As many men with prostate cancer don’t exhibit symptoms, it is crucial that regular screening takes place. A PSA or digital rectal exam may raise suspicion of cancer and prompt further investigations.
An examination using biopsy is used to ascertain whether cancer cells have spread outside the prostate gland. This involves extracting small samples using needle and viewing them under a microscope.
Table of Contents
The PSA ( Prostate Specific Antigen ) test
Blood tests are the primary means to screen for prostate cancer. They measure prostate-specific antigen (PSA) levels in the blood; an increase above 4ng/mL indicates an enlarged prostate or cancerous condition.
The PSA test is much more sensitive than digital rectal examination or transrectal ultrasound and can detect prostate cancer much earlier. Unfortunately, however, it does not accurately detect all cases; most men with PSA values higher than 4 probably have benign prostatic hyperplasia (BPH), an enlargement of the prostate gland that can lead to symptoms like erectile dysfunction and urinary frequency.
After having undergone prostatectomy (surgery to remove the prostate), PSA levels should drop significantly below zero; however, due to remaining normal prostate tissue they won’t reach absolute zero; this lowest point of PSA is known as its “nadir.” If PSA levels rise beyond this mark, your doctor will consider this a sign of prostate cancer recurrence and may conduct further tests in order to ascertain if cancer has returned in your prostate or elsewhere in your body.
There are various blood and urine tests that can help your physician assess your risk for prostate cancer, such as the 4K score test, Progensa test and Confirm MDx. These can provide additional data that may assist them in deciding when and whether a biopsy should be performed and when additional testing is necessary.
The digital rectal exam (DRE)
Up until it reaches advanced stages, prostate cancer rarely exhibits symptoms. But if it becomes advanced enough to press on and block the urethra or leak, causing slow or interrupted urine flow, blood in urine and semen, painful ejaculation and frequent need to pass urine, particularly overnight, it may produce problems.
As part of its initial screening for prostate cancer, doctors offer both a PSA blood test and digital rectal exam (DRE). A DRE involves inserting gloved fingers into your rectum to assess your prostate for hard or lumpy areas – this may feel slightly uncomfortable, but is completely safe procedure that has been utilized over many years.
If your PSA level is high, additional tests may be necessary to diagnose prostate cancer. A TRUS scan produces a three dimensional image of your prostate that provides important details on where and what severity any tumors might be present. It may also determine if a biopsy needs to take place; this procedure involves extracting a small piece of prostate tissue and studying it under a microscope by either a urologist or general practitioner. Traditionally men participating in clinical trials required to undergo both DRE and PSA blood tests but now there is another available which measures your low risk. This blood test known as Prostate Health Index can determine if you may require one.
Prostate cancer typically strikes men between the ages of 60-70. With advances in prostate screening using PSA blood tests, more cases have been discovered early than ever before and treatments offer men a good chance at living normal lives after localized disease has been treated successfully.
Your doctor will insert a probe into the rectum to feel for any abnormally firm or enlarged areas of the prostate after administering an anesthetic suppository or topical anesthetic to numb the area, with minimal discomfort experienced during the test and no harmful radiation emitted by this process. A computerized image will then be produced of both your prostate and surrounding structures.
Power Doppler ultrasound can also help provide more clarity; it shows patterns of blood flow through tissues and can reveal whether a tumour has spread into adjacent structures. A CT scan of the pelvis may also provide invaluable information regarding any enlarged lymph nodes or tumors present.
Cancerous prostate cells can sometimes spread (metastasize) outside of their initial location through the prostate capsule and spread into nearby fatty tissue or the seminal vesicles, which sit behind it and supply some of the fluid used to produce semen. Assessing whether a tumour has only spread within its original site, for example to nearby lymph nodes or bones is vital when selecting appropriate treatment strategies.
If the results of an elevated PSA and DRE indicate potential prostate issues, the next step should be analyzing tissue samples under a microscope through a process called biopsy. A healthcare provider will use an ultrasound probe needle guide to select the area of prostate which needs sampling before an automated spring-loaded tool quickly inserts a needle into it; you may experience pressure or discomfort as this happens.
Once the needle has been removed, a pathologist (a doctor who examines prostate tissues) determines whether or not cancerous cells exist and their grade, using what appears under a microscope as determined by Gleason scores (recently simplified). A pathologist also takes a close look at what kind of effects cancer might cause should it spread outside of its capsule.
Your treatment depends on whether the cancer has spread beyond your prostate (metastasized). Sometimes the rate of growth of prostate cancer can be so slow that no intervention is necessary, instead opting for active surveillance involving physical exams, PSA blood tests and DRE scans as part of routine monitoring. If taking finasteride which lowers PSA blood levels a different kind of test will be conducted to assess risk for prostate cancer.