Reviewed By: Dr. Kurt Kloss, MD
Last Reviewed Date: Dec 05, 2018
Last Modified Date: Dec 05, 2018
Published Date: Dec 05, 2018
TABLE OF CONTENTS
Chapter 1: Introduction to the Prostate
Chapter 2: Prostate Cancer
Chapter 3: Prostate Cancer Getting tested: Most common Questions Answered
Chapter 4: What you need to know about PSA.
Chapter 5: Prostatitis: A forgotten condition that needs attention.
Chapter 6: What about this burning urination?
Chapter 7: The Newest Trends in the World of Prostate Cancer.
Chapter 8: Conclusion
Introduction to the Prostate
Prostate is a small gland that has the shape of a walnut and is located in between a man’s bladder and his penis. It falls right in front of the rectum. A man’s urethra links the bladder to the penis, passing through the prostate. This is the regular path of your urine. What is special about your prostate gland is that it produces a specific liquid that acts as a protector to your sperms. This fluid also nourishes your swimmers. When a man ejaculates, the prostate gland squeezes this fluid along with the sperms to form the semen.
So, now that you understand the location and function of the prostate gland, it would be easy to realize the negative effects it exerts on the body when it is not normally functioning. When your prostate is not healthy, your urinary tract as well as your sexual life will be affected.
In general, the prostate gland faces three main malfunctioning: prostatitis, benign prostatic hyperplasia and prostate cancer. Similar to any other chronic or infectious disease, getting tested is the key factor ad preliminary step in your preventive health plan. While there are treatments for any illness, why increasing the risk of it and allowing it to progress. Your health and body are your responsibility and so is your well-being. It is your responsibility to keep peeking at it every once in a while; especially, when you might think that you are developing some new symptoms.
While many might disregard some symptoms or be lazy when it comes to being tested for relevant markers from your prostate health, here are some alarming statistics that could give you a wakeup call.
- Prostate Cancer is the most common type of cancer among men in the United States of America.
- In 2018, 164,690 new cases were diagnosed, and about 30,000 people died because of this condition.
- The ratio is 1 to 6. This is how common men are diagnosed with prostate cancer in the USA.
- It is a very common condition among men that are older than 60 years; but, somehow common for those between ages 41 and 60.
- Prostate cancer affects different races unequally. African Americans have the highest risks of developing the disease and dying from it. Then, comes white non-Hispanics and Latinos/Hispanics, as well as American Indians.
The key to save the lives of men is to have an early detection of this condition that will end up having a 100% 5-year survival rate, and a 98% 15-years survival rate. However, if the disease is diagnosed at an advanced rate, the five-year survival rate goes down to 30%. You surely do not want to fall in this last category and the best way to stay steer of it is to get tested, routinely. The most effective and pioneering way to detect prostate cancer is by doing a blood test to evaluate the levels of PSA (Prostate Specific Antigen).
What is Prostate Cancer?
Prostate cancer forms in the tissues of the prostate gland, which is part of the male reproductive system. The prostate is located just below the bladder and surrounds the urethra. Its primary function is the production of ejaculatory fluid, which aids in protecting sperm cells and enabling proper motility.
Age is the most important risk factor for the development of prostate cancer, since the disease is most likely to occur in men over 50. Other risk factors include a family history of prostate cancer, African-American heritage and a high fat diet.
Know the Signs of Prostate Cancer: It's More Common Than You Think
Did you know that about one of every five men will be diagnosed with prostate cancer? While prostate cancer awareness has risen over the recent years, many still don't realize how common the disease is, nor are they aware of the warning signs and symptoms of prostate cancer. This is an unfortunate situation, since knowing the symptoms of this potentially deadly disease and being screened for it regularly save lives.
Signs and Symptoms of Prostate Cancer
In its early stages, prostate cancer is often a silent disease, showing no noticeable symptoms. This is the reason why medical professionals stress on the importance of getting routine prostate health screenings. They explain that such screenings need to be done annually, for all men over the age 40 years. This will increase the possibility of an early detection. When symptoms of prostate cancer are showing, they consist of the following:
- Difficulty passing urine
- Frequent, intense urges to urinate, especially at night
- Weak urine stream
- Painful urination
- Blood in the urine or semen
- Painful ejaculation
- Aching in the lower back, pelvis or hips
Individuals who have prostate cancer may experience any or a combination of the above symptoms. Some men present just one or two, while others may experience several or even all of them. Since these symptoms can mean that you can have other prostate disorders and health conditions, experiencing them does not necessarily mean that you have cancer. Such conditions include including prostate infections or enlargement of the glands, some urinary tract infections or several STDs. However, all the above are just probabilities and guesses. This means that you cannot base your diagnosis on them. Instead, you need to make sure to seek medical attention as soon as possible. Prostate cancer is, in the vast majority of cases, easily treated and very successfully; but, the best chance of effective treatment comes from an early detection and proper intervention.
Prostate Cancer Diagnosis
Prostate cancer is often first detected through prostate screening. The standard screening test is a blood test called a Prostate-Specific Antigen (PSA) test. This test measures levels of PSA in the blood stream, a protein produced by the prostate gland. High levels of PSA are often found in men who have developed prostate cancer. However, a high PSA level does not always mean cancer. Other conditions and factors can increase PSA levels, such as:
- Enlarged prostate – This condition, also called benign prostatic hyperplasia (BPH), is a non-cancerous enlargement of the gland. It is very common among men as they reach middle age and beyond, and often causes PSA levels to rise.
- Prostatitis – This is the infection or inflammation of the prostate gland, which can cause an increase in your levels.
- Medications – Men who are prescribed male hormones, such as testosterone, or medications that increase testosterone levels may have elevated PSA levels, that is triggered by these medications.
- Aging – PSA levels rise gradually as men grow older, even when there is no prostatitis, cancer or other issues.
Given these other potential causes high levels of the PSA. It is just the first step in diagnosing prostate cancer. Men with high prostate PSA typically have further testing that may include a digital rectal exam, done by a doctor that examines the gland for abnormalities via the rectum; a prostate biopsy, where a sample of prostate tissue is examined for signs of cancer; and, other and medical imaging procedures.
How Does One Detect Prostate Cancer?
