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Testing For Prostate Cancer — Everything You Need to Know

August 30, 2021

Testing For Prostate Cancer — Everything You Need to Know

Testing for prostate cancer may involve several tests but does not need to be a confusing topic. Clinicians have mixed opinions on who they should test for prostate cancer due to limitation in test accuracy. Men who understand the risks and benefits can start the testing process.

While there is no way to test for prostate cancer yourself, getting tested is simple, and you can get started at home. Maxwell Plus has written this comprehensive guide to help you understand if and when you should get tested and what is involved if you choose to do so.

New tests and technologies are becoming readily available. The gold standard continues to evolve. The outlines here are up to date today, and we will endeavour to keep them updated with the latest information.

In this article we answers the following questions:

1. Who should get tested for prostate cancer?

2.What is the difference between clinically significant and insignificant prostate cancer?

3.What tests are available for prostate cancer?

4. What are the risks of prostate cancer testing?

5. What new testing is available for prostate cancer?

One key thing to remember is that testing for prostate cancer requires medical input and is unique to you as an individual. As such, any information here is general and shouldn’t be seen as personalised medical advice.

1. Who should get tested for prostate cancer?

The first step is to determine if testing makes sense for you. Current clinical guidelines state that if a man is informed and seeking testing, it should be made available. Reading a guide like this one or talking to a clinician is the best path to developing a clear understanding of the risks and benefits of testing and making an informed choice.

You may be asking if some signs or symptoms trigger the need for testing. While there are symptoms associated with prostate cancer, men should not wait for them for two reasons. One, these symptoms often only occur in men with late-stage prostate cancer. By then, the window of early intervention is narrow. Secondly, many non-life-threatening conditions share the symptoms typical of men with prostate cancer.

Most studies have concluded that men should start testing for prostate cancer at one of two ages. Men with a family history should consider testing when they turn 40. Other men should consider testing when they turn 50. Clinicians have chosen these ages based on large amounts of data on when men are diagnosed with prostate cancer. Prostate cancer is very rare in men under 40, so typically testing is not advised in men in this age group. If you are under 40 and are concerned about prostate cancer, your best course of action is discussing with a clinician such as Maxwell Plus’ expert clinicians.

When discussing family history, it is crucial to consider both men and women. Men with prostate cancer in their direct family have a significantly increased risk of developing prostate cancer. They also have a higher chance of it developing earlier and being more aggressive. This combination of risks means that men with a known family history should make an effort to get tested. Suppose there is a family history of Breast or Cervical cancer in your family. In that case, you may also be at an increased risk. While not as severe as a history of prostate cancer, it can still increase your odds. If you would like to learn more our Prostate Cancer Family History Ultimate Guide goes into great detail.

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2. What is the difference between Clinically Significant and Insignificant Prostate Cancer?

Not all forms of prostate cancer pose equal risk. The risk of any detected prostate cancer can depend on many factors, including the tumour’s size if it has spread beyond the prostate and the aggressiveness. Prostate cancers have several different grading systems. Determining the grade of a tumour is a complex process involving a specialist.

You may have heard the terms’ clinically insignificant cancer when reading about prostate cancer in the past. We use this term to describe cancers that pose a low risk to men, most commonly because these clinically insignificant cancers can be very slow-growing. Depending on a man’s age, these are unlikely to be a threat to life during the man’s expected remaining lifespan. The presence of slow-growing cancer is part of why the phrase “Many more men die with prostate cancer than from prostate cancer.”

The diagnostic process today is focused on finding clinically significant disease. These are the cancers that are fast-growing or otherwise dangerous and will benefit from treatment. Much of the discussion around discouraging testing in men without first educating them is to avoid clinically insignificant cancer treatment. Doing so aims to prevent risks from treatment in men who are not at risk. Researchers are developing new techniques and technologies like MRI and AI analysis to help clinicians differentiate between significant and insignificant cancer. These new technologies will allow doctors to prevent deaths while avoiding treating men unnecessarily.

3. What are the tests available for prostate cancer?

Blood tests for prostate cancer

Many men are familiar with the Prostate Specific Antigen (PSA) test as a blood test for prostate cancer. GPs regularly order this readily available test. The PSA test measures the level of an antigen in the blood. Men with prostate cancer tend to have a higher PSA. There are, however, complexities in analysing PSA results.

