Prostate Cancer Screening and Diagnosis

It’s a special fight, and it starts with an accurate diagnosis for prostate cancer.

Prostate cancer is a type of cancer that starts in the prostate gland. Certain cells grow uncontrollably, then they crowd and destroy healthy cells around the prostate gland and form a tumor. Urination and sexual function may be affected. Sometimes, cancerous cells move to other areas of the body. Approximately one in nine men will be diagnosed with the disease.

Adenocarcinoma is the most common type of prostate cancer. Several rare types include:

  • Sarcomas
  • Small cell carcinomas
  • Neuroendocrine tumor
  • Transitional cell carcinomas

Signs and symptoms of prostate cancer

For most men, there are no symptoms for early prostate cancer. Often the symptoms only occur when the cancer has already grown out of the prostate gland. Sometimes advanced prostate cancer can cause the symptoms below. Having a large or small prostate gland does not necessarily indicate the presence of cancer. Other health conditions, such as benign prostatic hyperplasia (BPH), can cause problems with urination and non-cancerous growth of the prostate.

For these reasons, it’s important to visit a doctor when you have questions about your symptoms. Prostate cancer is easiest to treat when it’s caught early. Some healthcare providers recommend screening for prostate cancer at age 45. If a close relative has had prostate cancer, then the screening may begin ten years before the age that the relative was diagnosed.

The most common symptoms for prostate cancer include:

  • Frequent urination, especially at night
  • Difficulty starting urination
  • Interrupted flow of urine
  • Dribbling urine
  • Blood in the urine or semen
  • Pain or burning during urination
  • Painful ejaculation
  • Erectile dysfunction
  • Frequent pain in the lower back, hips, pelvic or rectal area

Risk factors for prostate cancer

All men have a risk of developing prostate cancer. Out of every 100 men in the U.S., 13 will develop the disease.

  • Age: The most common risk factor for prostate cancer is age. As a man ages, his risk for prostate cancer increases.
  • African-American: Men who are African-American are more likely to get the disease. 
  • Family History: Men who have close relative with prostate cancer are at an increased risk for the disease. 
  • Diet: Eating a diet rich in high-fat dairy products and animal fat seems to increase the risk for prostate cancer.

Diagnosing prostate cancer

Screening tests

If you do not have symptoms of prostate cancer, it is important to talk with your doctor about the benefits and risks of screening for the disease. Even though screening can find cancer, it can also miss cancer. It can also find harmless conditions. In addition, screening can identify a very slow-growing cancer that may never become a problem. Prostate cancer screening can lead to treatments that can have serious side effects, such as incontinence and erectile dysfunction, so it is important to fully discuss your case with your urologist and other healthcare professionals.

Family history: Your doctor will ask about close relatives who have had prostate cancer. Tell the doctor about any pain, fever, or problems when passing urine and ejaculating.

PSA Test: This blood test will check for a protein called prostate-specific antigen (PSA). The PSA protein is made by cells in the prostate and helps to produce semen in the prostate ducts. Sometimes PSA leaks into the blood. High levels of PSA in the blood could be caused by cancer, or by other factors – health problems, some medications, having a digital rectal exam, riding a bike or motorcycle, or having had an orgasm recently. In addition, older men and African-American men often have higher than average PSA levels. When a high level of PSA is found, then another type of PSA test can be done.

Digital rectal exam (DRE): Using a finger that is gloved and lubricated, the urologist will move the finger into the rectum to feel the prostate gland.

Transperineal ultrasound (TPUS): This procedure uses ultrasound to send and receive sound waves and create images of the prostate gland and surrounding tissue. Safe and painless, this technique is non-invasive as it evaluates the perineum – the area between the scrotum and the anus.

Transrectal ultrasound (TRUS): This is typically an outpatient procedure that takes about 30 minutes. A narrow ultrasound probe will be inserted into the rectum. The prostate gland is separated from the rectum by the rectum wall. The ultrasound probe sends and receives sound waves that create images of the prostate gland and the tissue that surrounds it. Your doctor may recommend doing a biopsy of the prostate gland while the transrectal ultrasound is being done.

Biopsies

The only way to diagnosis prostate cancer is for a urologist to perform a biopsy. The biopsy may be done in one of two ways.

Transrectal biopsy: This is the most common way to perform a biopsy for prostate cancer. Often done during a transrectal ultrasound, a spring-propelled needle will be passed through the wall of the rectum and into the prostate gland. The needle will retrieve about 10 tissue samples.

Transperineal biopsy: A small incision is made in the area between the scrotum and anus. Then a spring-propelled needle will be inserted through the cut and into the prostate to extract about 10 tissue samples. To guide the urologist, an MRI scan or CT scan may be used.

MRI-guided biopsy: Magnetic resonance imaging (MRI) may be recommended to guide the urologist doing the biopsy of the prostate gland. The MRI uses a combination of a powerful magnetic field, radio waves, and a computer to produce detailed images of the prostate gland and surrounding tissue. The urologist watches the monitor as the biopsy is performed.

Diagnosing prostate cancer

Tissue samples taken from the prostate during the biopsy will be examined under a microscope. If cancer cells are found, they will be given a rank from 2-10 using a method called the Gleason score. A high ranking on the Gleason score suggests that the cancer is the most aggressive or abnormal type, and it is likely to quickly spread.

When the biopsy shows that prostate cancer is present, more tests may be done to determine if the cancer cells have spread to other parts of the body. It is important to know where the cancer cells have moved to create a personalized treatment plan.

Stages of prostate cancer

Your doctor will want to find exactly where the cancer is located and how much of it is in your body. This process is called staging. The stage is determined by the physical exam, biopsy, imaging, and other tests.

A specially trained physician called a pathologist will look at the cells taken during the biopsy to identify the stage of cancer. Then the urologist and tumor board will determine additional treatment options.

These are the main stages of prostate cancer. 

  • Stage 1: Cancer is only in the prostate gland. The tumor is not detected by an imaging test or physical exam. Generally, the five-year survival rate is almost 100 percent.
  • Stage 2: Cancer is only in the prostate gland. Cancer cells have a higher Gleason score and may quickly grow. Generally, the five year survival rate is 100 percent.
  • Stage 3: Cancer has moved only to the seminal vesicles nearby. Cancer has not moved to other organs. Generally, the five-year survival rate is almost 100 percent.
  • Stage 4: Cancer has spread to other parts of the body, such as the lymph nodes, lungs, liver, bones, or bladder. Generally, the five-year survival rate is about 29 percent.

As technology to treat prostate cancer continually advances, the survival rates are even greater than those established about 15 years ago and listed above.

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