The Prostate Specific Antigen (PSA) Test
ฝัง
- เผยแพร่เมื่อ 5 ก.ค. 2024
- For a deeper dive on PSA screening, click • Deeper Dive on PSA Scr... for a short Dr. Mike video excerpt
Fact sheet and infographic www.cancer.gov/cancertopics/fa...
US Preventive Services Task Force www.uspreventiveservicestaskfo...
Handout www.cancer.org/acs/groups/cont...
A more in depth handout www.bccancer.bc.ca/PPI/Typesof...
Helpful video exploring nuances www.cancer.org/healthy/informa...
Dr. Mike Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael's Hospital.
Check out our new website www.evanshealthlab.com/
Follow Dr. Mike for new videos! / docmikeevans
Written and Narrated by Dr. Mike Evans
Executive Producer, Dr. Mike Evans
Illustrations by Liisa Sorsa
Produced, Directed, and Photographed by Nick De Pencier
Editor, David Schmidt
Story/Graphic Facilitator, Disa Kauk
Production Assistant, Chris Niesing
Director of Operations, Mike Heinrich
©2014 Michael Evans and Reframe Health Films Inc.
Hi Dr. Mike, I'm studying to become a medical interpreter and I often have to watch various medical videos in order to get a better understanding of the human anatomy, various diseases, treatments, etc. I so appreciated this PSA Testing video. It was creative and fun to watch. So, thank you, I'll be watching more of your videos.
Dr. Mike - your videos have become a standard patient education resource in my practice in Michigan. Thank you!!
Great to hear. thanks a lot.
Excellent educational video. Every man with question about prostate cancer should watch it.
Thank you sooo much for taking the time to provide this information.
Hi Mike, This is a great video. Thank you for taking the time to do it. Your summary of the evidence is fair and comprehensive.\I will recommend it to my patients
I feel it's best to follow up a psa with a MRI or CT scan to see those anomalies.
I feel that a scan of the groin area could view a multitude of areas in one go
Thank you Dr. Mike!!! It looks like you made this video for me. I am 78 Y.O. and my PSA is 215!!! and I am in a panic state. In 2003 I had a indigo laser (waste of money) same year a TURP 10 grams (negative for cancer) in 2008 another TURP 53 grams negative for cancer. I'm afraid of all the treatments most of all biopsies with needle and radiation. Again thank you for your honesty. All I ever ask of a doctor is be honest no more.
I am 68 years living in India.I had UTI.after taking medicines as per Doctors advice that was ok.but my PSA level is 9.71.doctors given me antibiotics and urimax tabs.I am continuing.But I am worried for PSA level which is at present 9.71 I do not fell any sorts of problems except constipation,weakness of lower part of leg.I am sound health at.70+kg height 5ft.9 inches.Itake Ativan tan 3 mg in night.what should I do.high level of PSA 9.71 is alarming towards cancer.pl help.
So, this discussion and the comments amaze me. I am a 70 year old man who has been battling Advanced Metastatic Prostate Cancer since June of 2009. I had never heard of the PSA test and at age 59 my general practitioner chose to do a PSA test as part of my physical. In my case it turned out that I had a very aggressive form of PC with a PSA of 75. Of course then came scans and biopsies where a Gleason score of 9 was found. The cancer had escaped the Prostate gland and spread to distant lymph nodes also confirmed by biopsy. I understand where this is video and discussion is coming form but I and my whole family thank God I did not see this video before my diagnosis and prevented my doctor from doing the test. The real issue here is not "should we be doing the test" but what do we do with the information once we get the results. Don't blame the PSA test for the foolishness of people (including both doctors and patients) and their reactions to the results. Note: In all my years this is the first time I have ever commented on TH-cam but I thought
What kind of treatment have you been doing to treat your prostate cancer?
Thank you for your comments. What kind of treatment are you having since 2009? Thank you in advance.x
Will probably get my PSA test soon. Wonderfully explained Dr. Mike, thanks..
I learned a lot, thank you Doc!
thank you DocMikeEvans. I appreciate this education.
Brilliant informative video!
