Screening & Diagnosing Prostate Cancer
Prostate Cancer Screening
Prostate cancer does not usually show symptoms in the earliest stages of the disease, so when it is detected early it is usually due to routine screening tests and exams.
Screening for prostate cancer is the process of looking for the disease before a man has any signs or symptoms. By the time signs or symptoms appear, the prostate cancer may have advanced and spread to other parts of the body. Prostate cancer screening can help detect the disease during an early stage when it is easier to treat.
The following methods are commonly used to screen for prostate cancer:
- Digital rectal exam (DRE) - A DRE is a physical exam in which a doctor feels the prostate through the rectum to determine the size and shape of the prostate gland.
- PSA test - The PSA test measures the amount of prostate-specific antigen (PSA) in the blood. PSA is a fluid made by the prostate and normally present in the semen; small amounts can be present in the bloodstream. A higher level of PSA can be caused by an enlarged prostate, infection, or prostate cancer.
- Urine tests - A urine specimen test is to check for blood, infection, or abnormal cells. Blood in the urine can be due to prostate cancer. A urine-flow rate test is used to measure the strength of the flow. A low flow rate may be due to prostate cancer.
Diagnosing Prostate Cancer
If any of these tests indicate prostate cancer, the doctor may recommend a prostate biopsy, a procedure in which tissue is taken from the prostate and examined under the microscope. A biopsy is the only method of confirming whether or not prostate cancer is present.
- Prostate biopsy - The removal of cells or tissues from the prostate for examination by a pathologist.
Complications from a biopsy of the prostate may include fever, pain, blood in the urine or semen, and urinary tract infection.
Risks of Prostate Cancer Screening
The decision to be screened for prostate cancer is not necessarily an easy one to make. While one might think it better to find and treat prostate cancer during the early stages, the decision is much more complex - even medical experts differ in their opinions as to the appropriate use of prostate cancer screening.
According to the National Cancer Institute, a man should consider the following factors:
- Finding prostate cancer may not improve health or prolong life; some prostate cancers do not cause symptoms or become life-threatening; if disease is detected, it is not known if treatments prolong life, but it is known that treatments for prostate cancer can cause serious side effects such as impotence (inability to keep an erection) and incontinence (inability to control the flow of urine, resulting in leakage) which can negatively affect a mans quality of life.
- Testing results are not always accurate; false-negatives can delay treatment and false-positives can lead to unnecessary testing. If prostate cancer is suspected, a biopsy is performed to confirm a diagnosis, but undergoing a biopsy can result in complications (including fever, pain, blood in the urine or semen, and urinary tract infection).
Prostate Cancer Screening Recommendations
A man should discuss the benefits and risks of prostate cancer screening with his doctor. The decision whether to undergo screening for prostate cancer is a personal matter, but will take into account a mans age and life expectancy, overall health condition, his doctor's advice regarding routine screening, and his own feelings and opinions about his options.
- The American Urological Association recommends that men be screened for prostate cancer starting at age 40, including regular physical exams and PSA testing in order to establish a baseline PSA score before age related PSA-increases take place.
- The American Cancer Society recommends that men make an informed decision and should not be screened until they understand the uncertainties, risks, and potential benefits of prostate cancer screening. Man with average risk and expected to live at least 10 years should consider discussing screening at age 50; men with a higher risk (due to ethnicity or family history) should consider discussing screening at age 40 or 45, depending on personal situation.
Staging Prostate Cancer
Once prostate cancer is diagnosed, additional tests may be needed to see whether the disease is confined to the prostate gland or has spread to other parts of they body. Staging is the process of determining the extent, or stage, of the prostate cancer. Staging information can be helpful to you and your doctor in determining a treatment plan and understanding your prognosis.
The following imaging tests are sometimes used for staging prostate cancer:
- Bone Scan - A bone scan can help show whether prostate cancer has spread to the bones. If prostate cancer has advanced beyond the prostate, it often goes to the bones first. The test involves an injection of a low-level radioactive material; then special cameras are used to take pictures of your skeleton.
- Magnetic Resonance Imaging (MRI) - A MRI scan uses radio waves and strong magnets rather than x-rays to produce very detailed images of the body. The pictures can show whether the cancer has spread outside the prostate into the seminal vesicles or the bladder.
- Computerized Tomography (CT) - A CT scan (also known as a CAT scan) is a special kind of x-ray that gives detailed, cross-sectional images of the body. The test can help tell whether prostate cancer has spread into nearby lymph nodes or other areas in the pelvis.
- ProstaScint Scan - The ProstaScint scan uses an injection of low-level radioactive material to find cancer that has spread beyond the prostate. A special camera creates an image of the body, which can be used to find prostate cancer cells in lymph nodes and other soft (non-bone) organs.
Stages of Prostate Cancer
- Localized - cancer is confined to the prostate gland
- Regional - cancer has spread to nearby lymph nodes
- Distant - cancer has metastasized, or spread to other parts of the body
Choosing Treatment Approach for Early Prostate Cancer
If a man chooses to be screened and prostate cancer is diagnosed, a man will still have to make the decision for treatment. Some men may choose medical treatment and some may choose a watch and wait period. If prostate cancer is detected at an early stage, watchful waiting may be an appropriate option for some men.
As prostate cancer is often slow growing and unlikely to cause problems, some doctors fear that some men may needlessly endure the side effects of treatment. As all cases are different, however, a man should consider his doctor's opinion and his own values and preferences before making a decision.
The two primary side effects of prostate cancer treatment that must be considered are impotence (inability to achieve an erection) and incontinence (loss of ability to control urine). Some men may be more concerned about the side effects of treatment and some men may be more concerned about the cancer remaining in the body.