Prostate Specific Antigen (PSA) testing

What is PSA?

PSA (Prostate Specific Antigen) is a substance produced by prostate cells and is commonly used as a marker in prostate cancer screening. Its measurement is not a specific test for prostate cancer, and an elevated PSA level does not necessarily mean the presence of cancer. Non-cancerous conditions, such as benign prostatic hypertrophy (BPH) or prostate inflammation, can also increase PSA levels.

Why have a PSA blood test?

PSA blood testing is one of the first steps in prostate cancer screening. A blood sample is taken (you don’t have to fast), and the PSA level is measured. Elevated levels may indicate a prostate abnormality, but this does not necessarily confirm the presence of cancer. It is all the more important to take the patient’s age into account when interpreting PSA results; levels tend to increase naturally with age. On the other hand, high PSA levels in a younger man may be more worrying than high levels in an older man.

blood capture man

Nurse doing procedure of a blood capture from a vein.

What to do with an elevated PSA?

  • If the PSA level is high (total PSA > 4), further investigations may be recommended to assess the situation more thoroughly. This may include a prostate biopsy using one of the following methods:
  • It is recommended to consult a urologist to interpret the results of the PSA and determine the appropriate diagnostic steps. They can consider various factors, such as medical history, symptoms, age and results of other tests to assess the individual situation.
  • If a urologist deems the need for further investigation following elevated PSA levels or other clinical indications, two commonly used approaches are prostate MRI and prostate biopsy under ultrasound.
  • Prostate MRI, or magnetic resonance imaging of the prostate, is an advanced imaging technique that enables detailed visualization of the prostate. It provides valuable information on the structure, size and location of any abnormalities, such as tumors or suspicious areas. This non-invasive technique can help guide diagnostic and treatment decisions.
  • Ultrasound-guided prostate biopsy, on the other hand, is an ultrasound-guided procedure that allows the physician to visualize the prostate in real time during the biopsy, increasing sampling precision and enabling suspect areas to be specifically targeted.
These additional diagnostic approaches, prostate MRI and prostate biopsy under ultrasound, are often recommended when abnormal results or elevated PSA levels persist, in order to establish an accurate diagnosis and determine the appropriate treatment.

My PSA is elevated. Which doctor will treat me?

A urologist. He's your specialist for urinary and male sexual problems. We therefore recommend that you consult a urologist so that you can be presented with all possible diagnostic tests, treatments and surgeries and make an informed decision.

What additional diagnostic tests might be required?

1) Prostate biopsy

When a prostate biopsy is recommended, there are different approaches to tissue sampling. Two common methods are transrectal biopsy and transperineal biopsy.

Transrectal prostate biopsy is a procedure in which prostate tissue samples are taken through the wall of the rectum using a special needle. Although this method is widely used, it has certain drawbacks. One of the main drawbacks is the risk of infection, as the rectal mucosa may contain bacteria that can contaminate the prostate during sample collection. In addition, this approach can cause discomfort and bleeding in some patients. It has not been performed at the Marois clinics since 2017.

In contrast, transperineal prostate biopsy offers some significant advantages. In this procedure, prostate tissue samples are taken through the skin of the perineum, the area between the scrotum and the anus. This approach considerably reduces the risk of infection, as the skin of the perineum is generally cleaner than the rectal mucosa. In addition, transperineal biopsy can enable better visualization of the prostate and greater precision when taking samples, as the needle can be guided more directly to the suspect areas.

2) Magnetic resonance imaging (MRI)

The use of magnetic resonance imaging (MRI) of the prostate offers an important additional advantage: the ability to perform targeted biopsies. This approach makes it possible to better target the suspicious areas identified during MRI, thus improving the precision of tissue sampling.

Targeted biopsy combines prostate MRI images with real-time ultrasound during the biopsy procedure. Physicians use MRI images to locate and specifically target suspect areas of the prostate during biopsy, using real-time visual information from ultrasound to guide the sampling needle.

Targeted biopsy with fusion, on the other hand, involves the fusion of prostate MRI images with real-time transrectal ultrasound images during biopsy. This approach enables images to be precisely superimposed, facilitating accurate localization and targeting of suspect areas. The use of image fusion improves biopsy accuracy, as physicians can visualize in real time the trajectory of the sampling needle in relation to the suspect areas identified on MRI.

These targeted biopsy techniques optimize tissue sampling, focusing on areas with abnormalities or suspicious findings on prostate MRI. This can increase diagnostic accuracy by specifically targeting areas of the prostate where a tumor may be present, while reducing the risk of random sampling.

Prostate MRI combined with cognitive targeted biopsy or targeted biopsy with fusion represents a significant advance in improving the accuracy of prostate cancer diagnosis, enabling more personalized and precise management for patients.

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