Individuals who develop problems with urination or have blood in the urine should always see their health care professional.
The two screening tests widely available include:
- DRE: Digital rectal exam is usually performed in a doctor’s office. The test is not painful, but is slightly uncomfortable. The health care worker generally asks you to lie down and then inserts a gloved finger into the rectum. To avoid discomfort the finger is lubricated and the prostate is examined. The size, shape, texture (hardness) of the prostate is assessed.
- PSA: Prostate specific antigen testing involves drawing a sample of blood and analyzing the levels. This substance is released from the prostate. Low levels of PSA are usually found in all men, but high levels may be an indication of a tumor, inflammation or infection of the prostate.
Screening using the DRE and PSA may help identify prostate cancer at an earlier stage.
- Ultrasound: If there is suspicion of a prostate mass, an ultrasound is often the next step. The ultrasound probe is gently placed in the rectum and the surface of the prostate can be analyzed. This small pencil shaped probe can reveal a significant amount of information regarding the texture of the prostate gland.
- Prostate Biopsy: This procedure is performed when a cancer is suspected. The biopsy is done in conjunction with an ultrasound. A very fine needle is used under ultrasound guidance. The tissue obtained is then analyzed under a microscope.
Overview of Staging of Prostate Cancer
Once the diagnosis of prostate cancer is made, staging is the next step. Staging determines how far the cancer has spread and is dependent on clinical findings and biopsy results. Most men with prostate cancer can proceed directly to treatment without further staging.
The typical tests to determine staging include the following:
- Bone scan is done to image the skeleton. Prostate cancer does have a tendency to spread to the spinal column and the scan can readily detect cancer deposits all over the body.
- Ultrasound of the prostate is often used to determine if the cancer has invaded the nearby rectum or spine.
- CT scan of the abdomen and pelvis is often used to determine invasion of lymph nodes, liver and other organs.
- Some individuals are sensitive to the dye used in CT scans and thus undergo Magnetic resonance imaging (MRI). MRI is just as sensitive as CT scan and can help detect the spread of tumor to nearby lymph nodes and tissues.
- Biopsy of the retroperitoneal lymph nodes is sometimes used to stage prostate cancer and can be performed under CT guided needle biopsy.
Grading of the Cancer
Today, prostate cancer is often graded based on its aggressiveness. The most common scale used to assess prostate cancer cells is known as the Gleason score. The prostate cancer cells are analyzed under a microscope and graded from 1-5. The higher the score, the more aggressive the cancer.
Stages of Prostate Cancer
Prostate cancer is staged as follows:
- Stage I: means that the cancer can only be identified using microscopic techniques. Stage I prostate cancer can not be palpated with the finger. The tumor is almost always cured at this stage if completely removed.
- Stage II: cancer can be felt with the finger but remains confined to the prostate.
- Stage III: means that the cancer has spread beyond the confines of the prostate into adjacent tissues.
- Stage IV: means that the cancer has spread to the lymph nodes, bone, lung or liver.