THIS WAS A WONDERFUL PRESENTATION WOW MY GRANDFATHER DIED OF PROSTATE CANCER MY FATHER DIED FROM IT AND MY UNCLE ALL THE MEN SAME FAMILY MY BROTHER WHO IS 54 WENT TO CANADA AND HE'S OK NOW BUT HE HAS 3 SONS 17,15 AND 12 THEY ALL ARE WORRIED ABOUT THIS IM GOING TO SEND THEM THIS VIDEO IT WAS GREAT THANK YOU.
Been going to a urologist for over 10 years because my PSA is high.Have had biopsies and scans and all have negative. PSA has been in the upper teens for over 7 years.
Very good’ informative video.
I’m a 75 year old male so it’s highly relevant and quite comforting.
Although I’m fortunate to have access to specialists at a very reputable medical center(NYU) and am well pleased with the care I’ve received, well-done videos like yours are invaluable fir those of us who want to make informed decisions.
Thank you( I subscribed).
This is very helpful, has more recent research moved the debate on?
Thank Dr Mike very helpful . any thoughts now in 2020 about to test /find the aggressive variant of cancer you described .?
Dr. Mike, How does mpMRI change the scenario?
Thank you so much!
Good video-I try to have an educated discussion re. pros/cons of this test at a patient's medical since the evidence isn't nearly as compelling as for screens such as mammograms for breast cancer-tough to be the rare bird with the aggressive type of prostate cancer...
Thanks for this. Especially pointing out that many men live fine with prostate cancer without them even knowing they had it. Is psa the same or better than a prostate exam?
I am looking at the connection between adrenaline and PSA. I was doing too much speed work and my PSA went up a bit from the previous year.
So after much research and debate i have decided to flip a coin
What a fantastic and well explained video 👌
Excellent
Age 77. PSA of 26 ish, rectal biopsy showed low cancer present. Recommend radiation but not hormone treatment as described as horrific! But next visit they recommended the hormone treatment to bring down the PSA prior to radiation... due for an MRI soon. CT scan came back as ok. I do not really want to go down the hormone treatment track. Your thoughts please. Or any feedback/ advice.
Thanks for your video... I think I must be 1 of the 1000. PSA 48 at 50. After the swelling was gone I know I had my cancer for years. I mentioned to my oncologist that I thought people should get a test at 40, 35 if there is a family history. He mentioned I was not the norm and I was looking at it linearly. A few months after I was diagnosed a friend who had tested yearly had his levels jump into the teens. I guess he got the bird eh, he is in his 60s. Recently USPSTF released to only test in 55-69 without symptoms. Because I didn't have symptoms, and I guess because I'm 1 in a thousand, that infuriated me I would have been put off another 5 years. My oncologist seemed to think about my a statement I made that if someone tests at 40 and has a normal level then they get a base line that I never got. I don't know the right answer and I feel lucky to be one in a thousand. I believe the 45 radiation treatments and 6 chemo that I got has extended my life and with at least 2 enlarge lymph nodes I think I was on track to die from the cancer. I still recommend people get tested, but only if they know raised levels are not always cancer... and I hope they are one of 999 that get a good base line that I never got.
I'm another one in a thousand but did not get screened. So, with symptoms, I finally went to urology (at 50) after the family doc couldn't think of any reasons for symptoms (and the ibuprofen wasn't helping me pee). My PSA was well into the three figures. I'd have preferred early screening to catch that bird before it flew everywhere.
Im 49 but my PSA has climbed from when it was 13 in 6 months its now close to 25....at that rate it if left untreated it could be 50 plus in a year....Haven't had the biopsy, praying its something else....
@@terrellwilliams5829 might look at getting an MRI. Also if you can you might skip right to an Axumin or PSMA scan. Good luck!
