Unfortunately, prostate cancer has not been clearly linked to any preventable risk factors. Fortunately, however, the majority of men who are diagnosed with prostate cancer are still alive 5 years later. That is because prostate cancer is highly treatable. The most important thing is to detect prostate cancer early. This is why healthcare providers put such an emphasis on prostate cancer screening. The sooner it is diagnosed, the sooner prostate cancer treatments can started, and the higher the chances are that you will be able to go on living your life as close to normal as possible.
Prostate Specific Antigen Test
The PSA test is a blood test that checks for an antigen that is elevated in men with prostate cancer. The PSA is used both as a diagnostic tool and to monitor the progression of prostate cancer.
There are other benign conditions that can elevate the PSA score, so a high score does not mean you have prostate cancer. Not all men with prostate cancer have elevated PSA levels. Of men who have an elevated PSA score, only 25% of biopsies show cancer. The other 75% of men with elevated PSA levels do not have cancer.
Doctors monitor PSA levels to look for changes in prostate cancer, to see if it’s progressing, and to see if it’s recurred. An elevated PSA level may be the first sign of a prostate cancer relapse. There is no official normal amount of PSA and PSA levels can fluctuate. Types of cancer treatments and UTIs can change PSA levels.
While PSA levels aren’t a foolproof way to diagnose and monitor prostate cancer, the generally strong correlation between PSA levels and prostate cancer make it an important tool.
The American Cancer Society provides more information to help you understand your PSA levels.
Digital Rectal Exam
During a DRE, your doctor will feel your prostate with his or her finger. Doctors are looking for bumps or hard areas. An exam can help determine if cancer is on one side, both sides, or if it’s likely to have spread beyond the prostate. A DRE relies on the subjective impressions of the doctor conducting the exam.
Transrectal ultrasound
During a TRUS, a small probe about the width of a finger is inserted into the rectum. Ultrasounds use sound waves to create echos and turn them into an image of the inside of your body. A TRUS is usually done at your doctor’s office or an outpatient clinic and only takes about 10 minutes. It feels weird, but shouldn’t be painful. If you do experience any pain, the doctor can numb the area.
A newer alternative to TRUS is a Doppler ultrasound. This measures blood flow within the prostate gland. Prior to a Doppler ultrasound, some doctors will inject you with a contrast agent.
Prostate biopsy – The Test
During a core needle biopsy, your urologist will insert hollow needles into the prostate to collect tissue samples. A transrectal biopsy goes through the wall of the rectum. A transperineal biopsy goes through the skin between the scrotum and the anus. It’s uncomfortable, but not painful. Your doctor will usually numb the area first and each sample is taken in a fraction of a second. The procedure usually takes about 10 minutes. Your doctor will usually give you antibiotics to take before the procedure to reduce the risk of infection.
Doctors sometimes use an ultrasound to view the prostate while taking tissue samples. They may also use an MRI. This helps the doctors make sure the tissue samples they are collecting are from areas they are concerned about.
Afterward you’ll be sore and may notice blood in your urine or from your rectum. Blood in your semen may persist for weeks after the biopsy.
Prostate biopsy – The Analysis
Tissue from the biopsy is then examined under a microscope for cancer cells. The findings are written up in your pathology report. Because your prostate may contain cancer and the needles may not take a sample of that area of the biopsy, your doctor may do more than one biopsy if he or she is concerned about false-negative results.
Prostate biopsy – The Results
The pathology report will say how many samples were taken and how many contained cancer. It’ll say what percentage of each sample was made up of cancer cells. It will also say if the cancer is on one or both sides of your prostate.
Some cells may appear abnormal, but not cancerous. These suspicious areas are called prostatic intraepithelial neoplasia (PIN). Low-grade PIN looks mostly normal, high-grade PIN looks mostly abnormal. When high-grade PIN is found, 1 in 5 men will have cancer somewhere in their prostate, so doctors will conduct another biopsy.
When atypical small acinar proliferation (ASAP) is detected, a few cells look cancerous, but there aren’t enough of them to be certain. Doctors will conduct another biopsy, usually after a few months.
Proliferative inflammatory atrophy (PIA) is when prostate cells are unusually small and there’s inflammation. It’s believed that PIA increases your risk for high-grade PIN or possibly prostate cancer.
The American Cancer Society has a guide to understanding your pathology report.
If your doctor suspects the cancer may have spread outside your prostate, they’ll use imaging to see. If the likelihood that your cancer has spread is extremely low, they may decide not to put you through the hassle, discomfort, and expense of testing.
Gleason Score
Your Gleason score is a simple way to capture your cancer’s clinical stage and grade, using a number between 2 and 10. This is composed of your two Gleason grades. Normal prostate tissue is a grade 1, very abnormal tissue is a 5. Most cancers have a Gleason grade of 3 or higher.
Because prostate cancers have different areas with different grades, grades are assigned for the two areas that make up most of the cancer. The highest Gleason grade is always included, even if it’s just a tiny spot. These grades are then added together to form the Gleason score, or Gleason sum.
A Gleason score of 6 or lower is low-grade, 7 is considered intermediate-grade, and 8 to 10 is high-grade
.
Lymph node biopsy
Sometimes a lymph node biopsy is done as a separate procedure, usually when the prostate is going to be left in place but it’s suspected that the cancer might have spread to your lymph nodes. With a laparoscopic biopsy, a long tube with a camera and tools are inserted through small incisions in your abdomen. Recovery usually takes only a day or two and you’ll have very small scars. With fine needle aspiration (FNA) a sample of your cells from an enlarged lymph node will be taken using a long needle inserted through your skin. Your skin will be numbed with a local anesthetic. Generally, they’ll keep you in the clinic for a few hours after the procedure. But after this method of prostate cancer screening, you should feel back to normal in a day or two.
Computed tomography scan
A CT scan makes cross-sectional images of your body using x-rays. This helps doctors see if the cancer has spread to your lymph nodes, pelvis, or organs.
Bone Scan
Prostate cancer is known for spreading to lymph nodes and then the bones. Often it spreads to people’s lower spine. A bone scan is used to see if cancer has spread to your bones, before it causes damage and pain.
You’ll be injected with a small amount of radioactive material, which will settle in damaged areas of your bones. A picture is taken of your skeleton. This can identify suspicious areas, but doctors will use x-rays, CT scans, MRI scans, or biopsies to make a diagnosis.
Magnetic resonance imaging
An MRI scan uses radio waves and magnets to create images of the soft tissues in your body. They’ll sometimes inject you with a contrast material, gadolinium, to see things clearer. An MRI can provide a clear picture of the prostate and the area around it. Sometimes they’ll insert a probe, an endorectal coil, into your rectum for the scan. You can opt to be sedated if they use the probe, as it can be very uncomfortable.
Which Prostate Cancer Screening is Best for You?
Consulting with your general practitioner will be the best course of action to determine which method of screening for prostate cancer will be most applicable to your personal situation. Your GP will know the most about your and your family medical history and can account for these when deciding when to send you for screening and for which type.