Screening and Diagnosis of Prostate Cancer
Urologists and cancer specialists at Doylestown Hospital strongly urge men to discuss prostate cancer screening relative to their personal risks and circumstances with their primary care physician. Doctors frequently screen men for prostate cancer even when they do not have symptoms because the cancer is common and curable when detected early. However, for many years national and international medical experts in the United States and abroad have debated the risks and benefits associated with prostate cancer screening.
Because prostate cancer grows very slowly, many men develop the disease later in life, never have symptoms, and die as a result of something other than prostate cancer. The debate centers on whether treatment may cause more problems or unwanted side effects, such as erectile dysfunction or urinary incontinence, than the cancer itself. Conversely, when prostate cancer is detected early, usually it stays confined to the prostate gland and doctors can treat and cure the disease.
Prostate Cancer Screening Tests
If you and your physician decide that you should get screened for prostate cancer, the doctor will likely perform certain tests including:
Digital rectal exam (DRE) – The prostate is the size of a walnut and located underneath the bladder in front of the rectum. Because the prostate is close to the rectum, your physician can perform a physical exam that detects lumps, enlargement or other abnormalities. Your doctor will recommend further testing, if necessary.
Prostate-specific antigen (PSA) blood test – The prostate produces PSA, which is a protein primarily found in semen and in minimal amounts in the blood. Changes to PSA levels in a PSA test could signify the presence of prostate cancer. However, elevated PSA levels can also stem from other problems such as a man’s age, inflammation, urinary tract infections, an enlarged prostate or benign prostatic hyperplasia (BPH), or biopsies.
DRE and PSA tests may help your doctor identify prostate cancer at an early stage. The results of these screening tests can help you and your physician make decisions about your care.
Diagnosing Prostate Cancer
If the results of a screening test indicate prostate cancer, your doctor will most likely recommend a transrectal ultrasound and biopsy to make a diagnosis. These diagnostic tests are performed in your doctor’s office and are fully available at Doylestown Hospital:
Transrectal ultrasound – This test uses a small probe, about the size and shape of a cigar. The probe is inserted into the rectum to take images of the prostate.
Prostate biopsy - Your doctor will use ultrasound images as a guide to insert a needle to retrieve six to twelve thread-like pieces of prostate gland tissue. A pathologist evaluates the samples and determines if cancer is present and grades the aggressiveness of the cancer using a scoring system called the Gleason score. The score ranges from 2 (nonaggressive) to 10 (very aggressive). Scores between 4 and 6 are most common. The higher the number, the more likely the cancer will spread.
Tests to stage cancer often take place after prostate cancer is diagnosed. These tests may not be recommended if it is unlikely the cancer will spread beyond the prostate. Prostate cancers are staged using three criteria:
How far the cancer spread beyond the prostate
If cancer spread to the lymph nodes in areas near the prostate
If cancer has spread to organs distant from the prostate
If cancer has spread, urologists and cancer specialists at Doylestown Hospital may immediately recommend treatment strategies specific to your situation. In other instances, doctors conduct more tests to determine the best treatment approaches, such as:
Bone scan – This test evaluates the skeleton in order to determine whether cancer has spread to the bone.
Computerized tomography (CT) scan – This test evaluates if prostate cancer has spread to the tissues adjacent to the prostate gland, the pelvic lymph nodes, the skeleton, or other organs such as the brain or spinal cord.
Magnetic resonance imaging (MRI) – An MRI is another imaging strategy that your doctor may recommend and is similar to the CT scan.