PSA testing is the standard for routine prostate health screening and the detection of prostate cancer. PSA, or prostate-specific antigen, is an antigen produced by the prostate in small amounts as a component of the ejaculatory fluid. When the prostate is healthy, very little PSA is released into the bloodstream, while prostate problems, including cancer, cause greater amounts to be released that it normally is. PSA level testing, a simple blood test, measures the amount of PSA present in the bloodstream to detect levels that may be cause for further investigation of prostate health.
Digital rectal examinations are another common means of detecting prostate problems, including prostate cancer. Since the prostate gland is located just in front of the rectum, health care professionals can often detect prostate abnormalities by inserting a gloved and lubricated finger into the rectum and feeling the prostate gland through its wall, checking for enlargement, nodules, tumors or other irregularities.
If either of these two common screening methods reveals changes that may indicate prostate cancer, a biopsy is generally the next step. By taking a sample of prostate tissues and examining them for cancer cells, doctors can definitely diagnose prostate cancer or put a patient's mind at ease by ruling it out.
Prognosis of Prostate Cancer
Prostate cancer is very treatable, with a five-year survival rate of more than 99 percent. In fact, since many tumors never develop to life-threatening levels, doctors often opt to do nothing but observe it. This is the case when there is a slow growing prostate cancer. This is a strategy called active surveillance. Treatment options in aggressive cancers include medications, chemotherapy, radiation and surgery, among others.
Prostate Cancer Getting tested: Most common Questions Answered!
Men with no symptoms should have routine PSA levels testing, done once a year. For the average man, PSA prostate screening should begin at the age of 50, when a man's chances of developing prostate cancer begin to rise hastily. For men at high risks, annual screening should be done beginning age 40. Men with the following risk factors are considered high risk to prostate cancer:
- Men with first degree relatives (fathers, sons and/or brothers) who have been diagnosed with prostate cancer are at higher than average risk for developing the disease. If those relatives developed prostate cancer before age 65, the risk is even greater.
- Men of African-American heritage: since prostate cancer rates are higher among this ethnic group.
- Men who are 65 years of age or older, who account for about two of every three prostate cancer cases, according to the American Cancer Society.
What symptoms should push you into getting tested?
If you are experiencing symptoms that could be related to prostate problems, getting screened for prostate cancer is wise. Symptoms that should prompt PSA testing include:
- Frequent urges to urinate
- Frequent nighttime urination
- Pain or burning during urination
- A weak or interrupted urine stream
- Urinary incontinence, leakage
- Painful ejaculation
- Blood in urine or semen
- Frequent stiffness or pain in the lower back, hips, pelvis or upper thighs
What is the best age to get tested?
The term "prostate exam" generally refers to a digital rectal exam (DRE), which may be done in combination with a PSA test during cancer screenings; or, independently as a routine prostate health check. The DRE is a physical examination, done by your doctor, of the prostate gland. To perform this exam, your doctor will insert a gloved and lubricated finger into the rectum to feel for any changes or abnormalities in the prostate gland including enlargement, bumps, hard areas or texture changes that may indicate prostate conditions and/or prostate cancer.
Men of any age who have noticed any of the prostate-related symptoms listed above should see their doctor and get examined immediately. Routine annual prostate exams, as part of standard preventive care, are recommended for all men 40 years of age or above, as the risk of developing most prostate conditions begins to rise in men of this age group.
What is a normal prostate reading?
What is considered a normal PSA level in men during a cancer screening varies according to age. Men in their 50s or younger should have PSA levels below 2.5 nanograms per milliliter (ng/ml) of blood. In older men, a PSA level of 4.0 ng/ml are considered to be normal.
According to the American Cancer Society, men with a prostate PSA level between 4 and 10 ng/ml have a 1 in 4 chance of having prostate cancer. In men with PSA levels of 10 ng/ml or more, the chances of having prostate cancer are more that 50 percent. Additionally, the American Cancer Society also notes that the level considered normal varies from one doctor to another, with some recommending further testing with PSA test results as low as 2.5 or 3 – a decision that is often influenced by a patient's personal risk factors, including age, race and family prostate cancer history.
Are There any Screening Tests for Prostate Cancer?
There are two commonly used tests to screen for prostate cancer. These tests may be able to detect the condition before you have any symptoms. Using both tests together may also help find the cancer at a very early stage. These two are the digital rectal exam (DRE) and the prostate-specific antigen (PSA) blood test.
The Digital Rectal Exam (DRE)
During this exam, your doctor will press his gloved and lubricated finger into your rectum through your anus. He can then feel the size and shape of your prostate. This is a simple, safe procedure. You may feel slight discomfort; but you should not feel pain. However, the DRE alone can’t find early cancers. Therefore, the American Urology Association recommends that the DRE be done in conjunction with the PSA test.
The Prostate Specific Antigen (PSA) Blood Test
A PSA test is a non-invasive test that can be done quickly and easily. PSA is a protein that is made by the prostate gland as well as the cancer cells in your prostate. If your PSA blood levels are high, it could indicate cancer. However, there are several other factors and conditions that could cause such a pike in these numbers. One of them is if there is an inflammation of the prostate gland, also known as prostatitis. This could be caused by an infection. Another is benign (non-cancerous) prostatic hyperplasia (BPH), which is when the prostate becomes enlarged. Other possible reasons for increased PSA levels in your blood include:
- Age: It is normal for PSA levels to rise slowly the older you get.
- Ejaculation: Ejaculation can cause a short-term rise in PSA levels in the blood. It is not unusual for a doctor to advise against you ejaculating a few days before your PSA test.
- Riding a bicycle: There have been studies suggesting that when you ride a bicycle, your seated position is exerting pressure on your prostate leading to an increase in your PSA levels.
- Urologic Procedures: Biopsy (see below) and cystoscopy can cause PSA levels to rise, briefly.
- DRE: There have been studies to suggest that this test may cause a rise in PSA. Due to this possibility, it may be advisable to draw blood for the PSA test prior to the digital rectal exam, to be on the safe side.
- Medications: Those of you who are taking male hormones, such as testosterone, may have higher levels of PSA. This is also true for other medications that affect testosterone levels in the body.
What do the Various Levels of PSA in a Blood Test Mean?
The amount of PSA in your blood that is considered “normal” is 4 ng/mL (nanograms per milliliter). This does not necessarily mean that a person who has this number 4 does not have cancer. It is just the common level for most men who do not have prostate cancer. For those who have PSA levels below 4, only 15 percent of them will have a positive diagnosis for prostate cancer when going for the biopsy. If PSA levels are between 4 and10 ng/mL; then, there is a 25 percent higher risk to have prostate cancer. Finally, if your results are over 10 ng/mL, your chances increase to as much as 67 percent for a positive diagnosis.