I work in a doctor's office where I help with the gaps in care for testing and such among patients. Being relatively young and still in school I have heard there is much debate on the PSA screening test, and have noticed that of the many tests the PSA tests is one many men decline time after time. I have never really paid much attention or thought twice about why though beyond them just not wanting to. This video was awesome, and I feel like it gave me a much better understanding about the test itself and the results it may show. I LOVED the farm analogy. When I hear cancer I naturally think of awful outcomes and it being extremely dangerous. This video showed light on how although a male's PSA test may indicate cancer, they may not have ever known or had symptoms of it before, and the treatment and ways to go about the cancer may not be worth it. Although the test may be deceiving, if I were a male I still think I would like to have the test even if it indicated cancer and it was not aggressive or dangerous at least I would know and could take care of it because the chance of it being cancer would drive me crazy like this video says.
I guess the issue is that the doctors are not advanced enough to know whether the cancer is a turtle or a bird, the test just indicates that it is there... so unless the doctor actually cares to monitor you, they may take the easy route and treat it as a bird instead of the turtle (it's probably cheaper for them to treat them for cancer than to monitor them over a long period).
Very good. It was picked up by my Dr Oake when I was about 75 who told me it was slow and that something else would most likely kill me. He took a PSA about once a year and it has been higher each time and now about 20 and my age 93. I think I have TURTLE level cancer as Dr told me he may die before me and he seems to quit taking PSA. That was great article and my Dr very smart and honest
Because of the blood PSA test I ended up with advanced prostate cancer. My GP ignored all the symptoms because my psa levels were normal. I found out from my oncologist that 15% of men are non secreters so the blood test was useless so if you end up in the same position as me seek a second opinion.
One additional problem with the PSA is that Life Insurance Companies test you for it--and don't tell you. In essence, they take the choice of having one or not away from you. To make matters worse, they don't tell you some of the things that might make a temporary rise in the PSA possible--like sex within 24-48 hours, riding a bicycle or motorcycle within 7 days, etc. That being said, I wish somebody would sue the pants off of these giant corporations to make them more accountable. But here in the U.S.A. they control the politicians who are only too happy to pocket the money given to them for their next campaigns. This is further complicated by the fact that too many urologists make money from biopsies and the false positives add to their coffers as well. So they like the PSA and don't want anybody to change it. Somebody like the New York Times or MSNBC really needs to expose these frauds.
When it comes to frauds of this nature involving politicians and industry the NYT and MSNBC are the least likely to expose them!
They should tell you about what might make your PSA rise, I don't think they care. 9 years ago I was sent to a urologist, he was going to do the test but wanted to load me up with Cipro. an antibiotic. I had a bad reaction to the antibiotic, the side effects are, nerve damage, ligament and tendon damage or ruptures. I spent years getting over the problems and still never recovered completely. I never got the test but 9 years later I have no symptoms. They push these test and give you very strong antibiotics, and put you at risk. They need to do these test to stay in business.
My PSA - 0.7 ug/L,
It’s sounds helpful
Question. Does an infection affect the psa result?
My Doc recommended watching this video. Glad I did! Very clearly explained. Now I just hope if I get Cancer, I get the "turtle" version! Russ: age 71
What did you use to do this presentation?
Makes a lot of sense. Does not explain the enlarged prostate having BPH. Did it effective my PSA? Have Kaiser too.
Oh no. I just got the test done yesterday.
Brilliant video. Many thanks.
@Welly JRTE Many thanks
I am 83 years old.
It is very difficult to doubt a test, but I truly think that is causing more harm than good.
Your point is that 80& of men my age have turtle cancer.
You can shoot your prostrate full of holes, and find nothing.
Then you get endless prostrate problems.
Then you find that it really was not necessary.
Always a difficult choice.
Thanks for your review!
I wish the VA hospital would have recommended this video to me.
I spent 45 days getting radiation therapy that I probably didn't need.
It seems to me that a rationale approach is to get a baseline PSA at an appropriate age based on your age and other risk factors. Then test again at what seems, based on discussion with your doctor, appropriate intervals so PSA increase, if any, can be monitored. If an elevated PSA at a concerning rate appears, then maybe consider the PHI test as a way to screen for aggressiveness (I think it's reasonable to assume that even better tests will come along eventually).
