Prostate Cancer: Age-Specific Screening Guidelines

Prostate Cancer: Age-Specific Screening Guidelines | Johns Hopkins Medicine

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When should you start getting screened for prostate cancer ? The answer depends on multiple factors, including your age and family history.

Johns Hopkins urologist Christian Pavlovich, M.D., discusses what he wants men to know about today’s prostate cancer screening guidelines.

Prostate Cancer Screening Ages 40 to 54

The PSA test is a blood test that measures how much of a particular protein
(called prostate-specific antigen) is in your blood. It’s been the standard
for prostate cancer screening for 30 years.

Your doctor will consider many factors before suggesting when to start
prostate cancer screening. But he’ll probably start by recommending the PSA
test.

While the general guidelines recommend starting at age 55, you may need PSA
screening between the ages of 40 and 54 if you:

• Have at least one first-degree relative (such as your father or
  brother) who has had prostate cancer
• Have at least two extended family members who have had prostate cancer
• Are African-American, an ethnicity that has a higher risk of developing
  more aggressive cancers

Prostate Cancer Screening Ages 55 to 69

This is the age range where men will benefit the most from screening.
That’s because this is the time when:

• Men are most likely to get cancer
• Treatment makes the most sense, meaning when treatment benefits
  outweigh any potential risk of treatment side effects

Most men will get prostate cancer if they live long enough. Some prostate
cancers are more aggressive; others can be slow-growing. Doctors will take
your age and other factors into consideration before weighing the risks and
benefits of treatment.

You should ask your doctor how often he or she recommends you get screened.
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.

Decoding a PSA Test

Doctors will consider your age and the size of your prostate when
determining what your PSA score means. In general:

• For men in their 40s and 50s: A PSA score greater than 2.5 ng/ml is
  considered abnormal. The median PSA for this age range is 0.6 to 0.7
  ng/ml.
• For men in their 60s: A PSA score greater than 4.0 ng/ml is considered
  abnormal. The normal range is between 1.0 and 1.5 ng/ml.
• An abnormal rise: A PSA score may also be considered abnormal if it
  rises a certain amount in a single year. For example, if your score
  rises more than 0. 35 ng/ml in a single year, your doctor may recommend
  further testing.

An Abnormal PSA Test: What Comes Next?

If your PSA score is in the abnormal range, your doctor may recommend you
repeat the PSA test. If your levels are still high, your doctor might
recommend one of the newer prostate cancer screening tests available today.

These tests can help better assess your risk for prostate cancer and
determine whether a biopsy is necessary. Only a prostate biopsy can
definitively diagnose prostate cancer.

For individualized recommendations that suit you, ask your doctor about:

• What age you should start prostate cancer screening
• New blood, urine and imaging tests that are available
• Improved biopsy techniques, if applicable

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Prostate Cancer Stages | Johns Hopkins Medicine

Prostate Cancer Stages | Johns Hopkins Medicine

Following a prostate cancer diagnosis, staging is used to describe the extent of the disease. Prostate cancer staging is vital because it is used to guide the treatment plan and predict the patient’s prognosis.

Clinical Stages

The clinical stage is based on the results of the urologist’s physical examination of the patient’s prostate (including a digital rectal exam (DRE)) and any other tests done prior to definitive treatment (i.e., surgery or radiation).

The following clinical stages are used to describe prostate cancer:

• T1: The tumor cannot be felt during the DRE or  seen during imaging (e.g., a computed tomography (CT) scan or transrectal ultrasound). It may be found when surgery is done for another medical condition.
  • T1a: The tumor is discovered accidentally during a surgical procedure used to treat benign prostatic hyperplasia (BPH), which is the abnormal growth of benign prostate cells. Cancer is only found in 5 percent or less of the tissue removed.
  • T1b: The tumor is found accidentally during BPH surgery. Cancer cells are detected in more than 5 percent of the tissue removed.
  • T1c: The tumor is found during a needle biopsy that was performed because of an elevated PSA level.
• T2: The tumor appears to be confined to the prostate. Due to the size of the tumor, the doctor can feel it during the DRE. The cancer may also be seen with imaging.
  • T2a: The tumor has invaded one-half (or less) of one side of the prostate.
  • T2b: The tumor has spread to more than one-half of one side of the prostate, but not to both sides.
  • T2c: The cancer has invaded both sides of the prostate.
• T3: The tumor has grown outside the prostate. It may have spread to the seminal vesicles.
  • T3a: The tumor has developed outside the prostate; however, it has not spread to the seminal vesicles.
  • T3b: The tumor has spread to the seminal vesicles.
• T4: The tumor has spread to tissues next to the prostate other than the seminal vesicles. For example, the cancer may be growing in the rectum, bladder, urethral sphincter (muscle that controls urination) and/or pelvic wall.

Pathologic Staging

Following surgery to remove the prostate gland, a pathologist will assign the Gleason score and stage. The pathologist uses the TNM Staging System to describe how far the prostate cancer has spread. This system describes the tumor (T), lymph node (N) and metastasis (M) to lymph nodes and/or bones or other organs.

