Confused concerning the latest guidelines on testing and screening? Here's what it is advisable know.
Prostate cancer is the second commonest cancer in American men behind skin cancer. Most men can live long and productive lives with this disease if it is correctly managed and treated. Still, latest studies and evolving guidelines have demystified the testing and screening process.
Role of PSA
Is the prostate-specific antigen (PSA) test still one of the best screening option for men?
The PSA test remains to be controversial, as the vast majority of studies show that it is just not related to a greater quality of life or a lower risk of death from prostate cancer. And the outcomes don't all the time tell the entire story about whether or not you could have prostate cancer. Still, it may well provide some helpful information.
The test measures the quantity of PSA in your blood. PSA is a protein produced by each cancerous and non-cancerous tissue within the prostate. Although small amounts of PSA are normally circulating within the blood, high levels may suggest cancer. PSA number lower than 4 nanograms per milliliter [ng/mL] Considered to be an indication of a really low risk of cancer. A rating of 4 to 10 ng/mL is the grey area where the chance is high but not definitive. A PSA rating greater than 10 ng/mL is most worrisome.
In men with high PSA scores, the test is often repeated for accuracy. For example, PSA levels may temporarily rise for those who've had sex prior to now 24 to 48 hours. An enlarged prostate, which affects most men over time, also can affect PSA. Depending in your PSA rating, your doctor may recommend retesting anywhere from 4 weeks to 6 months to envision for rising levels.
A digital rectal exam [DRE] If your rating is greater than 4 ng/mL, it is commonly given. Here, your doctor feels your prostate for any hardness or irregularity within the tissue, which could indicate cancer. It's best to debate the professionals and cons of PSA testing along with your doctor.
Biopsy guidelines
If my PSA continues to rise, or exceeds 10 ng/mL, what's going to my doctor order next? Is it time for a biopsy?
For increasing or higher scores, there are some additional tests that could be offered. There is a test that appears for biomarkers of prostate cancer within the urine. The type and amount of biomarkers can indicate the likelihood that cancer is present and has spread.
Another is a blood test called a free PSA. PSA circulates within the blood in two forms – either sure to other proteins, or unbound, also generally known as free. A routine PSA test measures each sure and unbound PSA. The free PSA blood test is reported as a percentage of total PSA.
A lower percentage indicates the next risk of cancer. For example, cancer is more likely if the free PSA level is 15% or less and if it is larger than 25%. Depending on the outcomes of those tests, your current PSA rating, and the outcomes of the DRE, your doctor may recommend a biopsy to investigate samples of prostate tissue for cancer.
However, before the biopsy, it's possible you'll get a prostate MRI scan. This helps determine the scale and placement of the tumor for a more targeted biopsy with less sampling. Still, throughout the first biopsy, many doctors will recommend taking a biopsy of all the prostate gland, apart from the abnormal areas suggested by the scan.
Also, be mindful that if an MRI scan doesn't suggest cancer, your doctor may recommend a biopsy based on the outcomes of other tests.
New technologies
Are there latest diagnostic tests available?
There are two latest FDA-approved imaging technologies – the Axumin and gallium-68 PSMA-11 scans. Both are game changers, as they will help discover previously undiagnosed cancers that MRI can't all the time pick up.
Axumin is the trade name for fluciclovin F 18, a radioactive agent that enters your body. You then have a scan with positron emission tomography. [PET] and CT. Prostate cancer cells absorb amino acids at a faster rate than healthy cells. Axumin targets specific cells, that are visible under PET and CT scans.
The gallium-68 PSMA-11 test also uses an injectable radioactive agent together with a PET scan. Once injected, the agent binds to prostate-specific membrane antigen. [PSMA], high levels of that are present in prostate cancer cells. This makes it easier to see any PSMA-positive lesions within the prostate for a PET scan.
Additional research will guide how doctors can use these latest diagnostic tests in evaluating men with possible prostate cancer.
Photo: © jarun011/Getty Images