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Diagnosis of Prostate Cancer
Prostate Cancer Diagnosis Tests
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Below is an extract from the ebook "Dealing with Prostate Cancer"
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Diagnosis of Prostate Cancer
Undergoing screening processes, like a digital rectal examination or prostate-specific antigen tests,
when approaching the age of forty is a good preventive measure.
The positive aspect is that newer screening procedures, deeper and extensive research, and
growing public awareness have been able to offer a wider perspective of prostate cancer and
educate people about the possibilities and strategies of disease prevention and better treatment
options.
Diagnosis of prostate cancer is through screening of blood tests and/or through physical
examination.
Biopsy, Cystoscopy, and Transrectal ultrasonography are the recommended tests to diagnose
prostate cancer.
Normally, biopsy of the prostate involves removal of a piece of the prostate and examining it under
the microscope.
Prostate biopsy is done in the outpatient department and does not require any hospitalization. A
biopsy gun inserts and removes special hollow-core needles in less than a second. Normally, there
would be around three to six on each side of the prostate. Men report a little discomfort during a
prostate biopsy.
Cystoscopy is the insertion of a thin, flexible camera tube down the urethra. It shows the interior
of the urethra. Transrectal ultrasonography uses sound waves to create a picture of the prostate
from a probe in the rectum.
Scientists have reported in April 2007 that a new blood test that can detect the presence of a
prostate cancer antigen-2 (EPCA-2) in the early stages. It may indicate the presence and intensity
of prostate cancer.
X-rays and bone scans can also detect the spread of prostate cancer into the bones.
How is Prostate Cancer Diagnosed?
Prostate cancer does not show any exact symptoms. Detection of prostate cancer is often through
routine screening, or while undergoing tests for any other ailment.
Men that have relatives with prostate cancer and all other men over the age of fifty should have
prostate cancer screenings.
Doctors would normally question you regarding your ailments; specifically genital or urinary
diseases. They could question you about changes in the pattern of urinating, including frequency,
and if other family members have any history of prostate cancer.
It is not essential to conduct all the available tests for diagnosis of prostate cancer.
Doctors would normally suggest various tests and inform you of all the advantages and
disadvantages of these tests.
Doctors commonly use two tests in the initial stages for their patients who have not shown any
symptoms, to detect prostate cancer.
These are the digital rectal examination and prostate-specific antigen tests. These two tests in
combination can provide some clues about prostate cancer, although it is not always conclusive.
Prostate Cancer Diagnosis Tests
Tests for prostate cancer diagnosis include:
(I) PSA test: PSA refers to the prostate-specific antigen test. This test measures levels of a
specific protein made by the prostate and present in the blood. Men with prostate cancer report
high levels of this protein in their blood.
The prostate specific antigen is a normal secretion of the cells of the prostate gland. This is mainly
found in the semen. A very small amount is also found in the blood.
All PSA results are in nanograms per milliliter or ng/ml. A PSA count of 0 to 4 ng/ml is normal or
below normal. In some men, this could be the normal level.
A PSA count of 4 to 10 ng/ml is a little above normal.
A PSA count of 10 to 20 ng/ml is slightly above normal, while anything above 20 ng/ml is seen as a
very high level.
Sometimes, men with prostate cancer portray normal PSA levels. Normal PSA levels are not the
same for all men.
Normal levels of PSA in the blood are under 4 nanograms per milliliter. If there is cancerous growth
in your prostate gland, this level goes beyond 4.
If the PSA level in your blood is between 4 and 10, chances of you having prostate cancer is 1 in 4.
If it is more than 10, chances of prostate cancer are more than fifty percent and this could further
increase.
The normal PSA level for men aged between fifty and fifty-nine is about 3 nanograms per milliliter of
blood or lower.
A PSA of 4 nanograms per milliliter of blood or lower is considered normal for men aged between
sixty and sixty-nine.
Men aged 70 or more usually have a normal PSA level of 5 nanograms.