If a biopsy seems warranted, I'd stop and find someplace where I can get a 3T mpMRI and, if that indicates a biopsy is in order, have an mpMRI guided biopsy. Doctors, particularly urologists, need to encourage this less invasive approach rather than just pushing for a biopsy. If the (hopefully mpMRI guided) biopsy shows a low risk cancer, open and frank discussions of AS/WW need to be held.
Sticking our heads in the sand, primarily because statistics (slippery little devils that they are) say testing is useless, can put you in my situation in August 2013 (66 years old) -- a 25.6 PSA, high-risk, Gleason 8 cancer in 11/12 biopsy samples in a 58cc gland, with a DRE report of hard and nodular. I had only minimal symptoms that I attributed to "getting older." In my case, the mpMRI route wouldn't have changed anything, but nobody could know that at the outset. I sincerely wish I had had regular PSA tests so that, maybe, this could have been caught earlier (maybe at Gleason 7 in far fewer samples).
I've since had an HDR brachytherapy followed by 5 weeks of EBRT after 9 months of ADT (pushing my PSA down to 0.17 and shrinking my prostate to less than 30cc). I get my first post-RT PSA test done next week. Hoping for an undetectable PSA.
The problem is not too much testing. The problem is what urologists insist on pushing men into whenever a high PSA shows up.
Now are you fine
Hi Dr My PSA level is increasing in 3 months 4.58= 10:45 what’s your advice please.? I am waiting for MRI and what is advance advice please..? What should I do? I am having herbal medicine too
Just read your comment. My husband just had a test and the doctor said if you’d done sports the test, the test result might show higher count. So he’s not doing any this week and will do another one soon.
How are you now?
If you have a 4.0, I wouldn’t be concerned. Mine was 74. I had Gleason 10 stage 4 cancer.
Now are you fine
@@tubaeren4008 are you fine?
My thoughts on PSA screening. The only accurate identification of prostate cancer seems to be based on an mri of the prostate where the cancer is visualized. In a way the PSA Test is a waste of resources. I had an elevated PSA of 5.0. Then the dreaded 12 sample biopsy. The Gleason score is important because it identifies and grades the cancer cells. My score was 3+3 based on 5% of one sample with grade 3 and 0 in the others. After having a PSA every 6 months it was determined I needed a 24 sample biopsy!!!. Yes, I was sedated for that procedure. 0 cancer in all samples. The urologist is still having PSA every six months and wants to do an fusion mri guided biopsy. My PSA is now 3.5 and I am over seventy. Does this sound like over treatment? The name of the medical system in my city is being withheld to protect the guilty.
One thing I found remarkable when I did a PSA test is there are other factors that can dramatically increase your PSA. These are a broad spectrum of events from riding a bike or sexual activities that stimulate the prostate or even having intercourse! My doctor didn't notify me of these and went ahead with the test. You should abstain from any event that could give you a high PSA score! Think about that - you could end up agreeing and undergoing a biopsy (which has some serious risks, run the risk of the machine not being calibrated), or someone made some mistake in the procedure (which does happen) all because you rode a bike the day before your test!
I would suggest that, if your PSA has increased and you're under pressure to see your urologist, the first thing you should do is ask to take the test again.
You should be aware that the PSA test itself does NOT detect cancer in any way. People can have cancer with a PSA score of less than 4 who pass the test. People can also have no cancer who are above 4. Also, the amount of false positive results is very very high for this test - around 80%. IMO this is a very very poor test, but its up to everyone to make up their own minds.
I agree with you Cal..... Some sources say that too little is known about the value of PSA testing and when my tests showed a high result I could never get an answer to one question... How did playing football without a cup affect my prostate? I'm 90 now and still no answer....
@@paulg687 We need a better test as Otis Brawley, M.D. Oncologist told an interviewer on TH-cam.
But the AUA (Urology big shots) are not interested because the PSA is used because it is a profit driven tool. Until then............ We suffer and do they care?
