As PSA level 10 is the baseline of PSA blood test results, any value over 10 is considered suspicious and need another confirmation by a blood test named “Free PSA”, then DRE, then the doctor has to decide whether to wait and watch the PSA levels until it back to normal range or decide to take a prostate biopsy.
Full Answer
Can a PSA test be done more than a month later?
May 27, 2003 -- The PSA blood test is commonly used to check for signs of prostate cancer or other prostate problems. When a PSA level comes back high, the next step is often a biopsy. But a new study suggests another course of action: Another PSA test done more than a month later.
Should men with high PSA levels undergo prostate biopsy?
The Prostate Cancer Prevention Trial included a provision that men randomized to receive placebo undergo a prostate biopsy at the end of the study, even if they had normal PSA levels and digital rectal exams. To their surprise, investigators found that many of these men had prostate cancer — in some cases, high-grade prostate cancer.
Can a PSA test Save Your Life?
Even though a PSA test is likely to detect prostate cancer at an earlier stage, there is no evidence that the test saves lives. This is because prostate cancer is generally slow-growing and typically strikes men at an older age, when they are more likely to die from other causes.
Is it normal to have a high PSA level with aging?
The larger proportion of aging cells also results in a raised PSA, and this is normal. There are different types of PSA tests. While none of them can diagnose prostate cancer, a combination of two or more give better clues than the traditional basic test.
At what PSA level should treatment be done?
Recent studies have shown that for optimal results, PSA levels should be lower than 1 ng/ml, and even lower than 0.5 ng/ml. Levels that are above 1 or 2 ng/ml 12 to 18 months following completion of radiation treatments are very worrisome, because they indicate that the cancer may not have been eradicated.
Why would a physician recommend watch and wait for prostate cancer?
Avoid Side Effects of Treatment and Testing Similar to active surveillance, patients under watchful waiting may choose to delay treatment because of its associated risks and side effects. With watchful waiting, men with compromised health can also avoid the side effects associated with repeated tests and biopsies.
How long should you wait between PSA tests?
For most men, every two to three years is enough. Depending on the results of your first PSA test, your doctor may recommend you get screened less (or more) frequently.
At what PSA level should a biopsy be done?
A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy. Many doctors recommend a prostate biopsy for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%.
Is watchful waiting safe for prostate cancer?
Who can go on watchful waiting? Watchful waiting may be suitable for you if your prostate cancer isn't causing any symptoms or problems, and: treatments may not help you to live longer. your prostate cancer isn't likely to cause any problems during your lifetime or shorten your life.
How long can you wait with prostate cancer?
The inflammation and punctures need to heal. That's why you have to wait a minimum of 6-8 weeks after biopsy before you can get surgery or radiation.
What is considered a rapid rise in PSA levels?
PSA levels under 4 ng/ml are generally considered normal, while levels over 4 ng/ml are considered abnormal. PSA levels between 4 and 10 ng/ml indicate a risk of prostate cancer higher than normal. When the PSA level is above 10 ng/ml, risk of prostate cancer is much higher.
What can cause a sudden rise in PSA?
Besides cancer, other conditions that can raise PSA levels include an enlarged prostate (also known as benign prostatic hyperplasia or BPH ) and an inflamed or infected prostate (prostatitis). Also, PSA levels normally increase with age.
What is the average PSA for a 70 year old?
3.5-4.5: Normal for a man 60-70 yrs. 4.5-5.5: Normal for a man 70-80 yrs.
What does a urologist do if your PSA is elevated?
After an initial test result of elevated PSA levels, a urologist will want to perform another PSA test and other tests to diagnose the issue. Prostate-specific antigen, or PSA, is a protein produced in cells of the prostate gland and a PSA test measures the level of PSA in a man's blood.
How much should PSA increase per year?
In the overall study population, the mean change in PSA levels was 2.9% per year and the rate of change in PSA increased modestly with age (P < . 001). Overall, men who developed prostate cancer experienced a more rapid percent change in PSA per year than men who did not (P < .
How painful is a biopsy of the prostate?
You will feel some pressure when the probe is inserted, but it is usually not painful. Usually between 6 – 12 (sometimes more) prostatic tissue samples are obtained and the entire procedure lasts about 10 minutes. A local anesthetic can be used to numb the area and reduce any pain.