Are there Disadvantages to Getting the PSA Test?
The PSA blood test can be influenced by several factors. Factors that can cause raised PSA levels have already been discussed (see above). However, some factors might even show lower levels of PSA in your blood, even if you do have prostate cancer. So, the true levels will be hindered due to these factors and if you are only relying on PSA test without doing the DRE; then, you would be taking somehow of a risk. These PSA-lowering factors include:
Medications: Drugs such as Proscar, Propecia or Avodart, for treating BPH, may lower your PSA levels. Also, there have been studies suggesting that taking aspirin on a regular basis may have the same effect. This also applies to the long-term use of statins, like Lipitor, Crestor and Zocor. Finally, thiazide diuretics (a treatment for water retention associated with high blood pressure) taken over many years can lead to lowered PSA results.
Herbal Mixtures: Some of these, which are taken as supplements, may mask high PSA results. You should always tell your doctor whether you are taking any of these medications and/or supplements.
Being Overweight: Obese men tend to show lower levels of PSA in their blood tests.
What happens if I have an Abnormal Screening Test?
If your screening tests indicate possible prostate cancer; then, there are several approaches to proceed with. First, it would be wise to repeat the screening tests and compare results over time. A change over time is called “PSA velocity.” If your PSA levels are still high, and your doctor feels anything unusual during the DRE; then, further tests need to be done such as having a biopsy done. You must first understand that the only way to truly diagnose prostate cancer is through a biopsy. It is a procedure when a hollow needle is inserted into your prostate to obtain samples of the prostate tissue. This tissue is then examined under a microscope for signs of cancer. To determine if you need a biopsy, there are other tests that can be done.
What Tests Help Determine if a Biopsy is needed?
Additional PSA tests can be done to help your doctor decide if you should have a biopsy. These include:
The percent-free PSA test: PSA can either be attached to proteins in the blood, or freely circulating in it. This test shows how much PSA is freely circulating in your bloodstream as compared to the total levels found in your blood. Many studies explain that if your PSA levels are between 4 and 10 ng/mL and your percent-free PSA is low (less than 10 percent); then, you have about a 50 percent chance of having prostate cancer. In such a case, you would need to have a biopsy done There has also been some evidence to suggest that a lower percentage of free PSA might be related to cancer that is more aggressive.
PSA velocity: Even man with a PSA level lower than 4; but who is noticing a gradual increase in their levels of more than 0.75 ng/mL a year (a high PSA velocity) may have cancer and need a biopsy to be certain.
Urine PCA3 test: This test looks for a specific gene in your urine that only prostate cancer cells have. It is the PCA3 gene. This test together with the PSA test will help your doctor determine if you need to undergo a biopsy.
Transrectal ultrasound (TRUS): Another test proven to be very helpful, where a wand, or probe, is inserted into your rectum. Then, sound waves are sent out. These bounce back from the prostate gland to form a picture of it. The TRUS is often done along with a biopsy to aid in placing the needle.
About 1 out of every 9 men will be diagnosed with prostate cancer. But, only 1 of 41 will die from it. African American men are at a greater risk for prostate cancer than Caucasian men; and, that risk begins at an earlier age. The highest number of cases is diagnosed around the age of 65. However, you should initiate discussions with your doctor at around age 40. Especially if you are African American, or have other risk factors, such as close family history. Caucasian men, with no family history, have their risks going up after the age of 50. The medical community is conducting new research surrounding prostate cancer regularly. You and your doctor can determine whether and when you should be screened for prostate cancer.
What you need to know about PSA.
No matter what your age is or what your health status could be, your prostate produces prostate-specific antigen (PSA), a vital protein. Unusually high PSA levels can indicate serious health concerns for men. So, it's important to check yours regularly.
What exactly is the PSA Test?
The PSA test checks the level of the PSA protein present in a man's bloodstream. Although your body releases the vast majority of the PSA that your prostate produces via semen, some of this protein does enter your bloodstream.
Since both cancerous and noncancerous prostate cells produce this protein, an unusual PSA level isn't a serious condition on its own. However, higher levels of this protein often indicate health issues such as prostate cancer. Because prostate cancer is the most common type of cancer for men, and a leading cause of cancer-related death, this test can serve as a key step in cancer diagnosis and in identifying other serious conditions.
In fact, this test first became commonplace in 1986, when the U.S. Food and Drug Administration (FDA) approved it as a method for monitoring the advancement of prostate cancer. Less than a decade later, the FDA approved the PSA test as a tool for detecting prostate cancer in men without symptoms, when used along with a digital rectal exam.
While the PSA test is most closely linked to prostate cancer detection, it can reveal other significant concerns, too. This test can also help detect conditions like benign prostatic hyperplasia (BPH), or enlarged prostate, prostatitis, or inflamed prostate.
When to Take the PSA Test?
Although you won't find a single set of universally accepted guidelines for when to take the PSA test, key expert groups offer helpful advice that indicates when most men should begin thinking about this test. For example, the United States Preventive Services Task Force doesn't recommend taking the PSA test for screening purposes. They assert that the type of cancers this test could reveal may prompt invasive treatments. So, the patient would face what is called as “over-treatment”, which would do more harm than good.
In contrast, many professionals/physicians used to recommend that men over 50 undergo annual PSA screenings. While this standard is no longer in place, it is recommended that men take a PSA test every two years, if they meet a few key criteria.
The American Cancer Society suggests that most men begin talking to their doctors about the PSA test when they turn 50. But it does not recommend taking an initial test without first understanding the benefits and drawbacks.
The American Urological Association recommends most men to wait a little longer, or until the age of 55, before thinking of taking their first PSA test. However, it does not recommended it if you are over the age of 70 yrs; or, if you have a life expectancy under 15 years.
One recommendation that most medial bodies agrees on is that men, who are at higher risk of developing prostate cancer, can benefit from routine PSA tests. For example, if you're over 50, you have an increasingly higher chance of having this type of cancer as you age. If you have any other prostate cancer risk factors, consider taking a PSA test as early as age 40:
1. Geography: Men in the United States and North America have one of the highest rates of prostate cancer. Those who live in Africa, Asia, or Central or South America are less likely to have this type of cancer.
2. Race or Ethnicity: African-American men are among the highest at-risk groups for prostate cancer, and according to the American Cancer Society, they're about twice as likely as white men to die from this type of cancer. On average, Hispanic men and Asian-American men are less likely to have prostate cancer than white men.
