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Prostate-specific antigen (PSA)

The prostate gland makes a protein called prostate-specific antigen, or PSA. A healthy man without prostate tumor should have a small amount of PSA circulating in his blood.

Some conditions related to the prostate can cause the gland to produce more PSA than normal. These include prostatitis, benign prostatic hyperplasia (enlarged prostate), and prostate tumor.

Prostate-Specific Antigen (PSA) Blood Test

Prostate-specific antigen (PSA) is a substance produced by the prostate gland. Elevated PSA levels may indicate prostate tumor, a non-tumorous condition such as prostatitis, or an enlarged prostate.

Most men have PSA levels under four (ng/mL) and this has traditionally been used as the cutoff for concern about the risk of prostate tumor. Men with prostate tumor often have PSA levels higher than four, although it is a possibility at any PSA level. According to published reports, men who have a prostate gland that feels normal on examination and a PSA less than four have a 15% chance of having prostate tumor. Those with a PSA between four and 10 have a 25% chance of having prostate tumor and if the PSA is higher than 10, the risk increases and can be as high as 67%.

When Should I Have My PSA Levels Tested?

The American tumor Society says men should talk to their physicians about the benefits, risks, and limitations of prostate tumor screening before deciding whether to be tested. The group’s guidelines make it clear that prostate-specific antigen (PSA) blood testing should not occur unless this discussion happens. They recommend that most men at average risk for prostate tumor start the discussion at age 50 and those with higher risk for prostate tumor should start the discussion earlier.

The American Urological Association recommends that men ages 55 to 69 who are considering screening should talk with their physicians about the risks and benefits of testing and proceed based on their personal values and preferences. The group also adds:

  • PSA screening in men under age 40 is not recommended.

  • Routine screening in men between ages 40 and 54 at average risk is not recommended.

  • To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have decided on screening after a discussion with their physician. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over diagnosis and false positives.

  • Routine PSA screening is not recommended in men over age 70 or any man with less than a 10-15 year life expectancy.

What Does an Elevated PSA Level Mean?

Elevated PSA levels may indicate prostate tumor or a non-tumorous condition such as prostatitis or an enlarged prostate.

Your PSA level can also be affected by other factors:

Age. Your PSA will normally go up slowly as you age, even if you have no prostate problems.

  • Treatments. Some substances may affect blood PSA levels. Tell your health care provider if you are taking finasteride (Proscar or Propecia) or dutasteride (Avodart). These substances may falsely lower PSA levels typically by half of what it would normally be.

If your PSA level is high, your physician may recommend that you get a prostate biopsy to test for tumors.

Using the PSA Blood Test After Prostate Diagnosis

Although the PSA test is used mainly to screen for prostate tumor, it is valuable in other situations:

  • To guide treatment. Along with a physicians exam and tumor stage, the PSA test can help determine how advanced a prostate tumor is. This may affect treatment options.

  • To determine treatment success. After an operation or radiation, the PSA level can be monitored to help determine if treatment was successful. PSA levels normally fall to very low levels if the treatment removed or destroyed all of the tumor cells. A rising PSA level can mean that prostate tumor cells are present and your tumor has come back.

Staging prostate tumor

Staging of prostate tumor is used to communicate how advanced the disease is and to help plan treatment. Stages range from 1 to 4, with the disease being most advanced in stage 4. There are a number of factors that go into this labeling.

Prostate tumor, like many other tumors, is described based on the American Joint Committee staging system. This staging system is based on the size or extent of the tumor, the number of lymph nodes involved, and whether or not the tumor has spread or metastasized to distant sites or organs. Prognostic groups are further determined based on two additional factors: the PSA level and the Gleason score.

The role of PSA in staging

PSA levels are just one factor used in determining the stage and prognostic groups of prostate tumor.

Some men who have prostate tumor do not exhibit elevated PSA levels, and some non-tumorous conditions, like a prostate infection or benign enlargement, can cause high PSA levels.