Does anyone still doubt natural herbs? I have seen the great importance of natural herbs and the wonderful work they have done in people's lives. I wonder why people still spend their money on surgeries, injections, and medications every time they get sick. Natural herbs can cure all kinds of diseases, including, prostatitis, herpes, diabetics, asthma, cancer, hepatitis, etc. I have seen it with my own eyes. I was cured of irritable bowel syndrome and my sister and her husband were cured of herpes by Hopkins who uses natural herbs to cure different types of illnesses. Even Hopkins proved to the whole world that natural herbs can cure all diseases and he healed countless people using natural herbs. I know it's hard to believe, but I am a living testimony. There is nothing wrong with trying herbs. Contact Dr. (email). dr.hopkinsherbalcure00@gmail.com Come and thank me later ✌️✌️
..
Thank you for you’re comments. Without treatment how did your PSA levels go down?x
guys if you cant pee quecertin bromelian 500mg natural
onions high in quecertin
really work
5years ago I had 30 prostate biopsy and was told no cancer was found now they tell me I have got prostate cancer if I refuse the treatment will I die I feel really fit and energetic I'm 79 years and don't want to be unfit with treatment help me please
Eat well .. enjoy as much time as you can .. look at each healthy day as a gift .. stop the stress .. it will kill you faster than anything else ..
im 34 years old and have a psa of 3.6, waiting for a mri scan and a biopsy to be taken, very very worried
I was 36 and my doctor gave the test without my knowledge. Came back 3.3 - I never agreed to anything further once iknew what was going on. Im now 41 and fine hope your ok
A PSA of 3.6 is probably nothing to be worried about. Hope everything turned out well for you!
Dean, what did you find out, at 50 I learned my PSA was 48 I know the freaked out thing. I ended up doing 45 radiation and 6 chemo I'm now testing every three months and the last for were PSA tests undetectable. I think it save or at least extended my life. I know I had it for years and keep wondering what would have happened if I had a 3 year jump on this when I was at the doctors and he told me they do a blood test at 50. Maybe it still would have been in the prostate and I would have had better treatment options. I think it's important people know that only 25% of the time is it cancer.
@@RevolutionaryBrewer are you ok?? Pls share an update
@@MariamAhmed-sb8kz Hi im 46 now. Have not had another PSA test. It has been 10 years now. I feel fine, no urinary problems - enjoying life. Cheers!
What's an interesting fact about the PSA test, is why the value of PSA, that is the threshold for urologist recommendation, is 4. i.e. if you are above 4 your doctor will probably recommend you to have an appointment with a urologist. They 'arbitrarily' made this figure up. There's no scientific reason behind it, a mere wet finger in the air to detect which direction the wind is blowing. You can read this from the FDA transcripts when it was asked from the manufacturers of the PSA machine that required approval - it could have been 8 or whatever. Now, you can make up your own mind about that!
From what I've read.. with my Gleason of 9+ (at age 65) ... I am possible the 1 in 1000 who benefitted from the PSA leading to biopsy leading to ADT/radiation therapy (with side effects) but possibly preventing or delaying PC growth and therefore gaining more longevity. BUT what I did not know is that there might be 2 in 1000 who actually die from complications with the biopsy. I believe I was fortunate to have the PSA test but I recognize the conclusions of the studies that suggest overall PSAs are counterproductive. A tricky bit of math.
34 Urologists down voted this video. They had a Ferrari payment to make.
A good commentary.
What about testing for free PSA? Wouldn't that be more accurate?
I,m a 50 yr old male and have noticed I have even peeing more often. Was in really two minds about having a PSA test and the worry it would cause but after seeing this it really doesn't seem to warrant the hassle and worry.
Please, ignore this typical NHS advice and get tested ASAP! I wish my boyfriend had this test before…
@@giohope3475 m i have had three, all good
@@spleeeen4it Lucky you!
@@giohope3475 , they were all home test kits. I then saw a doc who told me i had the wrong symptoms for prostate cancer because i didn't have any problems starting or finishing urinating.
Unfortunately you barely mentioned what it means for a person with a strong family history of aggressive prostate cancer at a young age and the need for testing. This disease kills a lot of men including my father and his brother. Testing should be encouraged in this situation.