3. Family History: Genetics appear to impact prostate cancer, as it's more common in some families than in others. If you have a close relative, such as your father or brother, with a history of prostate cancer, your risk factor doubles. If multiple relatives have had prostate cancer, your risk factor is even higher.
4. Genetic Predisposition: Family history isn't the only genetic aspect that increases your risks. If you have inherited certain gene mutations, such as variants of BRCA1 or BRCA2, you could also have a higher chance of developing prostate cancer.
While the PSA test can be helpful for identifying the early stages of prostate cancer, this type of test can also assist cancer treatments and management. Some physicians recommend taking a PSA test before prostate cancer treatment, as it can reveal the location of the cancerous cells, determine the likelihood of the spread, and help with the treatment options. Doctors may also suggest a series of PSA tests after completing prostate cancer treatment, as these tests can indicate how well the treatment worked.
How to Take the PSA Test
No matter why you want to check your PSA levels, you will find that it is simple and straightforward. First, confirm which version of the test you should take. While the standard PSA test is most common, another option might give you more specific results.
Test 1- Free Versus Total PSA: This test can offer a more specific analysis by distinguishing between the two primary types of this protein — one that's bound to other proteins and one that circulates through your bloodstream unattached.
Test 2- PSA Velocity: This test checks your PSA levels over time to help reveal changes and patterns. It can also reveal your PSA doubling time, a metric that indicates how long it takes your PSA level to double.
Test 3- Ultrasensitive PSA: This test checks PSA levels after surgery or during the treatment rather than being a prostate cancer screening tool. It is more of a monitoring kind of test.
Once you've chosen the right option, order a PSA test online and then head to your chosen lab picked during the purchase process. Check with your lab to confirm whether you need to make an appointment ahead of time; or, you can go whenever works best for you. Since this type of blood test doesn't require fasting, you don't have to prepare in advance.
When you arrive to your appointment, a lab technician will draw some blood: a quick process that's relatively painless. First, the technician will ask you to make a fist or tie a band around your upper arm to locate your veins easily. After locating a vein, the technician will insert a needle, which is attached to a tube that collects your blood sample. Finally, the technician will remove the needle, use gentle pressure to place a bandage on the insertion site, and take your blood sample away for processing.
The blood draw process takes only a few minutes, but you'll typically have to wait a few days to receive your results. In most cases, you'll receive a notification that your results are available online, where you can check them at your convenience.
What to Expect from Your PSA Test Results
When you receive your PSA test results, you'll find that they measure the level of this protein in nanograms per milliliter (ng/mL). In general, a PSA level below 4 ng/mL is considered healthy, but your normal range may differ depending on your age. Because younger men naturally have lower PSA levels, many experts consider readings over 2.5 ng/mL a cause for concern. In contrast, older men naturally have larger prostates; and, therefore higher PSA levels are to be expected. So normal results for men between ages of 60 and 69 may be closer to 4.5 ng/mL.
If you've taken a PSA test before and you are getting tested again, you may also want to pay attention to how the results have changed over time. A PSA level that's relatively static could be sign of a healthy prostate, while PSA levels that have increased rapidly over the course of a year or two could indicate a growing problem.
What Causes Low PSA Levels?
When you take a PSA test, you want the results to be as accurate as possible. Take note of the following common causes of low PSA levels, as they may produce results that don't give you a complete picture of your health status.
In some cases, the medications you're taking may artificially decrease your PSA levels. Prescription medications like finasteride and dutasteride, which treat prostate issues, are two of the most common drugs known to make PSA levels appear lower than they actually are. Ketoconazole, a treatment for fungal infections, can also falsely lower your PSA levels. If you are taking these drugs, talk with your doctor before taking a PSA test, as the results may not be accurate.
Some herbal supplements can also impact your PSA test results. For example, taking supplements that include phytoestrogens can decrease your PSA levels due to the estrogen-like effects they produce.
What Causes Elevated PSA Levels?
Abnormally high PSA levels can cause serious concern; but they don't always indicate prostate cancer or related prostate issues. Get to know a few common causes of elevated PSA levels before you undergo the test.
Increasing age is one of the most common causes of increasing PSA levels. Men under 40 typically have smaller prostate glands, which secrete lower levels of PSA into the bloodstream. As you get closer to your 50s and 60s, your prostate naturally grows, producing higher levels of PSA in the bloodstream. It is not unusual for your PSA level to double between ages 40 and 70. But, aging alone is not typically a cause for concern. When evaluating your PSA levels, be sure you're considering them in the context of the normal range for your age group.
Sports Injuries and Athletic Activities
In some cases, regular exercise and serious injuries can cause your PSA levels to increase over time. Repeated injuries in the groin area, or strong impacts to the pelvic region can elevate your PSA levels. Along the same lines, certain types of athletic activities, such as bicycling, can cause PSA levels to climb. While a weekly bike ride might not affect PSA levels, competitive cycling and frequent extended rides may impact your results over a period of several years.
You already know that advanced age is linked to a naturally larger prostate and higher PSA levels. However, you can also develop an enlarged prostate if you have a condition like BPH, which is very common among men over 50. Even though BPH can elevate your PSA levels, it does not indicate prostate cancer and may not even require treatment. Consider talking to your doctor or getting a referral to a urologist to discuss whether your BPH is cause for concern or if you need medical assistance.
Just like irritation within or near the prostate can contribute to higher PSA levels, so can prostate inflammation, which is very common among men under 50. An inflamed prostate, or prostatitis, can cause elevated PSA levels that can decrease with treatment. Consider talking with your doctor to learn whether antibiotics can clear up your prostatitis and improve your PSA levels.
Urinary Tract Infections
While advanced age and other conditions cause PSA levels to increase permanently, some issues lead to elevated PSA levels for shorter time periods. Urinary tract infections don't affect the prostate directly, but since these infections affect areas close to the prostate, they cause irritation and increase PSA levels. If you have a urinary tract infection, reschedule your PSA test after your condition has improved.
Although you don't technically have to be prepared to take a PSA test, engaging in sex or ejaculating less than 24 hours before the test can artificially increase your results. For most men, the increase is likely to be relatively minor. In that case, your results will be very close to being abnormally high. However, for many recent ejaculations can push your levels into an elevated range. To ensure accurate results, consider avoiding ejaculation too close to the test.
