The Digital Rectal Exam
The prostate gland comprises three zones. Most cancers originate in the peripheral zone. Proctologists, urologists, and oncologists are trained to feel this area while performing a digital rectal exam .
Here, digital doesnt refer to technology. Instead, it refers to the fingers . In a DRE, your doctor inserts a well-lubricated gloved finger gently into the rectum to reach the prostate. Prostate enlargement and suspicious lesions may be felt during a DRE.
How Are Prostate Problems Diagnosed
To diagnose prostate problems, the health care provider will perform a digital rectal exam . The health care provider will also ask the patient
- when the problem began and how often it occurs
- what symptoms are present
- whether he has a history of recurrent urinary tract infections
- what medications he takes, both prescription and those bought over the counter
- the amount of fluid he typically drinks each day
- whether he consumes caffeine and alcohol
- about his general medical history, including any major illnesses or surgeries
Answers to these questions will help the health care provider identify the problem or determine what medical tests are needed. Diagnosing BPH may require a series of medical exams and tests.
Transrectal Ultrasound With Prostate Biopsy
Transrectal ultrasound is most often used to examine the prostate. In a transrectal ultrasound, the health care provider inserts a transducer slightly larger than a pen into the mans rectum next to the prostate. The ultrasound image shows the size of the prostate and any abnormal-looking areas, such as tumors. Transrectal ultrasound cannot definitively identify prostate cancer.
To determine whether a tumor is cancerous, the health care provider uses the transducer and ultrasound images to guide a needle to the tumor. The needle is then used to remove a few pieces of prostate tissue for examination with a microscope. This process, called biopsy, can reveal whether prostate cancer is present. A transrectal ultrasound with prostate biopsy is usually performed by a doctor in a health care providers office, outpatient center, or hospital with light sedation and local anesthesia. The biopsied prostate tissue is examined in a laboratory by a pathologista doctor who specializes in diagnosing diseases.
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Choosing Between A Prostate Mri Vs Biopsy
Whats worse than a false-positive PSA? A false-negative biopsy.
Research shows that 35% of biopsy results are false negatives. This means despite the invasive sampling of tissues, cancer can go undetected and continue to grow while symptoms persist.
Thats why having a prostate MRI before a biopsy is preferable. It shows the location of potential cancer, which helps direct the biopsy sampling.
Before you decide to get a prostate MRI vs. biopsy, here are a few things to know.
What Should The Normal Volume Of Prostate Be
Normal volume of the prostate should be less than 30 ml. This is calculated by 0.52 x length x width x height. MRI imaging is helpful in differentiation the prostatic zonal anatomy . Special techniques are used to improve the early detection of prostate cancer such as DWI, dynamic-contrast enhanced MRI and MR
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Detecting And Diagnosing Prostate Cancer
Prostate cancer is often detected during the course of a routine prostate exam and/or the PSA blood test, but diagnosing it may require other procedures.
PSA test: PSA is a protein found in prostate cells that helps to keep semen liquified. Most cases of prostate cancer develop in these cells, so an elevated PSA count may be a sign of prostate cancer. However, PSA results are more of an indicator than a firm diagnostic tooltheres not a certain PSA score that means a man has prostate cancer. Instead, there are various ranges that are considered average for different age groups. If the PSA score is elevated for your age, further testing may be recommended.
PSA levels are measured as ng/mL. According to the ACS:
- Men with a PSA level between 4 and 10 have about a 25 percent chance of having prostate cancer.
- Men with a PSA level higher than 10 have more than a 50 percent chance of having prostate cancer.
Not all men with high PSA levels have prostate cancer. High levels may also be caused by a urinary tract infection, prostatitis or benign prostatic hyperplasia, all of which are noncancerous conditions. Conversely, men with a low PSA level may still develop prostate cancer.
PSA tests are not an indication of how aggressive the prostate cancer may be. Many prostate cancers are slow-growing and dont require immediate treatment.