For T categories, please refer to the clinical stages section of this page. N0 indicates that the tumor has not spread to nearby lymph nodes while N1 means that it has. M0 means that the cancer has not spread to other areas of the body beyond nearby lymph nodes. M1 indicates that the cancer has spread to distant parts of the body, including distant lymph nodes (M1a), bones (M1b) and organs such as the liver, brain or lungs (M1c).

Partin Nomogram

Your doctor may use the Partin tables to predict your pathologic stage. The new Partin nomogram defines pathologic stages as:

• Organ-confined (OC) prostate cancer: This describes cancer found within the prostate gland.
• Extracapsular extension (ECE) orextraprostatic extension (EPE):Thetumor has broken through the capsule of the prostate gland. It may or may not be operable.
• Seminal vesicle (SV): The tumor has spread to the seminal vesicles adjacent to the prostate.
• Lymph nodes (LN): The tumor has spread to the lymph nodes near the prostate gland.

Knowing the stage of prostate cancer can help to determine how aggressively it needs to be treated and how likely it is to be removed by the available treatment options.

Partin Tables

For decades, doctors around the world have used the Partin tables to guide treatment decisions. Developed by Johns Hopkins urologists Alan Partin and Patrick Walsh, the tables use features of each man’s cancer to predict whether a tumor will be confined to the prostate — making it easier to select the most appropriate therapies.

Use the Partin tables

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Blood test for PSA, Kyiv, Pechersk

Prostate cancer tumor marker – prostate-specific antigen (PSA, PSA).

PSA decoding. PSA norm

PSA total, free – early diagnosis of prostate cancer. Determining the level of PSA is the most important diagnostic method for the early diagnosis of prostate cancer. Prostate specific antigen is a special protein that is produced by the tissues of the prostate and serves to liquefy semen after ejaculation. A certain amount of PSA enters the blood of a man and can be determined using special tests.

PSA is present in the blood in two fractions: free and bound PSA. The total value of free and bound PSA determines the total PSA. The norm of PSA in the blood of a healthy man should not exceed 4 ng / ml. Since the volume of the prostate can increase with age, the production of PSA increases and its concentration in the blood increases. Therefore, PSA levels in older men are higher than in younger ones. Determining the level of PSA is a very sensitive test for the early diagnosis of prostate cancer. This diagnosis is very important, since the initial stages of prostate cancer do not appear, and timely detection of the disease practically guarantees good treatment results.

Who needs a PSA test and when:

Current advice is that all men over 50 years of age should have a PSA test, digital rectal examination, and transrectal ultrasound of the prostate (TRUS) at least once a year. Men with a family history of prostate cancer should have regular annual check-ups after the age of 40.

PSA age norm is as follows:

40 – 49 years PSA level is not more than 2.5 ng/ml.
50 – 59 years PSA level not more than 3.5 ng/ml.
60 – 69 years old PSA level less than 4.5 ng/ml.
70 – 79 years PSA level not more than 6.5 ng/ml.

When the PSA level rises above 4 ng/ml, the probability of prostate cancer is 20-25%. If the PSA level is above 10 ng/ml, the chance of cancer is over 50%. As the PSA level rises, the chance of confirming prostate cancer increases.

Causes of increased PSA levels (PSA)

• prostate cancer
• prostate adenoma
• chronic calculous prostatitis (prostate stones)
• mechanical effect on the prostate (prostate massage, TRUS)

Full PSA analysis (free to total PSA ratio):

An even more accurate version of the study, which determines the ratio of free and total PSA.
Normal free PSA should not be lower than 10 – 15% of total PSA.
Free PSA (PSA) is more common in prostate adenoma, while bound PSA (PSA) is more common in prostate cancer. A high ratio of free to total PSA (more than 20%) is a false positive test result and is against the diagnosis of prostate cancer. Accordingly, a high PSA level with a low ratio (less than 10%) is observed in prostate cancer.

If the PSA level is above 4 ng/ml, but not more than 10 ng/ml, the possibility of prostate cancer exists, however, upon further examination, the diagnosis is not confirmed in most men. At a PSA level above 10 ng / ml, the likelihood of cancer increases significantly, however, a needle biopsy of the prostate is necessary to confirm the diagnosis.

In case of exceeding the PSA norm, a transrectal ultrasound (TRUS) of the prostate and a puncture biopsy are mandatory.

False positive PSA test result.

Higher than normal PSA levels are not always the result of prostate cancer. The concentration of PSA in the blood can increase with prostate adenoma, exacerbation of prostatitis, after ejaculation, due to digital examination or prostate massage, bladder catheterization or prostate biopsy. Especially often, a false-positive increase in the PSA level above the norm is observed during ejaculation and after prostate massage in the presence of prostate stones, since the prostate tissue is traumatized by stones. According to some data, the PSA test can be false positive in 4 – 6% of cases, sometimes reaching 30%.
Therefore, proper preparation before taking the test is mandatory.

Comprehensive PSA analysis is also used to monitor the results of prostate cancer treatment. After complete removal of the prostate gland, the PSA level drops to zero. If, after a while, the level rises, the likelihood of a relapse of the disease is high.