PSA levels of more than five indicate that further tests for prostate cancer are warranted.
Various factors other than prostate cancer can cause fluctuating or high PSA levels. These factors
might include non-cancerous enlargement of the prostate or BPH, advancing age, infection, and
inflammation of the prostate and certain medications like finasteride or dutasteride, urine
infections, inflammation, using a urinary catheter, recent prostate biopsies, prostatic massage, and
prostate or bladder surgery.
Doctors may consider other factors and suggest a re-examination after a certain period to check if
the PSA level has fallen. If PSA levels continue to rise, doctors would suggest other diagnostic
tests to possibly detect the presence of prostate cancer.
High PSA levels might indicate the existence of prostate cancer. Once you undergo prostate cancer
treatments, your PSA levels would fall.
The PSA test is also used for measuring any progress of the prostate cancer and the effectiveness
of your treatment.
Doctors normally recommend a baseline of the age of forty-five for PSA tests. They further
recommend yearly screenings for all men over the age of fifty. These screenings are all the more
important and essential if there are any cases of prostate cancer, or any other form of cancer, in
your family.
An indicator of prostate cancer is the amount of PSA present as blood proteins and as a free
circulation. The percent-free PSA test indicates the amount of free-moving PSA in the blood. If the
amount of free-moving PSA is high, it indicates the presence of prostate cancer.
Normally, the percentage of free circulating PSA is lower in men with prostate cancer. Doctors
suggest this test if your PSA results are within the border level. If your PSA test is within 4, 10, and
you have a lower percent-free PSA, prostate cancer chances are high, and it is best to go for a
biopsy.
However, this is not yet available everywhere.
The PSA test has its own limitations. Prostate cancer grows at a very slow pace. Therefore, coming
to conclusions based on PSA tests cannot offer any discrete solution. Some men could record high
PSA levels and undergo treatment for prostate cancer, although their cancer may not actually
advance to such alarming levels. This is because PSA does not indicate the extent of
aggressiveness of prostate cancer. Undergoing treatments like radiation and surgery have their
own side effects and discomfort.
You should take this test in combination with other tests.
(II) Digital rectal examination (DRE): The prostate gland is just behind the rectum. Doctors
insert a gloved and lubricated finger through the rectum to feel for any bumps or hard surfaces
suggesting growth of prostate cancer. This test takes little time and is not painful although a bit
uncomfortable.
This suggests the existence of prostate cancer. An enlarged prostate will remain smooth to touch
and therefore does not indicate prostate cancer. This process may not be painful but it is quite
uncomfortable.
A DRE alone cannot deliver conclusive results on prostate cancer, even less than a PSA test. In
many cases, the prostate may feel smooth even in the presence of prostate cancer. But, it can
sometimes detect prostate cancer in men with normal PSA levels.
The DRE test should be used in combination with PSA and other tests to confirm prostate cancer
diagnosis. However, medical experts are of the opinion that men over the age of fifty should
undergo regular PSA and DRE tests.
The DRE test is best for detecting the extent to which prostate cancer has spread to nearby
tissues in men diagnosed with prostate cancer.
Accurate early detection of prostate cancer is difficult. Undergoing tests for detection of prostate
cancer is therefore very subjective. You should discuss with your doctor and consider all possible
pros and cons. You should consider your general health, age, family history, lifestyle and similar
associated factors that could offer a deeper insight into the possibility of prostate cancer.
Young men with prostate cancer should undergo proper treatment as the cancer could assume
alarming ratios as you age. However, if prostate cancer is detected in elderly men, there is no
great need to undergo serious tests, as prostate cancer grows very slowly and chances of it
assuming alarming ratios is minimal. Most major medical organizations do not support regular
screening and testing for prostate cancer.
(III) MRI Scan: This is magnetic resonance imaging scan. This scan produces a computerized
image of the prostate with the help of magnetic fields.