Why was watchful waiting important?
Observation (watchful waiting) is sometimes used to describe a less intensive type of follow-up that may mean fewer tests and relying more on changes in a man's symptoms to decide if treatment is needed. This treatment is most often meant to control symptoms from the cancer, but not to cure it.
What does watchful waiting refer to?
(WACH-ful WAY-ting) Closely watching a patient's condition but not giving treatment unless symptoms appear or change. Watchful waiting is sometimes used in conditions that progress slowly. It is also used when the risks of treatment are greater than the possible benefits.
What is watchful waiting for BPH?
Watchful waiting is a time-honored approach to the management of patients with early benign prostatic hyperplasia (BPH) and minimal symptoms. The ability to manage a patient with BPH by a watchful waiting approach is dependent on our understanding of the natural history of the disease.
What is the difference between active surveillance and watchful waiting?
Active surveillance may require you to have many biopsies to track cancer growth. Watchful waiting is a less aggressive system of monitoring prostate cancer without treating it. It does not involve regular biopsies or other frequent testing.
What is the Gleason score for prostate cancer?
Is only in your prostate. Has a prostate-specific antigen ( PSA) level less than 10 ng/mL. Has a Gleason score of 7 or less, which means your cancer is slow-growing.
Can you wait to see if you have cancer?
Not have any symptoms. Feel OK about waiting to see if your cancer grows. (You’re in charge of all your treatment decisions.) Be able to go about your day-to-day life and not worry that your cancer will spread. Understand the benefits and risks of your decision to follow active surveillance.
Can prostate cancer patients live after radiation?
They have found that men with slow-growing tumors who choose active surveillance are likely to live as long after their prostate cancer diagnosis as men with slow-growing tumors who have surgery or radiation right away.
Can you watch for prostate cancer?
With watchful waiting, there are fewer tests . Instead, your doctor will watch to see if you get any prostate cancer symptoms. If you do, you and your doctor will talk about next steps. This could be treatments for the cancer. Or it could be treatments that will control the symptoms.
Can prostate cancer cause problems?
The prostate cancer probably won’t cause you any problems in your lifetime. If you have symptoms, you and your doctor can decide at that time whether you need treatment. Risks of Treatment. The decision to go with active surveillance or watchful waiting is a personal one.
How long did T1C prostate cancer last?
Investigators followed 81 men diagnosed with stage T1c prostate cancer for at least one year (some for nearly five years). The men underwent semiannual PSA tests and digital rectal exams and had annual prostate biopsies to see if the cancer had become active. At time of repeat biopsy, cancer had progressed in 25 men.
What are the side effects of a prostate transplant?
The most common side effects are. impotence (30%–70%) mild to severe incontinence (1%–2%). Brachytherapy. With ultrasound guidance, radioactive “seeds” or pellets are implanted in the prostate itself to irradiate the tumor. The most common side effects are. impotence (30%–50%) mild to severe incontinence (2%).
How many men were in the PCPT study?
Of the 18,882 men enrolled in the study, 9,459 received a placebo.
How many men have prostate cancer?
We always knew that prostate cancer is common and that, until recently, it often went undiagnosed: Autopsies of men who died of other causes have shown that about one-third of men over age 50 have some cancerous cells in their prostate, while 90% of men over age 90 have such cells.
Can antibodies detect prostate cancer?
One study published in the New England Journal of Medicine found that a computerized microarray device could use antibody detection to identify people with prostate cancer more accurately than a PSA test. Although more research has to be done, the hope is that antibody analysis will enable doctors to detect cancer at its earliest stages, when your own immune system has identified the abnormal growth and is trying to suppress it. (Source: Wang X, Yu J, Sreekumar A, et al. Autoantibody Signatures in Prostate Cancer. New England Journal of Medicine 2005;353:1224–35. PMID: 16177248.)
Can prostate cancer be removed surgically?
But when treating prostate cancer, a comparable amount of tissue cannot be removed surgically or targeted. It takes a skilled surgeon and radiation oncologist to eradicate diseased tissue without harming portions of the rectum, bladder, and penis, thereby minimizing the likelihood of complications.
