Prostate cancer is the second most common cancer in men globally and one of the most common causes of death in U.S men. Do you have elevated PSA? Do you know what it would mean if your test results said you did have elevated levels?
Recent literature reflects that screening methods for prostate cancer need to be revisited as a rise in prostate related over-diagnoses reflect a screening situation that may be costly for patients, financially and emotionally
This week, LetsGetChecked is joined by Dr. Rob Mordkin to discuss the current view-point on PSA testing in the U.S, what to do if you have elevated PSA and an analysis of the emotional impacts of PSA.
· What Is Prostate-Specific Antigen?
· How Common Is PSA Testing?
· Do Elevated PSA Levels Mean You Have Prostate Cancer?
· The Emotional Impacts Of Elevated PSA: A Study
· Should You Take A PSA Test?
What Is Prostate-Specific Antigen?
Prostate-specific antigen (PSA) is a protein that is produced in the prostate gland.
The prostate is a small gland that sits just below a man’s bladder. Prostate-specific antigen, or PSA is mainly found in semen but a small volume of PSA circulates in the blood-stream, which is why blood tests can be used to test levels of PSA in the body.
Prostate specific antigens are produced by cancerous and non-cancerous tissues in the prostate and may be indicative of prostate cancer. PSA Testing has traditionally been used to rule out prostate cancer, however it is important to note that levels of PSA in the body can arise for several reasons that are not related to cancer.
If you receive out of range test results it does not offer a definitive cancer diagnosis. PSA levels may be affected by a number of factors, including but not limited to benign prostatic hyperplasia (BPH), a swollen prostate, a urinary tract infection (UTI), recent ejaculation or prostatitis (swollen or infected prostate).
Elevated levels of PSA are often a side effect of ageing, as the level of protein produced in the prostate gland increases over time.
Prostate Specific Antigen tests that examine the blood can detect your level of PSA which may indicate that you should attend further screening, however, what an elevated PSA test reading might truly mean can be complicated.
How Common Is PSA Testing?
Since the early 1990s, PSA testing has been one of the most common screening methods for prostate cancer.
Dr. Rob Mordkin says:
“One in six American men will develop prostate cancer during their lifetime.”
Today, prostate cancer is the most commonly diagnosed non-skin cancer in the United States. Men are 33% times more likely to be diagnosed with prostate cancer than a woman is to be diagnosed with breast cancer.
Men are more likely to be diagnosed with prostate cancer between the ages of 50 and 75, however, the American Cancer Association states that under certain circumstances, men should begin screening earlier.
These guidelines include:
American Cancer Association Guidelines
- Men aged 40 years of age with more than one first-degree relative (son, brother, or father) who had prostate cancer before the age 65.
- Men aged 45 years of age with a single first-degree relative who had prostate cancer before age 65.
- 45-year-old African American men due to carrying a higher risk of prostate cancer.
Do Elevated PSA Levels Mean You Have Prostate Cancer?
Dr. Mordkin says: “Since 2010, regular prostate cancer screening, specifically the PSA blood test –has gone from widely promoted to scorned. It's been bashed by a U.S. federal task force and the American Urological Association has backpedaled on how it should best be applied.”
As it stands, there is relative concern among the medical community that PSA testing may cause more alarm than good, however, it must be recognized that much of this worry comes from the screening practices that are used to establish the diagnoses. One study titled Experiences of Uncertainty in Men with Elevated PSA states that 70% of men who go through PSA testing will not need to enter into subsequent prostate cancer treatment, however, because the range through which the antigen volume is raised, they may need to attend more expensive or painful screening situations.
This is due largely to the fact that the range of which the antigens are measured is high volume. Dr. Mordkin explains why PSA Testing has begun to lose popularity in 4 pillars:
The Test Isn't Cancer Specific: the PSA molecule is produced by both cancerous and non-cancerous prostate cells. Despite its lack of cancer specificity, the test has become the cornerstone of prostate cancer diagnosis even though "the ability of the PSA test to identify men with prostate cancer is slightly better than that of flipping a coin." Men need to be aware of the limitations of the test before doing the test.
Other Blood Tests May Be Better: New tests, such as 4K Score, are trying to improve the cancer detection specificity compared to standard PSA testing, however 4K score tests do not offer a definitive diagnosis but offer an indication of whether further testing is required, similarly to PSA testing.