Stage 1

Stage 1 prostate tumor is characterized by a Gleason score of less than 6: the tumor is restricted to one half of the prostate with no spreading to surrounding tissues and a PSA level below 10. The Gleason score compares tumor cells to normal cells. The more the cells differ from normal cells, the higher the score and the more aggressive the tumor. Like the PSA level, it is just one piece of the puzzle.

Stage 2a

In stage 2A prostate, the tumor is still restricted to one side of the prostate, but the Gleason score may be up to 7, and the PSA levels are greater than 10 but less than 20 ng/mL.

Stage 2B

By stage 2B, the tumor may have spread to the opposite side of the prostate gland, but it also may still be contained on one side. If the tumor is still restricted to one half of the prostate, a Gleason score of 8 or higher or a PSA level of 20 or greater categorizes the tumor as stage IIB. If the tumor has spread to both sides of the prostate then the stage is IIB regardless of the Gleason score and the PSA level.

Stages 3 and 4

By the time prostate tumor has reached stage 3 or stage 4, the tumor is very advanced. At this point, the stage is determined by the extent of the spread of the tumor, and the PSA level and Gleason score do not factor in the staging. In stage III the tumor has grown through the prostate capsule and may have invaded nearby tissue. By stage 4 the tumor is fixed or immovable and invades nearby structures beyond the seminal vesicles. It may also have spread to distant sites like lymph nodes or bones.

To determine the size and extent of the prostate tumor, physicians use imaging techniques like CT scans, MRIs, PET scans, and biopsies of prostate and other tissue.

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    (131) 057 - 0470

    15 MI
  • 200 Medical Plaza Driveway Suite 140,Los Angeles,CA

    Academic/Professional Titles Professor, Urology, Molecular Biology, Director of the Prostate Cancer Program Director of Urologic Research Co-Director of the Genitourinary Oncology Program in UCLA's Jonsson Cancer Center Bio Dr. Reiter is the Bing Professor of Urologic Oncology and Director of UCLA's prostate cancer program. He attended Stanford Medical School, completed his urologic training at Stanford and Baylor College of Medicine, and completed additional fellowship training in urological cancer at the National Cancer Institute. Dr. Reiter was awarded the Outstanding Achievement Award by the Urologic Oncology branch of the National Cancer Institute. His clinical and research interests include improving management of prostate cancer using functional MRI and molecular imaging of the disease, robotic prostatectomy, molecular biology of prostate cancer progression, and precision medicine and clinical trials for management of high-risk and metastatic prostate cancer. He specializes in robotically-assisted prostatectomy and cystectomy, as well as open surgery, with robotic experience dating back to 2004, for bladder, prostate, and renal malignancies. Dr. Reiter is involved in all aspects of urologic oncology, with an emphasis on prostate cancer, and brings extensive experience in robotic surgery and the applications of translational research and the latest in MRI and molecular imaging to the management of men with this disease. He is Principal Investigator on UCLA's Prostate Cancer SPORE, a 12 million dollar federal grant that is focused on translational research in prostate cancer. Patient Stories Robotic Surgery to remove Prostate Cancer