Is there a one size fits all treatment for prostate cancer?
There is no one-size-fits-all treatment for early-stage prostate cancer. Even the experts do not agree about which men with such cancers should be treated, which treatment method is best — or whether, for some tumors, any treatment is even necessary.
What is a PSA test?
May 27, 2003 -- The PSA blood test is commonly used to check for signs of prostate cancer or other prostate problems. When a PSA level comes back high, the next step is often a biopsy. But a new study suggests another course of action: Another PSA test done more than a month later. That's because PSA levels can fluctuate up ...
When was the PSA blood test first used?
The PSA blood test, first introduced in the U.S. in 1986, is still a controversial test for prostate cancer. Even though a PSA test is likely to detect prostate cancer at an earlier stage, there is no evidence that the test saves lives.
Why is prostate cancer so slow growing?
This is because prostate cancer is generally slow-growing and typically strikes men at an older age, when they are more likely to die from other causes. Thus, treating prostate cancer in some men, the argument goes, may cause more harm than benefit.
Does a high PSA level mean prostate cancer?
And it has never been established that the PSA test is going to reduce deaths caused by prostate cancer .". A high PSA level indicates some abnormality in the prostate -- possibly cancer, but also any type of prostate infection or prostate enlargement, which occurs in most men after age 50.
Is the National Cancer Institute against PSA screening?
Meanwhile, the U.S. Preventive Services Task Force and the National Cancer Institute are opposed to routine PSA screening, believing the risks of follow-up tests and the side effects of treatment may outweigh the possible benefits for many men. "I believe the PSA test saves lives," Eastham tells WebMD.
How long does it take for a PSA to be undetectable?
Following surgery (radical prostatectomy), your PSA number should be undetectable after about a month. That means zero PSA, not 0–4 ng/dl. However, some men will have a very low non-rising PSA after surgery, which can sometimes be caused by normal prostate tissue left behind. This is uncommon, and referred to as benign regeneration.
What to do if PSA rises after prostatectomy?
If your PSA starts to rise after you’ve undergone prostatectomy, “salvage” radiation therapy might be a good option to explore, and has been shown to improve outcomes over time.
What is the treatment for prostate cancer?
Androgen deprivation therapy (“hormone therapy”) is a key treatment strategy for prostate cancer that has recurred following local treatment. The goal of all hormone therapies is to stop the production and/or interfere with the effects of testosterone, which fuels the growth of prostate cancer cells. However, because not all prostate cancer cells ...
What is the PSA of cancer?
This is uncommon, and referred to as benign regeneration. However, the most widely accepted definition of a cancer recurrence is a PSA >0.2 ng/mL that has risen on at least two separate occasions, at least two weeks apart, measured by the same lab.
What is the goal of a PSA test?
The goal is to help you focus on what you need to know about rising PSA levels so you can hold meaningful, regular dialogues with all members of your health care team as you find the treatment path that’s right for you. Here are some questions you may have about the complexities of treatment in these cases—and some answers that will help prepare you for the ongoing discussions and decisions to be made to keep your prostate cancer under control.
What does PSA velocity mean?
PSA velocity or PSA doubling time, both of which measure the rate at which your PSA rises, can be a very significant factor in determining is the aggressiveness of your cancer. Men with a shorter PSA doubling time or a more rapid PSA velocity after initial therapy tend to have more aggressive disease, and are therefore more likely ...
Why is it important to use the same lab for all PSA tests?
Either way, it’s important to always use the same lab for all of your PSA tests because PSA values can fluctuate somewhat from lab to lab. Defining failure after other forms of therapy like seeds or cryotherapy is more challenging, but similar to that used with external radiation. 2.
What happens if your PSA is 4.0?
As you can see from the above, a variety of factors can lead to a gradual, or even a sudden, elevation in the PSA count. Doctors used to advise that a man with a PSA above 4.0 have a biopsy; nowadays, many doctors will advise the patient to have another test in three months, and if it is still high, take antibiotics to see if an infection was ...
What happens if PSA is low after removal?
Whatever the lowest PSA following treatment (zero after gland removal, or PSA nadir after any other treatment), it becomes the new baseline. If PSA begins to rise, there will be suspicion that the cancer has come back. A biopsy will be recommended after two or three successive rises.
