Last modified on May 22nd, 2020
Symptoms and Early DetectionIn its early stages, prostate cancer often causes no symptoms. When initial symptoms do occur, they may include any of the following: a need to urinate frequently, especially at night; difficulty starting urination or holding back urine; inability to urinate; and weak or interrupted flow of urine. If prostate cancer develops and is not treated, it can further cause the following symptoms: painful or burning urination; difficulty in having an erection; painful ejaculation; blood in urine or semen; loss of appetite and/or weight; and pain or stiffness in the lower back, hips, or upper thighs.In general, the earlier prostate cancer is detected, the better the outlook for the patient in terms of cure or arresting the cancer progression. The age at which screening for prostate cancer should begin is not known with certainty. However, the American Urological Association recommends that healthy men over the age of 40 should consider obtaining a baseline prostate cancer screening with a DRE and PSA test.Doctors use the following tests to detect prostate abnormalities, but these tests cannot emphatically show whether the abnormalities are cancerous or of a less serious condition. However, the results from these tests will assist the doctors to decide if further checks are necessary to detect the presence of prostate cancer.
Digital Rectal Examination (DRE)The DRE is the simplest, safest, and most cost-effective means of detecting prostate cancer, provided that the tumor is posteriorly situated and is sufficiently large to be perceptible. The DRE is performed with the man either bending over, lying on his side or with his knees drawn up to his chest on the examining table. The physician inserts a gloved finger into the rectum and examines the prostate gland, noting any abnormalities in size, contour or consistency. In addition to providing information about the size of the prostate, DRE can also reveal a number of features that may indicate prostate cancer. However, DRE is not the most effective way to detect an early cancer, so it should be combined with a PSA test.
Prostate-Specific Antigen (PSA)PSA is a glycoproteinn responsible for liquefying semen. The PSA test measures the level of PSA in the bloodstream, as it is only produced by the prostate. Very little PSA can escape from a healthy prostate into the bloodstream, but certain prostatic conditions such as benign (non-cancerous) enlargement of the prostate (BPH) and prostatitis (inflammation of the prostate) can cause larger amounts of PSA to leak into the blood.Approximately 25% of men with PSA levels above the normal range (greater than or equal to 4 ng/mL) have prostate cancer, and the risk increases to more than 60% in men with PSA levels above 10 ng/mL. It is however to be noted that PSA is by no means a perfect test, as many men with mildly elevated PSA values do not necessarily have prostate cancer.Of the two procedures, PSA is the single most effective screening test for early detection of prostate cancer as it is capable of detecting more than twice as many prostate cancers as DRE. However, evidences from research studies suggest that it is better to combine both test procedures to improve the overall rate of prostate cancer detection.
Biopsy and Staging of Prostate CancerIf initial tests show that prostate cancer might be present, the doctor may order further exams, including ultrasound and x-rays, to learn more about the cause of the symptoms. To actually confirm the presence of cancer, doctors must perform a prostate biopsy. The biopsy tissue taken will be examined by a pathologist. The pathologist will be able to confirm if cancer is present and if present be able to also grade the tumor to determine its degree of aggressiveness – how quickly it is likely to grow and spread. Doctors describe a tumor as low-, medium-, or high-grade cancer, based on the way it appears under the microscope.If cancer is found in the prostate by a prostate biopsy, then there is need for the doctor to stage the disease to determine the extent of the cancer (i.e., the “T” stage) and whether it has spread beyond the prostate gland to the surrounding tissues, the seminal vesicles, the lymph nodes and/or the bones. The T stage is determined by the DRE and other imaging studies of the prostate gland and surrounding tissues, such as ultrasound scan, CT scan, MRI scan, or MR spectroscopy scan.Advisedly, early detection and risk assessment of prostate cancer should be offered to men 40 years of age or older who wish to be screened. Knowing a man’s baseline PSA values in his 40s to compare with future PSA tests could help identify those men with life-threatening prostate cancer at a time when there are many treatment options and cure is possible. Also, if prostate cancer is detected on biopsy, all treatment options should be discussed. The benefits and risks of the many treatment options should be reviewed and discussed with men found to have prostate cancer.
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