    (131) 079 - 4770

    12 MI
  • 2811 Wilshire Boulevard Suite 810,Santa Monica,CA

      About Dr. Mark J. Kelly Dr. Mark J. Kelly, MD, is widely considered as one of the pillars of strength in the Urology field in Los Angeles over the last 25 years. He is often called the Doctors Urologist. He is certified by the American Board of Urology, the longstanding Chief of Urology at Saint Johns Health Center, and an Assistant Professor of Urological Oncology at the John Wayne Cancer Institute in Santa Monica, California. Dr. Kellys operates a state-of-the-art private practice in Santa Monica where he offers truly personalized and cutting-edge care for his patients. Dr. Kelly is a leading pioneer in the management of prostate cancer with expertise in prostate cancer detection, risk assessment, and in the performance of highly precise MRI Image-Guided Fusion Biopsy which can precisely locate prostate cancer. In many cases, this precision can result in the ability to recommend either no immediate treatment or, if necessary, Focal Treatment for ones prostate cancer.   Focal Therapy has the potential to cure those prostate cancers that should be treated while minimizing the well-established side effects of invasive robotic surgery and radiation therapy including urinary incontinence, erectile dysfunction, and rectal injury. Dr. Kelly is one of the only doctors in Greater Los Angeles to offer the ICEfx™ cryoablation system, which allows him to treat tumors without surgery and without causing sexual or urinary side effects. In addition to diagnosing and treating prostate cancer, Dr. Kelly has expertise in a full range of mens health issues, including all diseases of the male reproductive and urinary system. He has extensive experience in treating erectile dysfunction, including prosthetic surgery, helping men manage andropause and low testosterone, and diagnosing and treating sexually transmitted diseases. Dr. Kelly attended the prestigious Albert Einstein College of Medicine in New York City. After graduating, Dr. Kelly moved to Los Angeles, where he completed residencies in general surgery and urology at Kaiser Foundation Hospital under the tutelage of the world-renowned Dr. Stanley Brosman, who supervised Dr. Kellys urology residency and subsequently invited him to begin his private practice at Saint Johns. While at Saint Johns, Dr. Kelly worked with Dr. Donald Morton, the founding surgeon of the widely respected John Wayne Cancer Institute, a component of Saint Johns Health Center. To schedule an appointment with Dr. Kelly, call the Medical Office of Mark J. Kelly, MD, Inc. or request a consultation online. Click here to read Dr. Kelly's CV!

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  • 9808 Venice Blvd Suite 602,Culver City,CA

    About Advanced Urology Medical Offices  Advanced Urology Medical Offices is a group of top-notch urology practices that has served Greater Los Angeles for over 30 years. With locations in Los Angeles, Redondo Beach, San Pedro, and Culver City, California, patients of all ages and cultural backgrounds come to the clinics to receive high-quality, compassionate treatment for their urological complications. The clinic specializes in the treatment of urologic conditions and disorders, including kidney stones, erectile dysfunction, urinary tract infections, urinary incontinence, and cancers of the bladder, kidneys, testicles, and prostate.  Some people are hesitant to go into details about issues like these. Thats why the compassionate team of urologists and staff at Advanced Urology Medical Offices strives to provide a trusting, non-judgmental environment where patients feel that they can be open about some of their most personal symptoms. To treat such conditions, the clinics boast some of the most advanced technologies and treatments available in the field today. They frequently perform minimally invasive robotic surgeries using the daVinci® Surgical System, UroLift® implants, and Rezum™ water vapor therapy for enlarged prostates, and testosterone therapy for hormone replacement, to name a few.  For diagnostic purposes, Advanced Urology Medical Offices provides urodynamic testing to review the functioning of your urinary organs and prostate cancer screenings to check middle-aged men for prostate cancer. If youve noticed unusual symptoms related to your urination or your urinary system, dont hesitate to call your nearest Advanced Urology Medical Offices location or use the convenient online booking tool to schedule an appointment discreetly at your convenience.