The generic term ‘family history of prostate cancer’ is nearly useless (as so many men thru age 80 have [diagnosed or otherwise, clinically significant or otherwise] prostate cancer).
Instead, some sort of more focused label, such as ‘family history of aggressive or deadly prostate cancer diagnosed before age 60” or something along those lines.
And those folks should do early testing and address elevated PSA, MRI and biopsy findings appropriately.
Just my non-medical two cents.
It’s been 5 years and why haven’t they come up with a new better accurate test that doesn’t include the bhp men who face unnecessary stress every time their PSA comes out high.
Why do you need to check it?
After convid 19 and PCR false + I won’t be doing PSA test. I’ve seen elsewhere that you won’t live any longer treatment or not 😊
It would appear from this analogy, that one should bypass the PSA testing and hope that any cancer would be picked up from a rectal exam. and that information is FYI
The American medical system won’t let you ignore a high PSA score.
Is psa a blood test
Yes, PSA is a blood test.
I will not thank Dr Mike for this information because it makes me mad at Doctors who at psa of 12 done biopsy which infected my prostate with cancer. I had no symptoms of cancer presence. Post prostatectomy my life is ruined
Do not do a biopsy insist upon an MRI prostate test instead as it’s much less invasive much more accurate and the only reason urologist wants to do a biopsy is because he makes a small fortune on each patient and makes nothing on the MRI. the MRI is much more accurate and non-invasive!
Fact
Why do urologists continue to aggressively recommend PSA testing and invasive biopsies?
Good question. Could it be Money?
@@mattiaswild1927 Because they understand the disease and risks at an on the street level. It's not the money. The PSA test is cheap. a latex glove used in DRE is even cheaper. I'd have preferred screening and lots of treatment choices rather than chemo, radiation and hormone manipulation because it ran wild.
@@peterste8652 the money is from the treatments not the detection!
@@mrofnocnon so you're saying the financial gambit is from not detecting and then having a much bigger opportunity for treatment? My health insurance company has spilled big money on me so far. And more to come. Early detection would have made it a fraction instead. So, I guess you are right!
@@peterste8652 PSA test is cheap and useless!!!
Easy answer: NO. Quite the opposite. The PSA causes far more harm (about 95% of the time) than good
This is a very old video 2014?? It should be deleted from you-tube as things are much different now. We have new tests like the 4K and a 3T MRI etc
what if a 45 yr old man has a level of 3.11?
@MasteR BlasteR Read: The Great Prostate Hoax by Richard J. Ablin, PhD the discoverer of the PSA in 1970. The PSA is all a scam.
Read: The Rise and Fall of the Prostate Cancer Scam by Anthony H. Horan, M.D.
You have to do your own research. The conventional Urologist don''t really care to listen to if there are better treatments or alternative cures.
@MasteR BlasteR He did not treat you freely - for nothing unless you are destitute and have that kind of health coverage as in California as in the homeless a number of them get free care over here. But the doctor GETS PAID. Not every prostate cancer patient has the same outcome as you. If you do not know that you are naive, lucky, but do not know what goes on out there at all.
@MasteR BlasteR Not homeless and not a commie and not a confused racist right winger like YOU. Long live California. We don't want Trump's over here. He loses in Nov. and goes to prison in 2021
The reading my husband got is: till 49 should be 2.1
50-59 years old 3.4
60-69 years old 4.9
So going by the above is high.
mon frère comment
The PSA test is a very inaccurate test and doesn't diagnose cancer. As of 2023, the false positive rate is 70% and the false negative rate is 20%. The better option would be an MRI scan for those that can tolerate it. Another good option that is 94% accurate is a PSE (Prostate Screening Episwitch) test. It involves a urine sample and could benefit those that want an accurate test but can't have an MRI.
Please, ignore this typical NHS advise, and get tested! Keep repeating PSA after 45!
The PSA test is not a marker for prostate cancer never was. Give us a better test. Stop being greedy and making all those billions of dollars with the help of the PSA test. You know what I am talking about AUA. Stop harming men. It does not save lives. It is a crap shoot for men, but generates big revenue for you guys with the following treatments.