This image shows a detailed cross-sectional picture of the entire prostate gland. This helps doctors
study and understand the image to detect irregularities or the extent of growth of cells within the
prostate gland.
(IV) Trans-Rectal Ultrasound: This detection method uses sound waves to detect irregularities in
the prostate. Doctors use high frequency sound waves by passing a sensor over the body surface.
This produces a computerized image.
Doctors may use Transrectal ultrasonography tests to detect prostate cancer. This requires
insertion of a tube or a probe into the rectum. This produces a good image of the prostate on the
screen for complete diagnosis.
This scan can measure size and density of the prostate. The probe would also collect a sample of
the prostate for detailed diagnosis under a microscope. Although the scanning process is complete
within few minutes, it is uncomfortable.
(V) CT Scan: CT scan refers to computed tomography scan. This is a sophisticated x-ray with the
help of a computer and rotating x-ray beams. These produce images of soft tissue, bone and blood
vessels. These x-rays also show any areas of dense tissue that might suggest the existence of
prostate cancer.
(VI) Biopsy: This is a very accurate test to detect the existence of prostate cancer. Doctors take
around ten samples of your prostate tissue with the help of a thin needle. They later examine it
under the microscope to detect if the tissue is cancerous.
Some doctors conduct a biopsy of the prostate through the perineum. The perineum is the skin
between the rectum and the scrotum. The doctor would place a finger into the rectum to feel the
prostate and insert the biopsy needle through a small incision in the perineum. The procedure
involves the passing of a needle through the rectum into the prostate.
Doctors give a local anesthetic, as the process is normally painful and very uncomfortable. They
additionally prescribe antibiotics to prevent any possible infection.
Normally, a biopsy takes only fifteen minutes and can be done within the doctor’s office. You should
drink plenty of fluids over the next twenty-four hours. You could experience bleeding in your urine,
bowels or in semen after sexual intercourse for a few days after a biopsy for prostate cancer.
Although a biopsy is more effective in detecting prostate cancer than most other tests, it may not
deliver exact results in 5% to 10% of cases. The biopsy may not detect the presence of prostate
cancer if the needles do not pass through them. Doctors might suggest a second or a repeat
biopsy if results are negative while other factors indicate prostate cancer.
Biopsy results from your pathologist provide various clues as to the extent of your prostate cancer.
The number of biopsy core samples could indicate the extent of your cancer.
The percentage of cancer in the core samples can indicate the aggressiveness or intensity of the
disease. It also indicates the location of prostate cancer.
(VII) Bone scan: Prostate cancer, in advanced stages, can spread to bones; specifically those of
the spinal cord, thighs and legs.
You would then experience lot of pain in your thighs, legs and back.
Doctors may conduct a bone scan to detect if your prostate cancer has spread to the bones.
For a bone scan, doctors inject a small amount of a radioactive substance into a blood vessel. This
substance passes through the blood and collects in the bones. A scanner detects radiation levels.
The scanner also takes pictures of the bones or depicts them on a computer screen. These images
and radiation levels can help doctors assess the presence and extent of prostate cancer in the
bones.
Gradation of Prostate Cancer
Tests cannot completely determine or provide conclusive evidence of prostate cancer.
Prostate cancer investigation requires staging and gradation processes to show its intensity and
the extent of its spread within your body.
Gradation: Pathologists use terms like low, medium, or high grade to describe prostate cancer
findings. They use a specific system, popularly known as the Gleason system.
This system uses scores of 2 to 10 to indicate the extent of prostate cancer. Grade 1 refers to the
cancerous tissue as being similar to prostate gland tissue; the chance of prostate cancer is nil.
If prostate gland tissue features are available as a random basis across the prostate, it is a grade
5 tumor.
The Gleason score is the total of all the stages.
Another system involves gradation of G1 through G4. A higher score refers to high-grade tumors or
cancerous growth. Normally, high-grade tumors grow faster and spread more than low-grade
tumors.
