Types of Tests
Health history and current symptoms
Digital rectal exam (DRE)
Prostate-specific antigen test (PSA test)
What do PSA results mean?
Prostate biopsy
Deciding about repeat biopsy
If a biopsy is positive
These types of tests are most often used to check the prostate:
This first step lets your doctor hear and understand the "story" of
your prostate concerns. You'll be asked about whether you have
symptoms, how long you've had them, and how much they affect
your lifestyle. Your health history also includes any risk factors,
pain, fever, or trouble passing urine. You may be asked to give a
urine sample for testing.
DRE is the standard way to check the prostate. With a gloved and
lubricated finger, your doctor feels the prostate from the rectum.
The test lasts about 10-15 seconds.
This exam checks for:
- The size, firmness, and texture of the prostate
- Any hard areas, lumps, or growth spreading beyond the
prostate
- Any pain caused by touching or pressing the prostate
The DRE allows the doctor to feel only one side of the prostate.
A PSA test is another way to help your doctor check your prostate.
PSA is a protein made by normal cells and prostate cancer cells. It
is found in the blood and can be measured with a blood test. PSA
tests are often used to follow men after prostate cancer treatment.
PSA testing is still being studied to see if finding cancer early
lowers the risk of dying from prostate cancer.
PSA levels can rise if a man has prostate cancer, but a high PSA is
not proof of cancer. Other things can also make PSA levels go up.
These may give a
false positive
test result. These include having
BPH or prostatitis, or if the prostate gland is disturbed in any way
(riding a bicycle or motorcycle, a DRE, orgasm within the past 24
hours, and prostate biopsy or surgery can disturb the prostate).
Also, some prostate glands naturally produce more PSA than
others. PSA levels go up with age. African-American men tend to
have higher PSA levels in general than men of other races.
Researchers are trying to find more answers about:
- The PSA test's ability to tell cancer from benign prostate
problems
- The best thing to do if a man has a high PSA level
For now, men and their doctors use PSA readings over time as a
guide to see if more follow-up is needed.
PSA levels are measured in terms of units per volume of fluid
tested. Doctors often use a score of 4
nanograms (ng)
or higher
as the trigger for further tests, such as a prostate biopsy.
Your doctor may monitor your PSA velocity, which means looking
at the rate of change in your PSA levels over time. Rapid increases
in PSA readings can suggest cancer. If you have a mildly elevated
PSA, you and your doctor may choose to check PSA levels on a
scheduled basis and watch for any change in the PSA velocity.
If your symptoms or test results suggest cancer, your doctor will
refer you to a specialist (a urologist) for a prostate biopsy. A
biopsy is usually done in the doctor's office.
For a biopsy, small tissue samples are taken directly from the
prostate. Your doctor will take samples from several areas of the
prostate gland. This can help lower the chance of missing any
areas of the gland that may have cancer cells. Like other cancers,
doctors can only diagnose prostate cancer by looking at tissue
under a microscope.
Most men who have biopsies after routine exams do not have cancer.
"There is no magic PSA level below which a man can be assured of
having no risk of prostate cancer nor above which a biopsy should
automatically be performed. A man's decision to have a prostate
biopsy requires a thoughtful discussion with his physician,
considering not only the PSA level, but also his other risk factors,
his overall health status, and how he perceives the risks and
benefits of early detection."
--Dr. Howard Parnes, Chief of the Prostate and Urologic Cancer Research Group,
Division of Cancer Prevention, National Cancer Institute
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A test that can help your doctor decide if you need a repeat biopsy
is called
free PSA. This test is used for men who have higher PSA
values. The test looks at a form of PSA in the blood. Free PSA is
linked to BPH but not cancer.
Free PSA is figured as a percentage of the total PSA:
- If both total PSA and free PSA are higher than normal, this
suggests BPH rather than cancer.
- If regular PSA is high but free PSA is not, cancer is more
likely. More testing should be done.
Free PSA may help tell what kind of prostate problem you have. It
can be a guide for you and your doctor to choose the right
treatment. You and your doctor should talk about your personal
risk and free PSA results. Then you can decide together whether to
have follow-up biopsies and, if so, how often.
A positive biopsy means prostate cancer is present. A pathologist
will check your biopsy sample for cancer cells and will give a
Gleason score. The Gleason score ranges from 2 to 10 and
describes how likely it is that a tumor will spread. The lower the
number, the less likely the tumor is aggressive and may spread.
Treatment options depend on the stage (or extent) of the cancer
(stages range from 1 to 4), Gleason score, PSA level, and your age
and general health. These items will be available from your doctor
and are listed on your pathology report.
Reaching a decision about treatment of your prostate cancer is a
complex process. Many men find it helpful to talk with their
doctors, family, friends, and other men who have faced similar
decisions. There are many organizations that can provide more
information and support to you, your partner, and family.
"While it's important to make your own decision
about cancer screening, everybody should
consider getting a second opinion before
getting something like a biopsy."
It is a good idea to get a copy of your pathology report
from your doctor and carry it with you as you talk with
your health care providers.
Checklist of Questions for Your Doctor |
- What type of prostate problem do I have?
- Is more testing needed and what will it tell me?
- If I decide on watchful waiting, what changes in my
symptoms should I look for and how often should I
be tested?
- What type of treatment do you recommend for my prostate
problem?
- For men like me, has this treatment worked?
- How soon would I need to start treatment and how long
would it last?
- Do I need medicine and how long would I need to take it
before seeing improvement in my symptoms?
- What are the side effects of the medicine?
- Are there other medicines that could interfere with this
medication?
- If I need surgery, what are the benefits and risks?
- Would I have any side effects from surgery that could affect
my quality of life?
- Are these side effects temporary or permanent?
- How long is recovery time after surgery?
- Will I be able to fully return to normal?
- How will this affect my sex life?
- How often should I visit the doctor to monitor my condition?
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