Many factors other than prostate cancer can influence your PSA levels. The size of your prostate, recent vigorous exercise, and benign conditions like urinary infections can all cause the PSA to rise. Some medications can also cause the PSA to decrease. While this may sound positive, this decrease in PSA can be artificial and mask prostate cancer signs. Due to the PSA test’s vast variability, it is often insufficient and inaccurate when assessed independently.

In the past, a high PSA could lead men to unnecessary biopsies without consideration of other factors as they were typically the next step. This criticism is what clinicians mean when they say that the PSA has a poor specificity or a high false-positive rate. Today with the introduction of tests like MRI and updates to clinical practice, this is less of an issue.

More advanced blood tests are available to help determine if a high PSA is due to prostate cancer or something more benign. These tests include the PSA with Free-to-Total Ratio, the Prostate Health Index (PHI), the 4kScore, PCA3 urine test and many others. Suppose these tests are analysed comprehensively alongside how the numbers are changing year on year. In that case, clinicians can develop a more accurate picture of prostate cancer risk.

New analysis risk calculators and tools, including Prostate Specific Artificial Intelligence (PSAI), is used by some doctors to perform this comprehensive analysis. Follow up testing with a second PSA is also a common practice. Clinicians order this test 1-3 months after the first to help rule out short spikes in the PSA caused by an infection or other acute conditions.

What is a Normal PSA Result?

You may have already had one or more PSA tests as part of annual checkups with your GP. Many men ask the question, “what is a normal PSA?” or “What should my PSA be?”. International guidelines vary when a PSA should be considered high risk, with typical values being between 2.5μg/L and 4.0 μg/L. Many studies show that prostate can occur at many different PSA levels. While the risk of prostate cancer certainly increases as PSA increases, no single cut-off would correctly apply to all men. Many other factors need to be considered, such as age, family history, and how PSA has changed over time.

To illustrate this, take a look at the image below. Based on an analysis of 45,000 men from two major studies, this table shows the likelihood to be diagnosed with prostate cancer for many different PSA and age combinations. Due to the data in this study, this shows the results for any prostate cancer and would include men who are diagnosed with clinically insignificant disease. Nonetheless, it offers a wide variability. This table also looks different if we look at men with a family history compared to those with none. Nuances like these are why analysis must consider many factors and why decisions to biopsy are now less often made based on a single PSA result. You can read more about what is normal PSA result by reading our full article.

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MRI and other Medical Imaging for Prostate Cancer

For most men, the next step after being referred to a specialist is a multi-parametric MRI scan (mpMRI). MRI is a widely used imaging technique that uses magnetic fields rather than radiation to produce an image. Studies show mpMRI helps find more clinically significant disease whilst reducing biopsies in men who don’t need them. Interpretation of an MRI is a complex process performed by a radiologist. A urologist assessing a man for prostate cancer will look at the radiology report, other clinical factors and perhaps the MRI images themselves when deciding whether to biopsy. Many decision support tools, risk calculators, and clinical guidelines help to complete this complex clinical process.

Other forms of medical imaging, including ultrasound, CT and PET scans, are common during the diagnostic process. If and when you may need one of these scans is a urologist’s decision and will depend on the specifics of your diagnostic process.

4. What are the risk of prostate cancer testing?

Clinicians and patients must weigh associated risks against any medical process’s benefits. In the space of prostate cancer testing, hazards include the risks associated with procedures, the risk of unnecessary testing, the risk of a delayed diagnosis and potential stress and anxiety during the testing process. You should carefully consider these risks when choosing to begin testing.

The risks of unnecessary testing are that men undergo invasive procedures unnecessarily. Often a procedure such as a biopsy will be necessary to get a final confirmation on the presence or absence of prostate cancer. Ensuring that the number of biopsies completed is close to the number of cancers found is an essential clinical metric. This metric is called “positive biopsy rate” and shows the percentage of biopsies done that come back positive.

Counter to the risk of over-testing, there is some risk associated with a delayed diagnosis. The survival rate of prostate cancer is above 95% when diagnosed in stage 1 or stage 2. Survival falls to around 25% when caught beyond stage 2. Not getting tested or improper follow up of abnormal results can lead to a delayed diagnosis. Men with aggressive disease may miss their window for some treatment options if delayed. This window is especially relevant to men with a positive family history. They are more likely to be diagnosed with an aggressive form of prostate cancer.