What is the normal PSA level?
Basic or “total” PSA (tPSA) The basic PSA test is a measure of all the PSA in your blood sample, and today’s tests can detect PSA levels close to zero (0.1 ng/ml or nanograms per milliliter). A “normal” PSA from a perfectly healthy gland and no gland stimulation within 24 hours before the blood draw is expected to be within 2.5 – 4.0 ng/ml.
What is PSA in the blood?
Let me explain. PSA is a harmless protein produced by prostate cells. Small amounts leak into the bloodstream, and the amount can be measured in a laboratory. The larger the prostate, the more cells there are to produce PSA.
Why is the aggression level more accurate?
Second, if prostate cancer is diagnosed, the aggression level will be more accurate because a needle is image-directed into the core of the suspicious area where the most aggressive cells will be present. Second case: a man who has had at least one previous biopsy.
Can a prostate biopsy miss cancer?
On the other hand, if the first biopsy missed cancer that was there, there is a good possibility it will miss it a second, even a third time, while it continues to grow. This is because there are certain prostate zones that TRUS biopsies have a harder time accessing, where cancer can start and progress.
Is a PSA of 2.0 a good test for prostate cancer?
Also, prostate cancer (even aggressive prostate cancer) can exist in a man with a PSA lower than 2.0, though the probability is small. Therefore, total PSA is NOT a reliable way to screen for prostate cancer because even a noncancerous condition or situation can push the number up. More information is needed.
Is it safe to wait?
A 2015 study published by University of Chicago researchers concluded that men diagnosed with low-risk PCa “… may safely use the time following their initial biopsy to consider management options and obtain a restaging biopsy, if recommended,” for up to a year without raising risk of recurrence.
Not so safe after all
A 2018 paper presented at the 33 rd European Association of Urology Congress (Copenhagen, Denmark) underscores my concern. This was a much smaller study of 513 men at a single French medical center.
A better way
Let me approach this differently. Rather than ask, “Is it safe to delay treatment after prostate cancer diagnosis?” I would pose the question, “How can we make it safer to delay treatment after prostate cancer diagnosis?” The answer is, change the diagnosis and monitoring protocol.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions.
What causes PSA to rise?
Some sports and nutritional supplements, such as carnitine, fenugreek, pomegranate, and tribulus terrestris, can cause PSA levels to rise. If you have undergone urinary tract or prostate surgery recently, or if you have suffered a pelvic injury or sports injury. If you have prostatitis or BPH. ...
Why does my PSA level rise?
A bacterial infection in the urinary tract can cause PSA levels to rise temporarily. If you are not sure if you have a urinary tract infection, have a urine test before your PSA test to make sure. If you do have a urinary tract infection, you should wait at least six weeks after you have completed your antibiotic treatment before you have your PSA ...
How long before a prostate biopsy can you ejaculate?
Participate in sexual activity that involves ejaculation for 48 hours before your test. Ejaculation within this time frame may affect PSA results, especially in younger men. Schedule your PSA test to be done for at least six weeks after undergoing any of the following procedures: prostate biopsy, transurethral resection of the prostate (TURP) ...
What is a prostate specific antigen test?
PSA testing is just one tool men can choose to help them check up on their prostate health. Although the PSA test can be very helpful, it is not a perfect test. Currently, the medical community has not reached a consensus on which PSA ...
How to get accurate prostate test results?
This list of “don’ts” will help ensure your test results are as accurate as possible. Participate in vigorous exercise and activities that stimulate or “jostle” the prostate, such as bike riding, motorcycling, and riding a horse, ATV, or tractor, or getting a prostatic massage for 48 hours before your test.
Does prostate cancer save lives?
Prostate cancer screening and early detection does NOT saves men’s lives. Let’s do the math. Per the USPSTF (a US government health agency): “A small benefit and known harms from prostate cancer screening” and “Only one man in 1,000 could possibly have a life saving benefit from screening”.
Can a DRE test affect PSA?
Schedule a digital rectal examination (DRE) before your PSA test. Although a DRE should not have an impact on PSA levels, having the PSA test first is a precaution. Don’t forget to tell your doctor: If you undergoing chemotherapy, as these drugs can cause an elevated PSA level.