Staging: Staging refers to the extent of prostate cancer. Staging normally refers to the location
and spread of prostate cancer. Stage I and II refers to localized occurrences; your prostate cancer
has probably not spread outside the prostate gland.
Stage III refers to the locally advanced form of the disease. Your prostate cancer could be outside
the gland and may be in the seminal vesicles.
Stage IV means the cancer has spread beyond the seminal vesicles to lymph nodes and/or to
other tissues or organs.
Medical communities are divided over the beneficial effects of prostate cancer screening. Those
advocating regular screening believe that early detection of prostate cancer can offer better
treatment options and fewer side effects. However, another section feels that prostate cancer
grows very slowly and does not cause immediate problems. Therefore, treatment procedures
should be according to your age and other associated factors.
Is It Possible to Find Prostate Cancer Early
Early detection tests for prostate cancer became common since the nineties. Such tests include
prostate-specific antigen or PSA test and digital rectal exam or DRE test. These tests can detect
prostate cancer in the early stages. However, they have specific limitations and hence, results are
not always dependable and accurate.
The American Cancer Society (ACS) urges and recommends doctors to advise all men over the age
of fifty to undergo PSA and DRE tests every year. It further recommends that men with higher risk
like African-Americans or men having first-degree relatives with prostate cancer, undergo these
tests from the age of forty-five.
Rather, such men could have their first test at the age of forty. You can decide on further tests
depending on the results of the initial test. Doctors and health professionals should offer and allow
open discussion of the possibilities of prostate cancer, benefits of early detection, and treatment
options.
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Above is an extract from the ebook "Dealing with Prostate Cancer".
You have found the above information useful, right? Read on to find out more about this very
informative eBook.
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"You have prostate cancer and here is the prognosis...."
Imagine hearing such dreaded words and feel frightened and panic stricken!
It has been estimated in US alone, there will be more that 186,000+ new prostate cancer cases
and almost 29,000 deaths from prostate cancer.
Many people assume that prostate cancer only attacks the elderly and figure they'll just wait and
hope for the best. Bad decision. While the majority of cases do occur in men over 70, it has been
known to attack men as young as 50.
The disease also crosses ethnic lines and is the second most common malignant cancer in men.
African American men are at a higher risk than white men including Hispanic men.
According to the National Cancel Institute, "Dramatic differences in the incidence of prostate cancer
are also seen in different populations around the world." This is telling because there may be
dietary or other environmental factors involved.
Getting all the answers
Just like any disease, the earlier the detection the better the chances of beating it. That's all well
and good, but how do you know if you are at risk or heaven forbid, already showing symptoms?
What are the symptoms? You really need to have a good resource available for reference.
That's where "Dealing With Prostate Cancer" rides in to give you all the information you need to be
prepared. So often when dealing with a serious medical situation just having answers can bring
some much needed relief.
"Dealing With Prostate Cancer" understands your fears and provides you with answers to those
most burning questions. A few examples of what will help to ease your mind are:
- What are the different types of prostate cancer
- What is the progression or stages of the disease
- How common is prostate cancer
- Analysis of who is at risk for prostate cancer
- What symptoms should be watched for
- How should the disease be treated
- Are there alternative therapies for prostate cancer
- Your immune system and prostate cancer
- Does prostate cancer make a man impotent
- Nutrition and diet for prostate patients
- The right exercises your doctor may consider
- Is it possible to father children after treatment
- Can prostate cancer be prevented
Put your fears and anxiety behind you once and for all! Get the answers to these burning
questions and MUCH MORE inside "Dealing With Prostate Cancer."
You owe it to yourself and your loved ones to get the answers. Fear of the unknown is the worst
case enemy you need to fight. Getting the answers to the unknown is the first step to peace of
mind and living a long and healthy life!
Do it right now while you are focused. Don't wait until it's too late!
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Brought to you by Jacob Gan, PhD (Michigan)
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