MRIs For Prostate Cancer May Be The Next Big Thing: MRI of the prostate is noninvasive and essentially risk free. While not yet offered by all urologists, men concerned about prostate cancer should seek out physicians and centers that have this technology available.
You Need to Know Your Cancer: The LetsGetChecked screening test helps you to get more insights on your PSA levels. Not all prostate cancers behave the same. Many men who are diagnosed today have slow growing tumors which do not require treatment at all and are best simply observed. To figure out how aggressive a specific tumor may be, urologists have long relied on the visual appearance of the cancer cells under the microscope but are now moving beyond this by using genetic assays. Two such tests, ProstaVysion and Oncotype DX, look at molecular markers in the individual tumors to predict how quickly the disease may spread.
The Emotional Impacts Of Elevated PSA: A Study
A study published in the American Journal of Men’s Health outlines a qualitative research strategy in which a small sample group of men’s comments, thoughts and feelings towards their PSA screening experience were documented.
The results largely exposed a lacking communication between practitioners and patients along with subsequent anxiety. Let’s explore how the study was carried out:
- Participants who received an elevated PSA result were contacted following their screening to be interviewed for the study.
- Participants were interviewed for a duration from 45 minutes to 120 minutes.
- Participants were asked about their experience of PSA testing, with a focus on subjective feelings towards their results.
Three re-occurring themes emerged from the study:
- All participants experienced uncertainty regarding what an elevated PSA was, as well as anxiety having learned that they had an elevated PSA.
- Communication between practitioners either exacerbated the anxiety as described above or resolved it.
- All participants attempted to enact coping mechanisms to deal with their perceived and anxiety by cause of their diagnoses.
Men who had elevated PSA levels, but not a prostate cancer diagnosis often went on to experience anxiety that stemmed from a lack of understanding around what it meant to have elevated PSA.
Those who described their care provider as patient-centered and approachable were more likely to cope with their cope with their initial anxiety better than those who felt that they couldn’t cope with their diagnosis.
Participants who experienced anxiety and uncertainty largely dealt with this by reaching out for healthcare advice, information-seeking, defensive cognitive strategies and self-monitoring their symptoms.
While this study highlights that PSA testing may heighten anxiety in those who take the test and don’t understand their results, it is important to note that elevated PSA is a bio-marker for a few conditions including prostate gland dysfunction, damage, ageing and obesity.
If results are explained clearly to patients, it is likely that the test will remain helpful to healthcare practitioners and patients. This study largely highlights the necessity of open and well executed communication between patients and healthcare practitioners to avoid anxiety, especially regarding health results they don’t fully understand.
Should You Take A PSA Test?
Prostate cancer is second only to lung cancer as the leading cause of cancer death in the United States. Early detection is key in receiving appropriate and timely treatment
For men who choose to use PSA testing as their chosen method, the volume of PSA vs. the testing range varies. According to the Mayo Clinic , men with a PSA volume of less than 2.5ng/ml may need to be retested every two years, for men with a reading of over 2.5ng/ml, they should get tested each year.
Men who take a PSA test should bear in mind that they also may need a digital rectal exam (DRE) as part of their screening.
You should take a PSA test to offer insight into your prostate function if:
- You see blood in your semen and/or urine
- You have an increased need to urinate or you are urinating more frequently
- You are experiencing pain during sex
- You are suffering from chronic fatigue
- You have difficulty urinating standing up or maintaining a steady stream of urine
- You are experiencing pain during sex
- You feel nauseous
- You have lost weight unexpectedly
- You are experiencing pain in the crotch, thighs or lower back
You should think about prostate testing options if:
- You are over the age of 45
- You have 3 or more first-degree relatives with prostate cancer
- You have an infected or inflamed prostate (Prostatitis)
- You have an enlarged prostate (Prostatic Hyperplasia)
- You are suffering from erectile dysfunction
- You are on medication for cholesterol, urinary issues, low testosterone or high blood pressure
- You are obese
While the PSA test may be under fire recently, it’s useful to know that it can offer insight into your prostate gland function. Although the PSA test is said to over-diagnose, it has also saved lives through early preventative care. The PSA test can offer insight into whether further testing should be pursued following early onset symptoms.
Most importantly, the needs of patients who don’t understand their PSA level should be met. This is possible with LetsGetChecked who offer support and advice at every step of the way regarding your test results.
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Written by Hannah Kingston | Approved by Medical Director Dominic Rowley
Article amended on November 6th 2018