Digital Rectal Exams
Similar to ejaculation, digital rectal exams can artificially increase your PSA levels for a short period of time, typically over a day or two. If you're planning to get a digital rectal exam in conjunction with the PSA test for a more complete prostate cancer screening purposes, be sure to complete the blood test before undergoing the exam.
While some medications artificially lower PSA levels, others can elevate the level of this protein in your bloodstream. Many chemotherapy drugs cause abnormally high PSA levels; so, if you're undergoing treatment for cancer, talk with your doctor about how those medications could impact your test results.
Not all types of surgery automatically increase your PSA level, but some medical procedures can irritate your prostate, resulting in temporarily elevated PSA levels. Procedures related to organs near your prostate, such as your bladder, can also elevate PSA levels. Catheterization often causes mild trauma to the prostate, causing higher PSA levels that last a few days. Prostate biopsies and surgeries can also elevate PSA levels for weeks, so be sure to take this into consideration when scheduling your PSA test.
What to Do After Taking the PSA Test
If your PSA levels are abnormally high or low, make an appointment to discuss the results with your doctor. Low levels may not require additional action. In many cases, however, unusually high levels could prompt your doctor to review your risk factors to determine if you need additional testing, especially if your results are over 10 ng/mL.
For example, if you're African-American, over 50 years old, or aware of a family medical history of prostate cancer, these risk factors may help your doctor decide to pursue additional testing like a second PSA test or a digital rectal exam. If the secondary testing indicates a potentially cancerous lump, your doctor might recommend an ultrasound or a biopsy to confirm the diagnosis. If you do have prostate cancer, your physician may recommend treatment, especially if you're at risk for metastasis or cancer developing in other organs.
In contrast, if you don't have common risk factors for prostate cancer, your doctor may recommend that you don't pursue immediate testing. Instead, your physician may suggest another PSA test a few months down the road, rather than scheduling more invasive testing.
Even if your PSA test results appear normal, don't hesitate to talk them over with your doctor, especially if you're aware that you have a higher risk of developing prostate cancer. At the very least, your doctor may recommend more frequent PSA tests to keep a close eye on your health.
In some cases, your doctor may also recommend paying closer attention to factors that the American Cancer Society has identified as impacting your risk of developing prostate cancer. Your doctor may recommend that you modify your diet to include fewer servings of red meat and high-fat dairy in place of more fruits and vegetables. Your physician may also help you develop a plan for maintaining a healthy weight, as obesity may be linked to developing advanced prostate cancer.
What Are the Drawbacks of a PSA Test?
It's important to note that the PSA test does have some limitations and drawbacks. First, false positives and false negatives can happen with this test. Normal test results may not necessarily indicate that you don't have prostate cancer, and the opposite is true, too. Some studies have shown that elevated PSA levels don't always confirm a cancer diagnosis. In fact, just a quarter of men who have a biopsy after testing high for PSA levels ultimately receive a prostate cancer diagnosis.
In contrast, men with PSA levels within the normal range could still have prostate cancer. Since normal results on a PSA test can mistakenly assure men that they don't have cancer, relying completely on this test can be problematic.
In other cases, accurately detecting prostate cancer with a PSA test may not necessarily improve men's quality of life or extend their lifespans. Many forms of prostate cancer grow very slowly, and treating them aggressively can have negative side effects such as erectile dysfunction or incontinence. Since the PSA test can't distinguish between slow-developing and more aggressive forms of prostate cancer, overtreatment can occur as a result.
These limitations don't mean that you should ignore your PSA test results. Researchers are actively working to improve their understanding of PSA levels, which could ultimately make the PSA test more effective than ever. For example, some experts recommend referencing age-specific PSA ranges to improve accuracy, while others suggest analyzing PSA levels in conjunction with other protein-based biomarkers that appear in the blood.
What Are the Benefits of a PSA Test?
While some downsides do exist, most medical experts and professional bodies find that the benefits of a PSA test outweigh, by far, the drawbacks. Most importantly, this test can serve as a prostate cancer warning sign, indicating that you will probably need additional testing. If you have an aggressive form of prostate cancer, taking this test could help you get a diagnosis and begin treatment before the cancer spreads.
No matter what type of prostate cancer you might have, taking a PSA test may help you enjoy a longer life. Medical trials have shown that the PSA test could reduce mortality rates from prostate cancer, potentially reducing the death rate by almost half.
The PSA test serves as more than a prostate cancer screening tool. It also offers the benefit of helping you and your medical team map out the location of cancerous cells and even tracks the progress of cancer treatments. This versatile test can also identify related prostate conditions like prostatitis or BPH before they cause serious harm.
Whether you're over 40 or you have common risk factors for prostate cancer, it's critical to check your PSA levels regularly. With a PSA test, you can expect quick, confidential results, and you'll also gain the ability to detect warning signs early while maintaining good prostate health. Get your PSA test from Health Testing Centers today, and take an important step toward keeping your prostate healthy.
The Prostate Gland and PSA
The primary function of the prostate gland is in the production of ejaculatory fluid, which protects and nourishes sperm cells in semen and helps in enabling sperm motility. It is typically slightly larger than a walnut in young men and increases in size with age. The urethra, which is the tube through which urine, and semen in men is carried from the bladder to the genitals, runs through the center of the prostate gland.
Prostate-specific antigen (PSA) is produced in small amounts by the prostate gland as a component of the ejaculatory fluid. Very little PSA escapes into the bloodstream from a healthy prostate gland, so elevated prostate levels in the blood are an indication of a variety of prostate abnormalities, ranging from benign prostate conditions to malignant ones.
Common Causes of Elevated Prostate Levels
Elevated PSA levels in the blood can be an indication of several prostate disorders. Most common is benign prostatic hyperplasia (BPH), which becomes a problem for half of all men in their 60s and up to 90 percent of men in their 70s, according to the National Kidney and Urologic Diseases Information Clearinghouse, with some men beginning to develop symptoms as early as their 30s and 40s. Commonly referred to as benign prostate enlargement, BPH occurs as the inner portion of the prostate gland surrounding the urethra grows with age, causing prostate tissue to press on the urethra, restricting urine flow. This often leads to urinary problems, such as frequent urination, urinary hesitation or, in extreme cases, total urinary blockage. Treatments for BPH range from medications to surgical intervention.
