A Prostate Specific Antigen (PSA) Test
A prostate-specific antigen (PSA) test is an blood test that could be given to you for routine screening as part of the routine checkup of the doctor of primary care or urologist.
However, using the test to screen routinely is not without controversy. A high-level of results from PSA tests PSA test could be due to reasons that are not related to cancer like an an enlarged prostate, benign prostatic hyperplasia (BPH) or an infection of the prostate known as prostatitis. The patients who experience an elevated PSA result could be referred to further testing. This is why the test should be conducted after a thorough discussion with the doctor and patient.
The American Cancer Society uses these criteria to assess PSA results:
- A PSA test result that is below the threshold of 4 nanograms per milliliter (ng/ml) signifies that, 85 percent of the time you aren’t likely to be diagnosed with prostate cancer.
- A PSA between 4-10 is associated with one in four chance of developing prostate cancer.
- If your PSA is higher than 10, you are at risk. one in two possibility of developing prostate cancer.
However, doctors have not yet established a standard system for interpret PSA. The thresholds for concern and reference ranges differ greatly.
In the event that the PSA tests results show high, it’s likely you’ll be advised to repeat the tests.
A Digital Rectal Exam (DRE)
A digital rectal examination (DRE) is an examination of your prostate performed by a doctor as part of a routine checkup or as a reaction to symptoms suggesting problems with the prostate gland. When you undergo an DRE the doctor inserts an ungloved finger inside the rectum to look for nodules or areas that are asymmetric as well as irregularities in the shape, size and appearance in the prostate gland and may also be used to search for indications of prostate cancer.
As with similar to the PSA test, the results of a suspicious test on DRE results DRE does not necessarily indicate that you are suffering from prostate cancer. Instead, the results are taken into consideration in conjunction along with PSA Test results as well as any symptoms the patient might be suffering from.
Recently, there has been a lot of concern regarding primary care doctors who are unable to use the DRE efficiently. A study that was that was published in Annals of Family Medicine discovered that only half of the primary care physicians surveyed are comfortable with performing DREs. In fact the authors of the study advised against doctors who are primary care practitioners performing these tests.
Transrectal Ultrasound and Real-Time Biopsy
If you have the result of an increased PSA result or notice abnormal results from the DRE medical professional may suggest undergoing an ultrasound biopsy of your prostate. The most commonly used test to determine this is a transrectal ultrasound (TRUS) which is a procedure in which an ultrasound probe is placed into the rectum, and sound waves are created to form an image of your prostate.
When an ultrasound is performed biopsy, samples are typically taken from various locations of the prostate with the use of a hollow needle. This is known as real-time or Transrectal Prostate biopsy. The biopsy samples are evaluated in a pathology laboratory to determine if cancer cell lines are found.
Benefits of combining two methods are:
- The ability to target the suspicious regions of high grade (aggressive regions) and tumors that are clinically significant.
- Assisting in the prevention of false-positive diagnosis and overdiagnosis, or sampling areas that are not likely to be contaminated with cancer or more aggressive cancer.
- The best biopsy is one that is high-quality.
MRI Ultrasound Targeted Prostate Biopsy
The magnetic resonance image ( MRI) guided biopsies are also being utilized more often, in conjunction in conjunction with ultrasound, or on their own for guidance during the procedure of a prostate biopsy. MRI scans have the capability of revealing areas that could be cancerous with greater precision than ultrasound scans.
Research has suggested that the combination of the two techniques by using MRI to determine problematic areas prior to transrectal ultrasound and biopsy may help to detect cancer more precisely than a single TRUS biopsy. A case in point is a landmark study conducted by researchers from the National Cancer Institute’s urologic oncology division discovered that the MRI-fused method detected the more aggressive prostate cancer and less prostate cancers with low risk.
A joint statement from the American Urological Association and Society of Abdominal Radiologists recommends the use of MRI-fusion for those who are under active surveillance men who, with their doctors, have chosen to monitor the growth of a slow-growing cancer instead of treating it with aggressive treatment. It is also recommended for those who have had an elevated PSA test results, however, their previous biopsies have not been positive for cancer.
Preparing for Your Prostate Biopsy
In order to prepare yourself for the procedure Your urologist should inform you about the potential risks and advantages of having an ultrasound. The most frequent complications that occur following prostate biopsy include urine that is bloody semen, rectum or an urine tract infection and the acute retention of urine. These complications usually disappear quickly. Infrequently, erectile dysfunction is a possibility.
After this conversation with your doctor After this discussion, you will be required to fill out a consent forms. It is also possible to be asked to quit certain medicines, including anticoagulants, anti-inflammatory nonsteroidal drugs or herbal supplements and vitamins for a period of one to several days. The night prior to when the biopsy will be scheduled the doctor might ask you to perform an enema at your home. The day before, eating a light diet is generally suggested. Also, you may be asked to consume some antibiotic on the day prior or when you take the test.
If you are scheduled to undergo the procedure, you are asked to lie on your back and bend your knees. The doctor will place a small probe of the size of a finger inside the rectum. The probe allows the doctor look at pictures of the prostate. It also assists in determining where to inject local anesthetic. The images that the doctor observes can also guide the needle for biopsy. The doctor will collect 10 to 18 tissue samples from your prostate gland. These is then taken to a pathology lab. The entire process takes around 10 minutes. The doctor will notify you of results in the course of about one week.
Following this procedure, the rectum could be a bit sore. You might notice tiny quantities that contain blood within your urine, stool or semen which can persist for several days or even weeks. The prescription of antibiotics may be for a few days to avoid the spread of infection.
Making Sense of Prostate Biopsy Results
If your biopsy shows that certain cells are unusual, however they may or might not be cancer or cancerous, your doctor may recommend a second biopsy. If your biopsy is positive, that means cancer cells were identified.
The pathology report you receive will contain:
- A Gleason score that aids doctors in predicting how rapidly growing prostate cancer is
- The number of samples from biopsy which contain cancer from the total sampled
- A diagnosis for each biopsy or core sample
- The proportion of cancer in every sample
- It is not clear if the cancer is located on either or both sides of the prostate gland
Understanding Your Gleason Score
You Gleason score is the total of all “grades” the pathologist has given the samples of the prostate gland. The more difficult the cancer appears, the higher the severity. The most minimal Gleason score you could receive for prostate cancer is a 6. The cancers are regarded as low-grade and are not likely to be very aggressive. A Gleason score of 8-10 will be more aggressive. It is also likely to spread and grow rapidly. A cancer that has an Gleason score of 9-10 is likely to be more active.