Prostate
The PSA Test is a blood test used primarily to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate.
Most men without prostate cancer have PSA levels under 4 nanograms per milliliter (ng/ml) of blood. The chance of having prostate cancer goes up as the PSA level goes up. Men with a PSA Level between 4 and 10 have about a 1 in 4 chance of having prostate cancer. If the PSA is more than 10, the chance of having prostate cancer is over 50%.
The Gleason system assigns grades based on how much the cancer looks like normal prostate tissue.
- Cancers with a Gleason score of 6 or less may be called well-differentiated or low-grade
- Cancers with a Gleason score of 7 may be called moderately-differentiated or intermediate-grade
- Cancers with a Gleason score of 8 through 10 may be called poorly-differentiated or high-grade
Pi-Rads (Prostate Imaging Reporting and Data System) refers to a structured reporting scheme for evaluating the prostate for prostate cancer. The score is assessed on prostate MRI. Images are obtained using a multiparametric technique including T2 weighted images, a dynamic contrast-enhanced study, and diffusion-weighted images. A score is given according to each variable. The scale is based on 1 to 5 (which is given for each lesion), with 1 being most probably benign and 5 being highly suspicious of malignancy.
- PI-RADS 1 – Highly unlikely that clinically significant cancer is present.
- PI-RADS 2 – Unlikely that clinically significant cancer is present.
- PI-RADS 3 – Uncertain whether clinically significant cancer is present.
- PI-RADS 4 – Likely that clinically significant cancer are present.
- PI-RADS 5 – Highly likely that clinically significant cancer is present.
For results of PI-RADS 4 or 5, patients should be recommended for biopsy. For results of PI-RADS 1 or 2, a recommendation for biopsy is likely inappropriate, but other factors should be considered. For results of PI-RADS 3, biopsy may be appropriate depending on patient history, local preferences and preferred standard of care.
Combines anatomic imaging in the form of T2-weighted imaging, with functional imaging, which includes primarily diffusion weighted imaging (DWI) and dynamic contrast enhancement (DCE).
The use of specific MRI sequences as well as software that generates images from the resulting data, which uses the diffusion of water molecules to generate contrast in MR images. It allows the mapping of the diffusion process of molecules, mainly water, in biological tissues, in vivo and non-invasively.
A measure of the magnitude of diffusion (of water molecules) within tissue and is commonly clinically calculated using MRI with diffusion weighted imaging (DWI).
A T2-weighted imaging sequence provides anatomic information about the prostate gland. It offers detailed visualizations of the prostate gland and its distinct zones. T2-weighted imaging has applications in the detection, localization and staging of prostate cancers.
During dynamic contrast-enhanced (DCE) imaging, a contrast agent is used to evaluate blood flow through the prostate. Cancerous tissue absorbs the contrast agent more quickly than healthy tissue, which is apparent on DCE images. The role of DCE imaging is secondary to T2-Weighted Imaging and DWI, but it can help to detect small, yet significant cancers missed by the other two sequences.
A test for both men and women, it allows a doctor to check the lower rectum, pelvis and lower belly for cancer and other health problems. In men the doctor can check for prostate cancer, blood in the stool or an abnormal mass in the anus or rectum.
- Age 50 or older
- Family History
- Father or Brother has had prostate cancer
- Race/Ethnicity
- African-Americans are at a higher risk than Caucasians and Hispanics. Prostate cancer occurs less often in Asian-American and Hispanic/Latino men than non-Hispanic Caucasian men.
- Pre-Cancerous prostate changes can be a precursor to cancer
- Genetic (Chromosomal) abnormalities
- Such as a certain altered or missing gene
Coronary Calcium Score
Your calcium score is a quantitative measurement of the amount of calcium deposits within your coronary arteries, as well as its density. A zero score means that no calcium is present, and represents a low chance of having a heart attack in the next few years. When calcium is present, the higher the score, the higher your risk for a heart attack.
0 = no plaque detected. Risk of coronary artery disease is very low (less than 5%)
1-10 = calcium detected in small levels. Risk of coronary artery disease is still low (less than 10%)
11-100 = mild levels of plaque detected with certainty. Minimal narrowing of the arteries is likely.