Prostatitis, or inflammation of the prostate gland, is another common prostate problem that can cause elevated prostate levels. It can be caused by a bacterial infection and certain allergies, although in many cases, causes are unable to be definitively determined. Symptoms can include flu-like symptoms, such as fever, chills, fatigue and muscle aches, frequent or painful urination and pain or discomfort in the testicles, urethra, lower abdomen or back. More than half of all men will suffer the disorder at some point in their lives, and while it can become chronic in a small percentage of them, it is typically a temporary condition. Treatment depends upon the particular causes in each case, and can range from antibiotic or anti-inflammatory medications to surgery.
Prostate cancer, also a cause of elevated PSA levels, is the most dangerous prostate disorder and the chief reason that PSA level screening tests are done. According to the National Cancer Institute, approximately 220,000 new cases of prostate cancer are diagnosed annually, and the average man has a one in six chance of developing prostate cancer within his lifetime. With early detection, prostate cancer can be treated very successfully, with overall 5-year survival rates of 99.2 percent.
The most common type of prostate cancer by far is adenocarcinoma, which develops in gland cells that produce ejaculatory fluid. While some of these cancers can grow and spread to other parts of the body very quickly, most prostate cancers are slow growing. Fast growing prostate cancers are, in most cases, life-threatening and will require treatment. Slower growing prostate cancers, since they often never develop to the point of being life-threatening, are frequently left untreated, but monitored carefully for dangerous changes, a strategy called active surveillance.
Since PSA levels are indicative of prostate cancers and other prostate disorders, screening tests are recommended on an annual basis in men over age 50 to monitor prostate levels. Men with a family history of prostate cancer should begin annual screening by age 40, since they are at higher risk of developing the disease. PSA levels considered a reason for concern among different age groups are:
- Age 40-49: Above 2.5 ng/mL
- Age 50 -59: Above 3.5 ng/mL
- Age 60-69: Above 4.5 ng/mL
- Age 70-79: Above 6.5 ng/mL
Men over 50 or those with elevated prostate cancer risk who have not had prostate levels tested should request testing from their physicians, or can order PSA tests directly from Health Testing Centers. Ordering the same, high-quality PSA tests used by doctors online through Health Testing Centers is typically quicker, more convenient and less expensive than having them ordered by the family physician, and all testing is done in a national laboratory used extensively by professionals throughout the medical community.
Prostatitis: A forgotten condition that needs attention.
Prostatitis is a condition that affects the prostate gland, causing inflammation. Lab tests are often used to rule out other prostate conditions before a diagnosis of prostatitis is made.
Types of Prostatitis
Four conditions are classified as prostatitis. These are:
- Acute bacterial prostatitis – This form of prostatitis is the least common and the most easily identified. Typically, it is caused by a sudden bacterial infection and can affect men of all age groups.
- Chronic bacterial prostatitis – Also caused by a bacterial infection, this form of prostatitis is characterized by recurrent urinary tract infections, the infections appearing to go away, then flaring up again. It develops more gradually than acute bacterial prostatitis and its symptoms are typically less severe.
- Chronic prostatitis and chronic pelvic pain syndrome – This condition is a non-bacterial form of prostatitis and the most common. Its exact causes are unknown, but it can stem from persistent inflammation or infection, or can be related to pelvic muscle spasms.
- Asymptomatic inflammatory prostatitis – This condition causes inflammation in the prostate gland with no symptoms, and is generally discovered incidentally as a patient is examined for unrelated health issues. Prostatitis causes elevated prostate specific antigen (PSA) levels, so this condition may also be discovered through routine prostate cancer screening tests.
Common Prostatitis Symptoms
Prostatitis symptoms vary widely according to the type of prostatitis present and can differ greatly between affected individuals. Among the symptoms that men commonly experience are:
1. Fever, chills and skin flushing
2. Dysuria, which means pain or burning during urination.
3. Frequent urge to urinate, often very intense and not very productive, with very little urine passed.
4. Hematuria, or blood in the urine.
5. Nocturia, or a frequent need to urinate at night.
6. Pain or bleeding during or after ejaculation.
7. Difficulty urinating, such as trouble getting started, dribbling after urination, weak urine stream or difficulty emptying the bladder fully.
8. Pain in one or several of the following areas: The abdomen, groin, lower back, penis, testicles, and perineum (area between the scrotum and rectum).
Diagnosis and Treatment
Men who notice potential prostatitis symptoms should seek medical attention immediately. Prostatitis, depending upon the type, can have long-term health effects. Diagnosing prostatitis involves ruling out other diseases and health conditions that cause similar symptoms, then determining the type of prostatitis present and its cause.
As a rule, a physician will begin by questioning the patient about his symptoms, examining the abdomen and genitals, and performing a digital rectal exam (DRE), during which a gloved and lubricated finger will be inserted into the rectum. This enables the doctor to feel the prostate gland through the wall of the rectum to check for signs of swelling and/or tenderness.
If the physical exam reveals signs of prostatitis, lab tests will be done to confirm that diagnosis and determine whether the patient is affected by a bacterial form of the condition or a non-bacterial one. These generally include analyzing samples of urine, prostate fluid and blood for signs of infection, such as white blood cells or bacteria. A blood culture may also be done, in which the lab will grow any bacteria present to aid in identification or test the effects of various antibiotics.
Treatment of prostatitis varies based on the type, but can include oral or IV antibiotics.
What about this burning urination?
Burning urination is when you notice a burning feeling when you urinate. That feeling may be present when your urine passes in areas like the bladder or prostate gland. Many conditions can cause this feeling, including urinary tract infections, inflammatory conditions, several sexually transmitted diseases (STDs) and some kidney problems, for example. So how to diagnose burning urination? You will probably need the help of a health care professional for a solid diagnosis; but here is what you need to know.
This is the first step to diagnosing burning urination, since this problem can be caused by a rather long list of conditions. Knowing what other symptoms may also be present can help narrow that list. Symptoms that typically accompany burning or painful urination include:
- Urine that is bloody, cloudy or has an unusual and/or foul odor
- Urination issues, such as frequent urination, passing small amounts of urine, involuntary urine leakage, very concentrated (dark yellow) urine, or urges to urinate when your bladder is empty
- Fever or chills
- Nausea and/or vomiting
- Unusual discharge from the penis or vagina
- Bumps or rashes on or around the genitals
- Itching or inflammation (swelling) on or around the genitals
- Abdominal or pelvic pain
- Pain in the lower back or side
- Prostate pain
Make a note of any symptoms you are experiencing, and any others not listed here. Note how long and how often you have had them, and whether they appeared suddenly or gradually. These details can help in diagnosing burning urination.
