PSA test

[Pug207]

This test is not an accurate indication of Prostate Cancer. There are many with low PSA readings and high Gleason scores. Only sure test is rectum investigation and if hard area is felt then biopsy.

[Roger2Dodger]

Gleason score would determine PCa. A DRE would only suggest that something suspious in the prostate. a good tool used however, by Doctors.

Gleason Score is determined after a biopsy.

It's true PSA test are not always accurate, you can have low PSA and have PCa as well as a high reading. Although a good tool for testing.

A biopsy will determine PCa.

[Stemcfc in reply to Roger2Dodger]

I had the biopsy and was told there's a 2percent chance of infection anyway I ended up seriously ill with sceptasemia for nearly three months then got told I had tc2 and needed immediate robotic surgery in twelve months on and psa is on the rise again and after reading most people who have had surgery then go on to radiotherapy it's a long long road.

[Sten]

Can biopsy taking be replaced by magnet resonance imaging as a way of assessing PCa?

[cfrees1 in reply to Sten]

I don't believe so. The biopsys sounds bad but it really wasn't too terrible. I really think this is the only way to know for sure.

[MelbourneDavid in reply to Sten]

multiparametric MRI can decrease the number of biopsies by being done first. Just published: bbc.com/news/health-38665618

Still need a biopsy to identify the Gleason score of the cancer - small low risk should be monitored not treated. It can be frwer biopsy cores targetted at what the MRI found.

Trans-perineal biopsy avoids the infection risk almost totally. It's sterile so no antibiotics required and almost never any infections.

[Dr_WHO]

There are some rare forms of prostate cancer like small cell and Ductal (which I have) that do not always raise your PSA.

[Sten]

cfrees! Thanks for reply. I have had a biopsy, so know a little about it, but there still seems to be a sepsis risk. Dr_WHO! Interesting! Could be useful for tomorrow´s urologist appointment. (My Gleason from 2011: 4-5 in one out of 14 samples, the other 13 no malignant cells.)

[MelbourneDavid]

Rectal examination by general practitioners has been shown to be almost useless as a screening tool. Very many prostate cancers aren't detected by rectal exam until too late. My 20cc cancer ws not detectable by rectal exam even by an expert because of its position.

All but a small proportion of prostatecancers produce elevated PSA levels.

More interesting,a PSA over 1.0 in your 40's ir early 50's is associated with a very high risk of invasive prostate cancer within 20 years. PSA less than 1.0 at that age is associated with low risk.

[Dr_WHO]

While rare, there are some forms of prostate cancer that does not raise your PSA. I know as I have one form, Ductal. Do not rely on just PSA test. You may end up like me. Eight years of PSA testing, 18 years of digital exams. When they found it, it was Stage 4.

[neville_g]

Agree with Pug207. On PSA there are 15 to 20% false positives/negatives so that an MRI scan is necessary to confirm full state of prostate, then targeted biopsy can be carried out. On the DRE (rectum examination) all hard areas are suspect, smooth or knobbly, and definitely need biopsy investigation. PSA velocity (the rate of increase in PSA over time) is a pointer to cancer and if it is very rapid, mine increased from 2.5 to 6.5 in 4 months and I had 60% cancer on one side. In the UK now an MRI scan seems to be preceding a biopsy, Whilst this enables a targeted biopsy, in my case a biopsy first would definitely have found the cancer and maybe I could have had my prostatectomy earlier (Gleason Grade was 3 + 4)

Best wishes,

nev_g

[azroy]

The only real test for Prostate cancer is the special MRI prostate test.

i have two biopsy's, one with 12 samples, no cancer. Another with 18 biopsy's with maybe cancer in one of the 18. Now having the MRI Prostate Exam. Very expensive, and finally got my insurance to approve it. I am 75 years old with no other health problems.