Diagnosis of Prostate Cancer
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A man with prostate cancer may not have any symptoms. For men who do have symptoms, the common symptoms include:
- Urinary problems
- Not being able to pass urine
- Having a hard time starting or stopping the urine flow
- Needing to urinate often, especially at night
- Weak flow of urine
- Urine flow that starts and stops
- Pain or burning during urination
- Difficulty having an erection
- Blood in the urine or semen
- Frequent pain in the lower back, hips, or upper thighs
Most often, these symptoms are not due to cancer. Benign prosatic hypertrophy (BPH), an infection, or another health problem may cause them. If you have any of these symptoms, you should tell your doctor so that problems can be diagnosed and treated.
Detection and Diagnosis
A variety of tests are available to screen and diagnose prostate cancer. They include:
- PSA test
- Digital rectal exam
- Trans rectal ultrasound
- Trans rectal biopsy
PSA test: The prostate-specific antigen (PSA) test is one of the best ways to screen for prostate cancer. This blood test measures a protein made by the prostate that is normally present in the blood. The amount of this protein in the blood will increase in men who have prostate cancer.
Digital rectal exam: In a digital rectal exam (DRE), a doctor inserts a gloved, lubricated finger into a man’s rectum in order to feel the prostate. If the doctor finds a roughness and irregular unevenness to the tissue, prostate cancer might be suspected. An enlarged prostate that is not cancerous will likely still feel smooth.
Trans rectal ultrasound: The doctor inserts a probe into the rectum to check your prostate for abnormal areas. The probe sends out ultrasonic waves that are not heard. These waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.
Trans rectal biopsy: A biopsy is the removal of tissue to look for cancer cells. It’s the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.
Staging of Prostate Cancer
If the biopsy shows cancer, the doctor needs to learn the extent or stage of the disease to choose the best treatment. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body.
Some men may need tests that make pictures of the body:
- Bone scan: The doctor injects a small amount of a radioactive substance into a blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones on a computer screen or on film. The pictures may show cancer that has spread to the bones.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your pelvis or other parts of the body. Doctors use CT scans to look for prostate cancer that has spread to lymph nodes and other areas. You may receive contrast material by injection into a blood vessel in your arm or hand, or by enema. The contrast material makes abnormal areas easier to see.
- MRI: A strong magnet linked to a computer is used to make detailed pictures of areas inside your body. The doctor can view these pictures on a monitor and can print them on film. An MRI can show whether cancer has spread to lymph nodes or other areas. Sometimes contrast material makes abnormal areas show up more clearly on the picture.
When prostate cancer spreads, it’s often found in nearby lymph nodes. If cancer has reached these nodes, it may also have spread to other lymph nodes, the bones, or other organs.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if prostate cancer spreads to bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, it’s treated as prostate cancer, not bone cancer. This new tumor is referred as “distant” or metastatic disease.
These are the stages of prostate cancer:
- Stage I: The cancer can’t be felt during a digital rectal exam, and it can’t be seen on a sonogram. It’s found by chance when surgery is done for another reason, usually for BPH. The cancer is only in the prostate.
- Stage II: The tumor is more advanced or a higher grade than Stage I, but the tumor doesn’t extend beyond the prostate. It may be felt during a digital rectal exam, or it may be seen on a sonogram.
- Stage III: The tumor extends beyond the prostate. The tumor may have invaded the seminal vesicles, but cancer cells haven’t spread to the lymph nodes.
- Stage IV: The tumor may have invaded the bladder, rectum, or nearby structures (beyond the seminal vesicles). It may have spread to the lymph nodes, bones, or to other parts of the body.
Recurrent Prostate Cancer
Recurrent prostate cancer is cancer that has recurred after it has been treated. The cancer may come back in, or nearby, the prostate or in other parts of the body.