Other details that may be important to your diagnosis include health conditions you may have, such as diabetes, allergies or immune system disorders. Any medication or supplements you take also play a part. You may also be asked for a sexual history to determine whether STDs may be the cause of your burning urination problem. If you are female, a pregnancy test may be necessary, as this can be a possible reason.
You will likely also be asked about other factors that may cause irritation or inflammation in the urinary tract and/or genitals. These may include whether you are using any new soaps or other personal care products, engaged in activities like bicycle or horseback riding, or whether you have had any recent medical procedures or treatments that might contribute to your symptoms.
Testing Commonly Used to Help Diagnose Burning Urination
Using clues provided by your symptom’s assessment, your healthcare professional may recommend a variety of tests that can help diagnose the cause or causes of burning urination. Among the most common of these are:
This test analyzes a sample of your urine. It looks for the presence of white blood cells, red blood cells, proteins and abnormal chemicals in the sample, among other indicators, to screen for possible inflammation in the urinary tract.
This lab test looks for signs of infection in a urine sample and helps identify the specific bacteria causing that infection. It can also help your healthcare professional determine which antibiotics are best to use in treating it.
Under certain circumstances, healthcare professionals may use a swab to take a sample, which will be sent to a lab to check for signs of infection. For example, in females with burning urination, swab samples may be taken from the vagina or urethra (the tube that carries urine out of the body). For men who have been feeling some burning while urinating, they will have some swab samples of their fluid sent to the lab to aid diagnosis.
STD Screening Tests
STDs are a common cause of burning urination. For that reason, testing for these diseases is often recommended in sexually active people who are experiencing this problem. This may include urine tests to check for signs of chlamydia, gonorrhea, and trichomoniasis; as well as blood tests to look for other STDs that can cause burning urination, such as herpes or syphilis. HIV testing may also be recommended in some cases, since this viral infection can weaken the immune system, enabling frequent urinary tract infections or other opportunistic infections that can lead to burning urination.
Yeast Infection Tests
Vaginal yeast infections are another common cause of burning urination. Tests that are often used to detect these infections include urine tests, which look for yeast in a urine sample, and swab tests that look for signs of yeast overgrowth in vaginal fluids.
Kidney Function Tests
If your burning urination has been going on for a long time and/or is accompanied by symptoms like back pain, fever and chills, bloody urine or changes in normal urination habits, your healthcare professional may recommend some tests to determine how well your kidneys are functioning. Common tests for this purpose include:
1. Basic Metabolic Panel
Checks the levels of glucose, calcium, chloride, carbon dioxide, potassium and sodium in your blood sample, as well as BUN (blood urea nitrogen) and creatinine, providing important indicators of kidney health and function.
2. BUN/Creatinine Ratio
Uses a blood sample to measure levels of these waste products in the body to evaluate kidney function.
3. Kidney Function Panel
Measures the levels of electrolytes, proteins, minerals, waste products and sugar in a blood sample to assess kidney function.
4. Prostate Testing
Prostate tests may be recommended for men who feel burning while urinating. These typically include blood tests to check for signs of prostate cancer, like the PSA tests, and in some cases, medical imaging.
Other testing that may be done include examinations of the bladder and other components of the urinary tract with ultrasound or other medical imaging techniques, as well as neurological tests to look for nerve damage that can cause painful or burning urination.
In most cases, burning or painful urination can be treated successfully, reducing or eliminating your discomfort. Typically, this involves treating the underlying causes, which most often needs medications, such as antibiotics for urinary tract infections and some STDs, antiviral medications for herpes or HIV, or antifungal treatment for yeast infections, for instance. Of course, you will need medical help and an accurate diagnosis to get the right treatment. So, working with your healthcare provider is essential.
The Newest Trends in the World of Prostate Cancer.
About one in six American men will be diagnosed with prostate cancer in his lifetime. Some studies show that at least half of all men over 50 have some form of prostate cancer. Those 85 and older are even more likely to develop the disease. In fact, age is the most important single risk factor for the development of this condition.
Part of the male reproductive system, the prostate is a walnut-shaped gland located just below the bladder surrounding the urethra, and when prostate cancer occurs, it forms inside the tissues of the prostate gland. In its early stages, it can be silent, producing no real symptoms.
Most prostate cancers are not fatal because they are small and slow-growing. It is a very treatable form of cancer with a higher than 95 percent five-year survival rate among those diagnosed with the disease.
So how do you know when (or whether) to treat prostate cancer? Is testing the right thing to do? Is aggressive treatment the right approach? How can prostate cancer that matters – the type that can be fatal – be prevented or stopped? Let’s examine what’s new in the medical treatment and prevention of this common cancer.
1. How is prostate cancer detected, nowadays?
Just like we explained earlier, PSA testing is still the standard for routine prostate health screening and detection that tests for both low-risk and life-threatening cancers. In a healthy prostate, little PSA is released into the bloodstream. A PSA level test is a simple blood test that measures the amount of PSA present. If higher than normal levels are detected, most healthcare providers suggest further testing. Another form of testing is through a digital rectal examination. Sometimes abnormalities can be found by insertion of a gloved, lubricated finger. The healthcare provider can feel the prostate gland, checking for enlargement, nodules, tumors or other abnormalities.
2. Which types of prostate cancer matter the most?
Cancers develop in more than one shape and size, from a low-risk, localized malignancy to a potentially lethal tumor that can spread throughout the body. Intense research is ongoing to determine whom among those diagnosed with prostate cancer need treatment right away; and, whom should be watched and monitored with simple PSA testing and if necessary, repeated biopsies. In that case, treatments will be delayed. This is what “active surveillance” is all about; and, it is a more conservative approach that was recommended since 2011 by the National Institutes of Health in a science conference at which men with low-risk prostate cancer and their treatment management were the subject.
3. What are the latest medical advances in prostate cancer?
Besides the standard PSA blood test, an MRI can help pinpoint those cancers that are most worrisome. If the result is negative, or shows only a small lesion, then the patient has a much better chance of a good outcome. Other advances include looking at biomarkers that can detect the most dangerous, more aggressive cancers. But the procedure is expensive, rarely covered by insurance and not yet widely used.
Focal therapy is another option, similar to a lumpectomy in breast cancer that treats the lesion without invasive surgery to the prostate.
