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Prostate Cancer Screenings & Diagnosis
Testing options to locate and identify prostate cancer.
It’s important to catch prostate cancer as early as possible. Early detection improves your chances of beating the disease. Our cancer specialists perform comprehensive prostate cancer screening with an array of advanced tests. If we find that you have prostate cancer, we’ll provide the most accurate diagnosis possible so you and your doctor can decide on a personalized treatment plan.
How is prostate cancer diagnosed?
We use four tests to screen for and diagnose prostate cancer:
- Digital rectal exam (DRE)
- Prostate-specific antigen (PSA) screening
- Prostate ultrasound
- Prostate biopsy
DREs and PSA screenings are the first line of defense against prostate cancer. If these tests return a result that could indicate prostate cancer, your doctor may order a prostate ultrasound or a prostate biopsy.
For a DRE, your doctor will insert a gloved, lubricated finger into the rectum to feel the back wall of the prostate. A normal prostate should feel soft, smooth, and round. Your doctor will feel to make sure your prostate has no:
- Firm areas
- Hard nodules (swollen spots)
These abnormalities don’t necessarily indicate prostate cancer. But if they’re present, your doctor may order more tests to be sure.
Prostate-specific antigen is a protein that your prostate produces as part of its normal function. Small amounts of PSA leaks out into the bloodstream, and we can detect it with a simple blood test.
High levels of PSA in the bloodstream could signify a few different prostate problems, such as:
- Prostate cancer
- Prostate enlargement (noncancerous)
- Prostate inflammation (noncancerous)
Elevated levels of PSA don’t always mean a patient has prostate cancer. And patients can have low PSA levels and still have prostate cancer. That’s why it’s important for you to have both a PSA screening and a DRE for the best chance of detecting prostate cancer as early as possible.
In a prostate ultrasound, your doctor places a lubricated ultrasound probe into the rectum. This probe emits high-frequency sound waves that we use to create a picture of the prostate.
This test for prostate cancer lets us see how big your prostate is and if there are any visible problems with it. Theprostate ultrasound also helps us more accurately perform prostate biopsies, which we usually perform for questionable DREs or PSA screenings.
This prostate cancer test involves removing small pieces of tissue from the prostate. We look at these pieces under a microscope to see if they contain cancerous cells. The biopsy only takes about 15 minutes.
You’ll probably only feel mild discomfort during the test. There may be some bleeding afterward. Rarely, some patients have developed infections or experienced significant bleeding, swelling of the prostate, or difficulty urinating after a prostate biopsy.
If your biopsy is negative, that means we didn’t see cancer on the tissue we analyzed. But there still may be cancerous tissue in other parts of the prostate. Your doctor may order a repeat biopsy if your case is suspicious but your biopsy is negative.
How often should I have a prostate cancer screening?
Your best chance of beating prostate cancer depends on finding the cancer as early as possible. We use the American Cancer Society’s (ACS) recommendations for prostate cancer early detection.
The ACS’ recommendations for prostate cancer screening are as follows:
- Men at average risk for prostate cancer who have a life expectancy of at least 10 more years should start screenings at age 50.
- Men at high risk for prostate cancer (including all African-American men, as well as men with a close relative such as a father, brother, or son diagnosed with prostate cancer younger than age 65) should start screenings at age 45.
- Men with more than one close relative diagnosed with prostate cancer younger than age 65 should start screenings at age 40.
Depending on your PSA screening levels, you may need repeat screenings every year or every other year. You and your doctor can decide on the best plan.
What happens if I have prostate cancer?
If we detect prostate cancer, our pathologists (doctors who diagnose diseases) will determine the grade and stage of your disease. This allows us to determine what your options are so we can work with you on a personalized treatment plan. Your diagnosis will include both the grade and stage of your prostate cancer.
Prostate cancer grading
Cancer grading describes how abnormal or aggressive the cancer cells appear. A cancer’s grade helps our doctors predict long-term results, likely response to treatment, and chance of survival.
We use the Gleason scale to grade prostate cancer. This system assigns cancer cells a score of 1 to 10. The Gleason scale has three main levels:
- Score of 4 or less: This is a low-grade, slow-growing form of prostate cancer that looks most like normal prostate cells. It is the least dangerous form of prostate cancer.
- Score between 4 and 7: This is a middle-grade prostate cancer and is the most common form. It can act more like a low-grade or high-grade cancer depending on PSA levels and the amount of cancer present.
- Score of 8 or above: This is a high-grade cancer that looks least like normal prostate cells. It is the most dangerous form and is very aggressive in its growth. This type of prostate cancer is hard to treat and more likely to reappear after treatment.
Prostate cancer staging
Cancer staging describes how much cancer is present and where it is located. More cancer in the body means a higher likelihood of the cancer spreading. It also means treatment is less likely to be effective.
We use the TNM system to stage cancer, which describes three features of prostate cancer:
- T stands for tumor and uses different numbers and letters to explain the size of the prostate cancer tumor.
- N stands for nodes and describes if the prostate cancer has spread to the lymph nodes.
- M stands for metastatic and describes if the prostate cancer has spread elsewhere in the body.
Prostate cancer T status
There are four main stages in this system: T1, T2, T3 and T4. Each one also has various sub-stages.
Characteristics of stage T1 prostate cancer include:
- The tumor is only in the prostate and is undetectable by a DRE or a prostate ultrasound.
- Stage T1a: we found Cancer in 5 percent or less of a prostate biopsy tissue sample.
- Stage T1b: we found Cancer in more than 5 percent of a prostate biopsy tissue sample.
Characteristics of stage T2 prostate cancer include:
- The tumor is only in the prostate and is detectable by a DRE or a prostate ultrasound.
- Stage T2a: The tumor involves less than half of one lobe of the prostate and usually can be detected during a DRE.
- Stage T2b: The tumor involves more than half of one lobe of the prostate and usually can be detected during a DRE.
Characteristics of stage T3 prostate cancer include:
- The tumor has spread to surrounding tissues or to the seminal vesicles (the glands that make the fluid that mixes with sperm to form semen).
- Stage T3a: The tumor has spread outside the prostate on only one side.
- Stage T3b: The tumor has spread outside the prostate on both sides.
- Stage T3c: The tumor has spread to one or both of the seminal tubes.
Characteristics of stage T4 prostate cancer include:
- The tumor is still in the pelvic region but may have spread to other organs near the prostate, such as the bladder.
- Stage T4a: The tumor has spread outside the prostate to any or all of the bladder neck, external sphincter and/or rectum.
- Stage T4b: The tumor has spread beyond the prostate and may affect the levator muscles (which raise or lower the prostate), and it may be attached to the pelvic wall.
Prostate cancer N status
There are four stages in this system:
- Stage N0 : Prostate cancer cells have spread but have not yet spread to the pelvic lymph nodes.
- Stage N1: Prostate cancer tumors have spread to a single lymph node in the pelvic area and are approximately 2 centimeters (about 0.75 inch) or less.
- Stage N2 -- prostate cancer cells either have spread to a single lymph node and are more than 2 centimeters but less than 5 centimeters (about 2 inches) or have spread to more than one lymph node and are no larger than 5 centimeters.
Prostate cancer M status
There are two stages in this system:
- Stage M0: Prostate cancer cells have spread to the pelvic area.
- Stage M1: Prostate cancer cells have spread outside the pelvic area to other areas of the body.