    (131) 067 - 0911

    9 MI
  • 2080 Century Park East Suite 1407,Los Angeles,CA

    Adam Ramin, MD, is board certified in urology, with sub-specialization in Urological Oncology and Robotic Surgery. His considerable medical expertise and surgical skills are enhanced by a true desire to provide a personalized, patient-first approach to medical care at his busy practice thats located in the Century City district of Los Angeles. Dr. Ramin received his medical degree from Mount Sinai School of Medicine in New York and completed his urological surgery residency at Loma Linda University Medical Center in 2000. He subsequently completed fellowship training in urological oncology and laparoscopic urology at City of Hope National Medical Center in Duarte, California. After completing his fellowship training, Dr. Ramin joined the faculty at the City of Hope as Assistant Professor of Surgery. He was among the first few surgeons in the United States to perform robot-assisted laparoscopic prostatectomy using the da Vinci system. Dr. Ramin has since performed more than 2000 laparoscopic and robotic procedures for prostate, kidney, and bladder cancers. He also provides innovative care for men and women experiencing urological issues such as prostatic enlargement, pelvic organ prolapse, erectile dysfunction, and urinary incontinence. As an expert in prostate cancer and robotic laparoscopic prostatectomy, Dr. Ramin has published numerous articles and research papers regarding prostate cancer. He has also trained numerous urologists in the techniques of minimally invasive laparoscopy and robotic surgery. Dr. Ramin is on staff at several prestigious medical institutions, including City of Hope National Medical Center, Cedars Sinai Medical Center in Los Angeles, and Saint John's Health Center in Santa Monica, California. For expert urological care thats provided in a warm and friendly environment where patients come first, schedule a visit with Dr. Ramin.

    (142) 426 - 0026

    10 MI
Questions & Answers Questions & Answers

When one looks at all stages of prostate small cell carcinoma, the 5-year survival rate is 99%, the 10-year relative survival rate is 98%, and the 15-year survival rate is 96%. However, survival rates are far more accurate when one looks at them at different stages of the disease. At the local stage, prostate small cell carcinoma has a 100% surviva


The spread of prostate small cell carcinoma to other parts of the body is categorized as either local or distant. Local generally means the spread of  the disease is within the pelvis area, and when it spreads outside the pelvic region, it is known as distant. It grows by breaking away from the original tumor in the prostate and travels via the ly


Burning or pain during urination. Difficulty urinating, or trouble starting and stopping while urinating. More frequent urges to urinate at night. Loss of bladder control. Decreased flow or velocity of urine stream. Blood in urine (hematuria)


Advanced prostate small cell carcinoma can cause many types of complications in the body. These effects can they stay for as long as the disease is in a stage of development. Urinary inconsistency is the most immediate and invasive complications. One might even require treatment for specific complications once the disease treatment is complete.