A new, FDA-approved drug (as of May, 2013) is Xofigo, known generically as radium-223 dichloride. It works by emitting radioactive particles to targeted cancerous tissue in the bones. But it has side effects and can be costly. Talk to your healthcare provider about whether or not it fits your particular case.
4. I hear conflicting reports about the PSA screening test? Should I take it?
It depends on who you ask. In 2013, the American Urological Association recommended against PSA screening for men under 40 and for those 40-55 who were no more than average risk for prostate cancer. While the PSA test can detect some cancers that may never cause real trouble, side effects from treatments administered can create their own set of problems.
What the American Cancer Society recommends is that patients make an informed decision based upon family history, current information, and a frank discussion with their healthcare provider about pros and cons of standard PSA testing.
5. What are the pros and cons of screening for prostate cancer?
The PSA test often finds slow-growing cancers and since cancer is frightening to most people, some say the test is well worth it.
On the flip side, men with positive PSA test results that are likely to have only the most slow-growing type of cancer, or even false positive test results, can be subjected to repeated tests and biopsies that cause more harm than good. In cases involving slow-growth cancer, some patients undergo radiation or surgery with its inherent risk factors, including emotional trauma.
Some of the side effects of cancer treatments can include:
- Erectile dysfunction and loss of sex drive
- Problems with urination
- Problems with digestion and intestinal tract
- Swelling of the penis, scrotum or prostate
- Nausea, vomiting and loss of appetite Fatigue, infection and hair loss
The American Board of Internal Medicine (as of March, 2014) is now looking at ways to reduce overdiagnosis and overtreatment in a number of categories, including prostate cancer, in an effort to reduce healthcare costs and potentially harmful medical care.
6. I’ve already been diagnosed with prostate cancer. How do I know if mine is slow-growing or potentially lethal and what is the right treatment for me?
It seems that there are more men have been diagnosed with prostate cancer than there is dying from it. The diagnosis spike occurred when PSA tests were introduced; so, there are numerous questions about why we need to be testing for it so frequently while it is a low-risk type of cancer that is not really life-threatening.
In slow-growing cancers, some healthcare providers opt to take a wait-and-see approach, a strategy called “active surveillance.” In aggressive cancers, treatment may include medications, chemotherapy, radiation and surgery, among other treatment options.
According to the National Cancer Institute, what type of prostate cancer you have depends upon the score that categorizes the type of cancer found. A Gleason score is comprised of two Gleason grades (best and worst), with Grade 1 the lowest score and Grade 5 the most dangerous. The National Cancer Institute says “low-risk” is a Gleason score of six or less, a PSA result less than 10 and a tumor that is small in size and localized.
Still, those numbers may be of little comfort if you’re the patient who just got diagnosed. Both physicians and patients report an inherent pressure to do something rather than nothing. Varying treatments depend upon the hospital/clinic, the physician and the patient, rather than the actual risk. What should be done is to talk to your healthcare provider; and, if you fall within the “low-risk” range of slow-growing prostate cancer, ask about “active surveillance.” Sometimes, you just need to wait patiently.
7. Does an enlarged prostate mean I’ll develop cancer?
No, but an enlarged prostate is a very common problem. About 17 million men suffer from what is medically referred to as benign prostatic hyperplasia (BPH), but frequently called “enlarged prostate.” The American Urological Association says the disorder is so commonplace that it’s likely to affect 50 percent of all men by the time they reach the age of 60, and 90 percent by the age of 85. As the prostate enlarges, it puts pressure on the urethra, affecting urinary flow. The sources for this age-related disorder are not well known.
For those worried about prostate cancer, signs and symptoms can include:
- Difficulty passing urine
- Frequent need to urinate, especially at night
- Weak urine stream
- Painful urination
- Blood in the urine or semen
- Painful ejaculation
- Low back pain, or pain in the pelvis or hips
- Age remains the most important risk for prostate cancer, plus a family history, heritage (African-Americans are at higher risk) and diets high in fat.
8. Should I take supplements to decrease my risk for prostate cancer?
A new study by the Journal of the American Medical Association found that patients who took soy supplements after having their prostate cancer removed were just as likely to have the cancer return as those who didn’t take the supplements. Another study showed a link between fish oil supplements and an increased risk of prostate cancer. However, the American Cancer Society maintains that soy foods and omega-3-rich foods (salmon and other fish) are still a better alternative to a diet high in red meats. Bottom line: talk to your healthcare provider about whether you need supplements and what might work best for you.
With all the advances and epidemiological studies surrounding prostate health, one has to be very careful as to stay healthy and understand what all the researches findings mean. While prostate cancer can be a slow progressing type for some, it could be an aggressive one for others. So, getting tested for PSA and undergoing a DRE routinely can be very beneficial. Despite the controversies surrounding the risk of getting tested, the true risk remains in the way a primary care giver and patient decide to act upon the results rather than the results themselves. For many, active surveillance is the best adopted method to make sure the progress of the cancer is slow.
Getting tested will give you an accurate slope for whether you are or might be at risk of this type of cancer. So, despite what anyone advises, going this route is the best way for you to stay on the safe side.
While some are relieved that they are following a let’s watch and see as an approach for the prostate cancer, others may be very stressed during all this prolonged period. If you are among this group, Harvard Medical University advises them to adopt mindful meditation. By adopting a wellness approach and a healthier dietary lifestyle, you are reducing your anxiety and reducing the livelihood of undergoing aggressive treatment that you do not really need.
Harvard Health Publishing- Harvard Medical School. Prostate Health & Disease. (2016). Retrieved from: https://www.health.harvard.edu/topics/prostate-health-and-disease
Harvard Health Publishing- Harvard Medical School. Prostate Cancer. (2016). Retrieved from https://www.health.harvard.edu/topics/prostate-cancer/
Harvard Health Publishing- Harvard Medical School. Meditation may ease anxiety from active surveillance. (2016). Retrieved from https://www.health.harvard.edu/mens-health/meditation-may-ease-anxiety-from-active-surveillance
Harvard Health Publishing- Harvard Medical School. Test may diagnose prostate cancer more accurately. (2016). Retrieved from https://www.health.harvard.edu/mens-health/test-may-diagnose-prostate-cancer-more-accurately
Harvard Health Publishing- Harvard Medical School. Ask the doctor: Concern about a now "normal" PSA. (2016). Retrieved from https://www.health.harvard.edu/cancer/ask-the-doctor-concern-about-a-now-normal-psa