Many diagnostic processes can be a source of stress and worry. Testing can be particularly stressful due to the number of tests needed to receive a definitive answer. Any man undergoing testing must have the appropriate support. This support includes both enough information and communication with the doctor to understand the situation and ask questions along the way. Some men may seek further support through specialist services to help them in their time of need.

You should consider all of these risks when deciding to start testing for prostate cancer. Ultimately the choice is your decision which makes it essential to stay informed. As medicine is a constantly evolving field, it pays to stay up to date and work with a clinician who understands the latest clinical practice. If you would like to speak to one of our expert clinicians, you can fill out our contact form.

5. What new testing is available for prostate cancer tests?

New research and technology have led to further tests that help in the prostate cancer testing process. We’ll look at several tests that are becoming more popular and what they mean for men considering testing. Researchers are developing many new tests that may one day be available to men. Not all of these tests will be available everywhere, and some may not be in clinical use today.

New and future blood and urine tests

New research and technology have led to further tests that help in the prostate cancer testing process. We’ll look at several tests that are becoming more popular and what they mean for men considering testing. Researchers are developing many new tests that may one day be available to men. Not all of these tests will be available everywhere, and some may not be in clinical use today.

The first category of tests is new blood and urine markers. These measure markers in the blood or urine, which may indicate the presence of prostate cancer. Tests like the PHI and 4K Score are becoming more common and used to differentiate between prostate cancer and other benign diseases in men with an elevated PSA. Similarly, the PCA 3 test is a urine-based test that can help alongside PSA and other methods to determine the likelihood of cancer. Clinicians use these tests in combination with standard PSA testing. As they are typically more expensive, they are often only used in men in a high-risk category based on their PSA level.

Genetic testing

Another category of testing is genetic testing. Genetic testing can fall into two subcategories of prostate-specific DNA testing and circulating tumour cells. DNA testing looks for specific mutations in your DNA known to increase the chance of having prostate cancer. Because these are DNA changes, they have been with you since birth and do not directly indicate if you have cancer today. On the other hand, Circulating Tumour Cell (CTC) tests look for small DNA fragments circulating in the blood. These cells are present when a man has a tumour and can be an indicator of prostate cancer. Men will still need additional tests like MRI to determine where the tumour is within the prostate. Still, these tests promise to provide accurate early detection. CTC tests are currently early in their development and are not readily and affordably available yet.

Prostate-Specific Artificial Intelligence (PSAI™)

Beyond new markers and tests, there have been significant advances in analysis tools. These tools look at all the data available and, based on a database of men who have undergone testing previously and have a known outcome, can estimate prostate cancer risk. They can also find suspicious data such as areas in an MRI that may be indicative of cancer. Maxwell Plus’s Prostate-Specific Artificial Intelligence (PSAI™) falls into this category and helps doctors at Maxwell Plus every day.

Maxwell Plus’s Prostate-Specific Artificial Intelligence (PSAI™) is a collection of tools designed for Maxwell Plus doctors to assist in analysing data. These algorithms use AI to combine blood tests, medical images and factors like age and family history into a total risk score. This score helps the doctors make decisions at numerous points in the diagnostic process and has helped lead to many high-grade cancers without over-treating men.

We developed these algorithms based on data from over 250,000 men from studies and clinics across the world. This data was assessed for quality and used to train and evaluate each algorithm. Data includes both research data and clinical data to ensure that the AI performs just as well when exposed to real-world clinical data variability. Maxwell Plus’s doctors work with men and their regular GP as an additional service focused solely on prostate cancer testing. Getting started is quick and easy, with no GP referral required.

Summary — Prostate cancer testing

There are three important things to remember about prostate cancer testing.

  1. Determine if testing makes sense for you. You can do this via our risk assessment.
  2. Learn about the different types of testing available to you. Discuss these options with your GPs or with a Maxwell Plus clinician
  3. Consider the risks of prostate cancer testing. No test is perfect so it is important that you understand that risk exists and ensure your clinician is doing everything to minimise that risk for you.

If you have any questions about your health situation or require a doctor to talk to, please let us know by filling out the form below. We will be happy to help.