PSA blood test
The Prostrate Specific Antigen (PSA) test enables the medical practitioner to detect prostrate cancer at an early stage. Prostrate Specific Antigen (PSA) is a protein produced in small amounts in the cells of the prostrate gland. A PSA blood test helps to determine whether stage of prostrate cancer is advanced enough to perform a biopsy of the prostrate gland or not. When the prostrate gland enlarges, PSA level in the blood tends to rise. This is indicative of cancer or benign non-cancerous conditions. PSA is called biological marker or tumor. As men age, both benign prostrate conditions and prostrate cancer become more frequent. The most common benign prostrate conditions are prostatitis which is inflammation of the prostrate, and benign prostatic hyperplastia which refers to the enlargement of the prostrate. When the PSA test is combined with rectal examination, 90% of prostrate cancers can be detected. In the U.S., the American Cancer Society recommends PSA blood test at least once a year to avoid the risk of prostrate cancer.
The PSA test has been called the 'male PAP test'. The normal range for a PSA blood test is between 0 - 4 ng/ml (nanograms per milliliter). A PSA level of 4 - 10 ng/ml is considered slightly elevated. Levels between 10 -20 ng/ml are considered moderately elevated. Anything about 20 ng/ml is considered highly elevated. Although the higher the PSA level, the higher the risk of cancer, one abnormal PSA test result does not necessarily mean it is cancer that is present, as various other factors may cause PSA levels to fluctuate.
The PSA test is a radioimmunoassay. In a diagnostic laboratory, the patient's blood sample is exposed to the antibody against PSA. That moment the amount of antigen (PSA) can be measured. It should be borne in mind that a man who is undergoing hormone therapy for prostrate cancer may have a low PSA test reading during or immediately after the treatment. The low level may not be a true measurement of PSA in the patient's body. It is essential that such patients brief the doctor who may probably advise him to wait a few months after hormone treatment before having a PSA test done.
PSA test does not help a man with fast-growing tumors or aggressive cancer. It helps only in detection of small tumor and slow growing tumors which are unlikely to threaten a man's life. PSA test also cannot detect cancers spreading to the other parts of the body beforehand. There is a fear of false positives test results in PSA testing. Sometimes PSA level could be elevated but that does not necessarily mean cancer is present. A fear of false negative test result can also occur in PSA testing. That is the PSA test result will show negative even if prostrate cancer is actually present in the patient. PSA blood test is often followed by other diagnostic tests such as ultrasound, x rays and cystoscopy to determine the presence of cancer or any other problem in the prostrate.
Prostrate Biopsy
Some doctors opine that prostrate cancer begins with a condition called 'prostatic intraepithelial neoplasia' (PIN). Almost 50% of men have PIN by the time they reach the age of 50 years. There occur changes in the microscopic appearance of the prostrate gland cells in this condition. These changes can be either normal or abnormal. If a person had an abnormal high-grade PIN, then there is 30 to 50 % of cancer. Men diagnosed with such high-grade PIN are asked to undergo repeated Prostrate Biopsies. Other reasons for prostrate biopsy are:
- An elevated PSA level in a blood test.
- Significant change in the standard PSA level over time.
- Standard PSA level but a low free/total PSA ratio as indicated by the PSA II test.
- Suspicious feeling prostrate on digital rectal examination.
Normally for a prostrate biopsy, the tissue is taken using a fine needle from ten or more places in the prostrate. Nowadays, specialists recommend the biopsies of the prostrate to be carried out only under ultrasound guidance. Several samples from the prostrate are taken using a method called 'sextant biopsy'. Biopsies are taken using 'Trans-Rectal Ultrasound' (TRUS) to guide the precise placement of the biopsy needle. The patient is administered an enema prior to carrying out the biopsy. There is no need for anesthesia but an antibiotic is given in order to prevent possible infection. The biopsy specimens ('cores') are sent to a pathologist for evaluation.
Pelvic Ultrasound
Pelvic ultrasound is used to detect and pain in the lower belly (pelvis) organs and examine the ovaries, uterus, cervix and the fallopian tubes. In men, it is used for bladder, prostrate gland and seminal vesicles study. A pelvic ultrasound reads clearly both the organs and structures that are solid and uniform like the uterus, prostrate gland or fluid-filled like bladder. It is usually used to find the cause of pelvic pain, such as ectopic pregnancy in women and tumors or masses. Transvaginal ultrasound helps in studying the uterus and other organs better.
Scrotal ultrasound is primarily used to evaluate the disorders of the testicles and surrounding areas. Pain and swelling in the scrotum and mass in the scrotum area or any other trauma can be detected and evaluated by a scrotal ultrasound. The scrotal ultrasound is a valuable tool in determining the cause of testicular pain and swelling. Ultrasound imaging helps to identity inflammation of the scrotum and an absent or undescended testicle, testicle torsion, abnormal blood vessel or a lump or tumor. Normally it is used to detect if the prostrate is enlarged.
Bibliography / Reference
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