Men’s Guide to Prostate Changes, Part 4: Testing
Based on the “Understanding Prostate Changes: A Health Guide for
Men” page of the
National Cancer Institute website
Edited (with Introduction) by Dr. Don Rose, Writer,
This article discusses many prostate-related
topics, ranging from the basics (what it is) to information about prostate changes
that happen with age (common changes, how they are treated,
and what one needs to know about testing for prostate changes, including cancer).
Since negative changes become more likely the older we get,
this information is especially relevant for
senior citizens. (The article is broken up into five segments. This is part
4.) --Dr. Don Rose
The following types of tests
are most often used to check the prostate (abnormal findings from any of these tests
can help diagnose a problem and suggest the next steps to take):
DRE (digital rectal exam) --
a test to feel the prostate
PSA (prostate-specific antigen)
test -- a blood test
Biopsy -- a test that directly checks
a small part of the prostate itself for cancer.
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
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
PSA levels are measured in
terms of units per volume of fluid tested. Doctors often use a score of 4
or higher as the trigger for further tests, such as a prostate biopsy.
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. 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. While it's important to
make your own decisions about cancer screenings, you should consider getting a second
opinion before getting something like a biopsy.
"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
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
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
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
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. 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.
Prostate Cancer Screening
Screening means testing for cancer before you have any
symptoms. A screening test can often help find cancer at an early stage. When found
early, cancer is less likely to have spread and may be easier to treat. By the time
symptoms appear, the cancer may have started to spread. Remember, even if your doctor
suggests prostate cancer screening, this doesn't necessarily mean that you have
Screening tests are most useful when they have been proven
to find cancer early and lower a person's chance of dying from cancer. For prostate
cancer, doctors don't yet know these answers and more research is being done.
research studies, with thousands of men, are going on now to study prostate
cancer screening. The National Cancer Institute is studying the combination of PSA
testing and DRE as a way to get more accurate results.
Some cancers never cause symptoms or become life-threatening.
If they are found by a screening test, the cancer may then be treated. For prostate
cancer in its early stages, it isn't known whether treatment would help you live
longer than if no treatment were given when a screening test detects prostate cancer.
Talk with your doctor about
your risk of prostate cancer and your need for screening tests.
Cancer Information Service (toll-free)
Telephone: 1–800–4–CANCER (1–800–422–6237)
NCI’s Web site:
NCI’s live online assistance:
For more information
about Medicare benefits, contact:
National Kidney and Urologic
Diseases Information Clearinghouse
This article is based on the webpage “Understanding Prostate Changes: A Health Guide for
Men” -- part of the
National Cancer Institute website. The information provided here is, to the
best of our knowledge, reliable and accurate. However, while
always strives to provide true, precise and consistent information, we cannot guarantee
100 percent accuracy. Readers are encouraged to review the original article, and
use any resource links provided to gather more information before drawing conclusions
and making decisions.
Dr. Don Rose writes books, papers and articles
on computers, the Internet, AI, science and technology, and issues related to seniors.
For more information about
and its many services and benefits for seniors – available in
, and other states nationwide -- please visit the following