Preparing for a PSA blood test

To avoid false results, it is best to have a PSA test immediately before a rectal digital examination or two weeks after it.

During the initial consultation at the MedCenterService clinic, first, blood will be taken from your vein for a detailed PSA analysis, after which the urologist andrologist will conduct a rectal examination of the prostate gland, if necessary, take prostate secretion for analysis and perform a transrectal ultrasound (TRUS) of the prostate . Thus, all diagnostics of prostate diseases will be made during the first visit to the urologist. You will receive the test results and medical appointments the next day.

For more accurate test results, you need:
A pause of at least 1 month after prostate biopsy.
A pause of at least 2 weeks after digital rectal examination, transrectal ultrasound (TRUS) of the prostate, bladder catheterization, cystoscopy and any other mechanical effects on the prostate gland.
At least 2 days of abstinence from sexual intercourse, eating meat, alcohol, cycling, physical overload, enemas.

The material for analysis is venous blood. The duration of the analysis is 1 working day.

In our clinic “MedCenterService” you can always take a blood test for PSA.

Trust your problems to professionals. We have comfortable conditions for examination and treatment, tactful and delicate specialists, complete anonymity and confidentiality. Convenient location in Kyiv, Pechersk, near the Klovskaya metro station.

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PSA test – prostate cancer marker

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PSA in the blood. What does it mean and what does it say.

• General information
• Normal PSA
• PSA general and free
• How to donate blood for PSA
• How often do you need to donate blood for PSA
• PSA after prostatectomy
• PSA analysis price

The PSA blood test is a laboratory blood test that measures the amount of prostate specific antigen (PSA) in a man’s blood. PSA is a protein produced in the male body by the prostate gland. An elevated PSA in a man’s blood indicates an abnormal function of the prostate gland and should be the first “bell” for a man. When PSA is elevated, this does not necessarily indicate the presence of a cancerous tumor in the gland, it can also indicate any inflammatory processes in the prostate.

The PSA test and its results are the reason for the attending urologist to take further steps in the treatment / diagnosis of the patient. Blood donation for PSA is included in the standard list of procedures for prostate diagnostics at the European Prostate Center.

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Normal PSA

that The prostate grows in size with age – this is natural. As the prostate grows, so does the PSA value, measured in nanograms per milliliter. Therefore, when we talk about “normal PSA levels”, it is important to understand the age of the patient in question. Table with normal PSA values ​​according to age:

Elevated PSA, in combination with other examinations: MRI of the prostate, rectal examination, TRUS, may serve as a reason for the attending urologist to refer the patient for a prostate biopsy.

Very rare patients, about 1% of cases, where even with a low / normal PSA there is a chance that the patient has prostate cancer. Practice shows that in such cases we are talking about aggressive forms of prostate cancer.

Elevated PSA alone does not indicate the presence of prostate cancer. However, urological clinics in Germany keep statistics and have developed the following table, which draws a parallel between the PSA value and the chance of detecting prostate cancer during a prostate biopsy. Statistics based on a survey of 2267 men:

According to statistics, in 13% of men over 55 years old, the PSA value in the blood exceeds 4 ng / ml, but this does not mean that they have prostate cancer. As mentioned earlier, elevated PSA can be caused by both prostate cancer and prostate adenoma (benign hyperplasia), prostatitis, infections in the genitourinary system.

German urological standard – with a PSA value above 10 ng / ml, bone scintigraphy of the bones of the skeleton is indicated

European Prostate Center

Reliable information about the nature of the disease: prostate adenoma or prostate cancer, can only be obtained after a prostate biopsy. To date, prostate biopsy is the only method that can determine the nature of the neoplasm with a 100% guarantee.

Detailed information about prostate biopsy

PSA total and free

PSA blood test used as a tumor marker in the diagnosis of prostate cancer. There are 2 values ​​of PSA in the blood: free and bound, the sum of the two values ​​\u200b\u200bis the total PSA. The ratio of free PSA in general is expressed as a percentage and looks something like this: PSA total – 5.54; PSA free – 0. 98; % free PSA 18. Reference value >15%.

The lower the percentage, the greater the chance that the elevated PSA was caused by a malignant tumor (prostate cancer). If the indicator is below 10-15%, then this should be the reason to refer the patient for further examinations: ultrasound, TRUS, MRI, prostate biopsy.

How to donate blood for PSA

In our practice, we often encounter disagreements between the standards that are accepted in the CIS and in Germany. When conducting urological examinations in our center, when donating blood for PSA, we adhere to the following standards:

• PSA can be taken no earlier than 4 weeks after the prostate biopsy
• no earlier than 4 weeks after the end of the course of antibiotics
• PSA is not necessary on an empty stomach, but it is desirable to avoid eating fatty foods
• avoid two days before the test physical activity, sexual activity
• do not expose the body to emotional stress a few hours before the test

How often do you need to donate blood for PSA

German urologists recommend annual urological examinations for men over 40 years of age, which include a blood test for PSA, especially for men whose close relatives (brother, father) have had cases of prostate cancer.