testing called prostate cancer markers (PCMs), we have a much clearer picture of which men need further evaluation with a prostate biopsy.
After a suspicious physical exam or PSA test, your physician may recommend further screening. Sometimes, men are referred for a prostate biopsy. However, we recommend that further non-invasive testing be performed unless immediate biopsy is warranted due to initial test results.
Prostate cancer screening with MRI (magnetic resonance imaging) may help avoid unnecessary biopsies by providing physicians with a clear view of the prostate. MRI can detect lesions and indicate whether cancer has spread beyond the prostate. However, like PSA, a negative MRI does not necessarily mean that the patient is in the clear. MRI has been shown in research to be better at finding larger size lesions, but can still miscategorize relative lesion size, making it less than ideal to be used in conjunction with targeted therapy.
There are also numerous advanced tests called prostate cancer biomarkers available. Prostate cancer markers (PCMs) are molecules found in blood, tissue, or body fluids that are signs of an abnormal process. Blood, urine, and tissue tests can help differentiate between prostate cancer and benign prostate conditions that are non-cancerous. These tests for biomarkers for prostate cancer include:
- Blood-based PCMs: These tests, including Beckman Coulter’s Prostate Health Index (phi) and the Opko 4K test, have shown to be superior to PSA in identifying significant vs insignificant prostate cancer. ProstateNext, a blood- or saliva-based genetic analysis, also can help in diagnosis to determine if men may be carriers of a gene known as BRCA1 or BRCA2.
- Urine-based PCMs: These tests, including Select MDx and Mi-Prostate Score (MiPS), which evaluate prostate cells present in the urine, have shown to be very accurate in determining which individual may have high-grade prostate cancer upon biopsy.
- Tissue-based PCMs: These tests use prostate tissue removed in a biopsy to help understand how aggressive the type of cancer is that was found on biopsy or after prostate surgery (prostatectomy), or to indicate which areas of the prostate may be harboring prostate cancer if the biopsy was negative. These tests include the Prolaris Test, the Decipher test, the Oncotype DX test, and the ConfirmMDX test.
Read more about prostate cancer biomarkers.
A small percentage of prostate cancers are caused by inherited germline genetic mutations. The most common gene mutations that increase a man’s risk of prostate cancer also increase the risk of other cancers. Genetic testing may be recommended by your health care practitioner if there is a family pattern of certain types of cancers, including prostate, colorectal, pancreatic, and breast. The most common genetic mutations that increase a man’s risk of prostate cancer are:
- BRCA1 or BRCA2 genes raise the risk of breast cancer (in men and women) as well as ovarian cancer in women. These genetic mutations also may increase the risk of prostate cancer in some men.
- Lynch syndrome, or hereditary non-polyposis colorectal cancer, increases a person’s risk for a number of cancers, including colorectal and prostate cancer.
Family history is the leading risk factor for prostate cancer. A man’s risk of developing prostate cancer more than doubles if he has a brother or father who received a prostate cancer diagnosis. The risk is greater with a brother than a father. Men with several affected relatives also have a much higher risk of developing prostate cancer.
Yet, even with family history being the strongest risk factor for developing prostate cancer, only about 5 to 10 percent of all prostate cancer diagnoses are hereditary. Men with a family history need to be extra vigilant about being screened regularly, but even men without a family history could benefit from screening.
In most cases, men will not experience any signs of prostate cancer, especially early in the disease when it is most treatable. That is why regular physical exams, PSA testing, and additional prostate cancer marker testing is needed to detect prostate cancer and determine if it should be medically treated.
Some men may experience signs of prostate cancer, particularly as the disease progresses. Men may experience some or all of these signs of prostate cancer; however, non-cancerous benign prostate conditions also can cause these symptoms. Signs of prostate cancer may include:
- Significant problems urinating, including a significantly reduced urinary stream, the need to urinate more often, especially at night, or the inability to pass urine
- Blood in the urine or semen
- Trouble getting an erection (erectile dysfunction or ED)
- Pain in the hips, back (spine), chest (ribs), or other areas from cancer that has spread to bones
- Weakness or numbness in the legs or feet, or even loss of bladder or bowel control from cancer pressing on the spinal cord
If you have an elevated PSA level—anything above 1.5 ng/ML—don’t panic. Elevated PSA levels can indicate non-cancerous conditions. If you do have prostate cancer, it may be very slow growing and not cause a problem. Your next step is to consult with a specialized healthcare provider or urologist who offers comprehensive and customized evaluations, including the availability of non-invasive tests that look for prostate cancer markers in your blood and urine.
If you have a high PSA level, an abnormal physical exam, a family history of prostate cancer, or other risk factors, Precision Prostate Cancer Care can provide a customized evaluation of your risks for prostate cancer as well as detection and treatment options. We offer all forms of advanced testing for prostate cancer, including tests that look for biomarkers for prostate cancer. We also provide second opinions and new prostate cancer treatment options such as targeted focal cryotherapy (TFT), which often has fewer side effects than prostate removal surgery or radiation in men who are eligible after obtaining a 3D prostate biopsy.
To learn more, schedule a free phone consultation or learn now to become a patient.