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Prostate cancer is a result of cells in the prostate gland that start to grow uncontrollably. Situated below the bladder and in front of the rectum, the prostate gland is found only in males and is responsible for making semen. When the malignant (or cancerous) cells in the prostate reach stage IV, it is medically referred to as metastatic.Metastatic cancer usually spreads through bones and lymph nodes. Once spread in the lymph nodes, they start spreading in liver and lungs. It is rarer for these cancer cells to move to the other parts of the body, such as the brain.If the prostate cancer spreads to the hip bone, it is not bone cancer, It is still prostate cancer. It contains the same prostate cancer cells that the original tumor had.Nature of the spreading of cancerMetastatic cancer cells sometimes break away from the original tumor and go to a blood lymph vessel. Once they enter the lymph vessel, they can easily move through any part of the body. These metastatic cells stop in blood capillaries and some tiny blood vessels at a distant location.The metastatic cells then break through the wall of the blood vessel and get fused to any nearest tissue that they can find. Once attached
Common symptoms of prostate cancerThe prostate gland is responsible for producing some fluid of the semen and controlling urination in men. Prostate cancer is accountable for affecting the prostate gland. The gland is located right below the bladder and in front of the rectum. In advanced cases, it can spread to nearby organs to the prostate, most notably the bladder. It is the most common cancer among men in the United States. Early detection of the prostate cancer is treatable while advanced stages might get fatal.Regular testing is important to complete diagnostics before it hits the metastasis phase, i.e. when it starts spreading to other body parts. The prostate cancer symptoms are divided into two groups early prostate cancer symptoms and advanced prostate cancer symptoms. Prostate cancer is treated differently at different stages. Before discussing the treatment, lets have a brief introduction of the different stages.Prostate cancer stagesProstate cancer is divided into four stages, and each has a different treatment approach. The extent of spread and size of tumor decides what stage of cancer it is.Stage IIn the very first stage of prostate cancer, the tumor is non-detecta
Prostate cancer is one of the most common conditions that affect men. In this disorder, there is an abnormal multiplication in the growth of cancer cells that go on to form a tumor. The prostate gland is one that aids in the production of semen and it is situated around the male urethra.Typically, prostate cancer is painless in the initial stage; thus, there may be no signs and symptoms that indicate the growth of cancer cells. This is a major reason for a large population of men being unaware of the prevailing condition. However, as the condition becomes serious, one may include a slew of issues such as an abnormal flow of urine, pain during ejaculation, and the feeling of being unable to completely empty the bladder. The above changes or symptoms are seen in several other genital conditions and do not always imply the development of prostate cancer.The severity of the condition can greatly vary from one man to another. In most cases, if the prostate cancer is in its early stage, there can be treatment methods mapped for successful treatment. Also, in some older men, the tumor may grow very slowly and can surprising never cause an issue in their daily routine. On the other hand,
Today, prostate cancer is one of the most common conditions that has affected men across the world. The prostate is a male gland that carries out the function of producing seminal fluid for the nourishment and transportation of sperm. Cancer is triggered when there is an abnormal growth of cells in a part of the body. Likewise, prostate cancer sparks off when cells in the prostate begin to grow in an uncontrolled fashion. Initially, the growth can be harmless; however, a malignant spread can cause major harm. When detected in the early stages, prostate cancer comes with the greater chance of being treated successfully.According to research, family history can greatly impact the risk of prostate cancer in men. Men with inherited mutations in BRCA genes are more susceptible to suffering from cancer in the gland. Thus, there is an increased emphasis on undergoing routine testing to detect any mutations well in time.Genetic screening for prostate cancerGenetic screening or testing comprises of examining an individual's DNA and find out the order in which the DNA molecules are put together. Typically, there are two different types of genetic screening methods employed.The first kind of
Prostate cancer that has reached its stage IV or metastatic state is treatable but unfortunately not curable. Metastatic prostate cancer can usually be treated by standard therapies such as hormone therapy, immunotherapy, and chemotherapy. Using these treatments over a period of time, metastatic prostate cancer can be controlled for several years.Hormone therapyThe simple theory behind the treatment through hormone therapy is that it deprives a man's body of male hormones that are necessary for prostate cancer cells to grow. The treatment of hormone therapy, initially can be achieved with orchiectomy, which means removal of one or both the testicles, or luteinizing hormone-releasing hormone (LHRH) analogues solely or in combination with an anti-androgen.ChemotherapyJust like hormone therapy, chemotherapy is a systematic therapy in which the cancer-fighting drug circulates in the blood and to the parts of the body where the cancer may have spread. It can also kill or eliminate cancer cells at sites that are at great distances from the original cancer. Conventional chemotherapy drugs that are available for the treatment can have serious side-effects including loss of immunity, loss o
Prostate is a gland of the male reproductive system and PSA (prostate specific agent) is a protein produced by prostate cells. Prostate cancer is diagnosed with the help of a PSA test. PSA test is performed by taking a blood sample from the patient. High PSA range indicates cancer or inflamed prostate. So, when PSA test is taken, other factors that confirm prostate cancer must be taken into account as well.Prostate cancer is one of the most common cancers in men. Though high level of PSA can indicate cancer, a healthy man without any cancer should have little amount of PSA in his blood circulation.To prepare for the test, make sure your doctor is aware of the medication you are on. Some medication can tamper with your blood test and make your PSA range appear falsely low. Other than informing your doctor about the medication, there is nothing more you have to do to prepare for the test.The PSA test is performed for these reasons: To check if the patient has prostate cancer To check if the treatments for prostate cancer are going right and if the cancer has returned To check if the prostate gland is normal or not during physical examChecking the PSA range may increase the chance of
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