101-300 = moderate levels of plaque detected with certainty. Risk of a heart attack within 3-5 years is high.
301 and higher = extensive levels of plaque detected. Very high risk of heart attack; vascular disease is likely present.
Traditional risk factor analysis (based on cholesterol, blood pressure and risk assessment tests) has failed millions of Americans. In fact, for more than 100,000 Americans every year, a fatal heart attack is their first and only sign of heart disease.
The calcium score has shown to be the best technology available to detect early stage heart disease, superior to cholesterol, blood and stress tests. It is used at the nation’s leading cardiology centers, including UCLA, Johns Hopkins and the Mayo Clinic. Every President of the United States is required to have one, as are NASA astronauts.
Risks are low and the benefits generally outweigh them. The risks include radiation exposure (in low amounts), and the possibility that the calcium score may lead to other testing, which may or may not provide results with clinical value.
If your score is zero, you should have your next calcium score test in 5 years. If your score is between 1-10, a repeat scan every 2-3 years may be advised. If your score is higher, or if you have heart disease and are treating it, you will want to talk to discuss the frequency of coronary calcium testing with your doctor.
Low-dose Lung Screening
If you are a current or former smoker, or your job has put you at risk for lung cancer, a low-dose lung screening test may be for you. It is a safe and fast CT scan of the lungs that exposes the patient to less radiation than a traditional chest CT scan. This screening has been shown to reduce lung cancer deaths by 20%.
No, a CT scan provides far more detailed images and can detect smaller, earlier stage cancers than X-ray. In addition, the 20% reduced cancer deaths made possible by low-dose lung screening were from a clinical trial that compared CT screening with X-ray screening.
It is not uncommon for a LDCT to find a small nodule or mass in the lungs, especially in current or former smokers. Most nodules are not cancer, and could be the result of an old infection, scar tissue or another cause. Your doctor may want to monitor the nodule over time, or recommend another imaging test or biopsy.
In many cases, LDCT screening is covered by insurance. Please ask your insurance company if your plan covers you. If not, it is offered as a cash payment procedure for a nominal fee.
If no lung problems are detected, your LDCT should be repeated in one year. After two years, your doctor may recommend a different frequency of screening.
Peripheral Artery Disease
Peripheral artery disease (PAD) refers to the narrowing of the “peripheral” arteries, which are blood vessels in the legs, arms, stomach and head. It is caused by a buildup of cholesterol and scar tissue on the walls of the artery which forms a substance known as plaque. The plaque builds up gradually and over time it will clog the artery, restricting the flow of blood. In some cases, PAD may be caused by blood clots that break free from within larger arteries and get lodged in narrower arteries, which also reduces blood flow.
It is important to note that quitting smoking reduces your risk of developing PAD by 60% within 10 years.
PAD often goes unnoticed and undiagnosed by healthcare providers. Additionally, the symptoms of PAD are easily mistaken for other conditions, such as neuropathy or just the aches and pains of getting older.
Symptoms include:
- Leg pain, numbness, tingling or weakness
- Changes in the color of the arms or legs
- Foot or toe wounds that do not heal or heal slowly
- Decrease in the temperature of the lower legs and feet compared to the rest of the body
- Erectile dysfunction
- Poor nail or hair growth
Yes, and PAD is frequently under-diagnosed in women. This may be due to two important reasons: First, women are less likely to complain about leg pain to their doctor than men. Second, men with PAD are more likely than women to have coronary artery disease, so their doctors are actively looking for PAD. As a result, when women are eventually diagnosed with PAD, the disease is more likely to have become severe.
PAD is easily diagnosed with simple, easy and painless tests. These can include physical examination by your doctor, ankle-brachial index (ABI), ultrasound, X-Ray (arteriogram), CT (CT angiography), and MRI (MR angiography). In some cases, and angiogram may be performed to identify the precise location of blockages within the peripheral arteries.
If the disease is not severe, PAD can be treated with medication and/or lifestyle changes. If it has progressed to the point where an intervention is needed, there are minimally invasive procedures available for you and your doctor to consider.