The National Comprehensive Cancer Network suggests these screening guidelines and recommendations for men older than 45:
Screening For Prostate Cancer
Prostate cancer is typically treatable if caught early. More than 90 percent of prostate cancers are found when the disease is in the beginning stages, confined to the prostate and nearby organs.
Unlike screenings for breast and colon cancers, there are no universal screening guidelines for prostate cancer. The U.S. Preventive Services Task Force recommends that men age 55 to 69 weigh the benefits and risks before deciding whether they should undergo screening, which is typically performed with a blood test that measures levels of a protein called prostate-specific antigen .
However, men in high-risk groupssuch as those who are of African-American descent and/or have a first-degree relative diagnosed with prostate cancer before age 65should consider speaking with their doctor about starting screenings at an earlier age.
Men older than 70 shouldnt be routinely screened for prostate cancer, according to the USPSTF.
Regardless of age or risk factors, men should get checked if they suddenly experience issues with urination, erectile dysfunction or unexplained pain.
The USPSTF suggests that, before deciding on a screening, men should seek expert advice about the benefits and harms of screening. Risks may include:
- False positives
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What Is A Ct Scan
A CT scan is a test that uses x-rays and a computer to create detailed pictures of the inside of your body. It takes pictures from different angles. The computer puts them together to make a 3 dimensional image.
CT stands for computed tomography.
You usually have a CT scan in the x-ray department as an outpatient. A radiographer operates the scanner. The whole appointment can take up to an hour and a half depending on which part of your body they are scanning.
How Do Doctors Decide Which Imaging A Person Should Receive
We usually use CT first for most people, unless a tumor is much better seen on MRI. But we go back and forth as needed. If we see something on a CT scan were unsure about, we may recommend an MRI for further evaluation. If someone has several MRIs and is unable to lie still or hold their breath so we can get a good image, we may suggest a CT as an alternative. Were guided by the principle of whether the benefits of a test outweigh its risks. Thats what medical imaging is about.
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What Happens Before The Cat Scan
If a dye is required for your CAT scan, you may be instructed to have a blood test first. The purpose of the blood test is to make sure your kidneys will be able to get rid of the dye. Not getting this blood test may delay your CAT scan appointment.
Drink only clear liquids after midnight the night before your scan. Clear liquids include things you can see through . Examples include clear broth, tea, strained fruit juices, strained vegetable soup, black coffee, and ginger ale. You may also eat plain Jell-O.
Ct Scanner For Designing Individual Treatment Plans
A CT scan uses computer tomography to produce a 3-dimensional image of the prostate and surrounding organs. CT scans rely on computer-reconstructed X-rays to give a cross-sectional view of the body. A CT scan through the pelvis reveals the outline of the prostate. The arm of the CT scanner directs pinpoint-thin X-ray beans through the portions of the body under examination as it rapidly passes over the patient.CT scans can identify prostate enlargement and show the size and shape of the gland, but it is not as effective for assessing the extent of cancer or visualizing cancer within the gland itself, as is the case with color flow Doppler imaging. While CT scans provide less defined images of the internal architecture, CT images do accurately delineate the spatial relationship between the prostate, rectum and public bones. CT also can evaluate for lymph node spread. More contemporary spiral or helical CT scans provide greater resolution while taking less time to acquire the information.
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What Are The Benefits Of A Prostate Mri
The MRI scan can help find a cancer of the prostate gland, especially if you have elevated or rising PSA.
If a cancer has already been found, the MRI images can show whether it has spread outside the prostate gland or not. This can have a very important impact on whether or not you have treatment, and if so, which type of treatment you receive.
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How Is Prostate Cancer Diagnosed And Evaluated
Your primary doctor will ask about your medical history, risk factors and symptoms. You will also undergo a physical exam.
Many patients undergo regular prostate cancer screening before symptoms appear. Screening may involve one or more of the following tests:
- Prostate-specific antigen : This test analyzes a blood sample for levels of PSA, a protein the prostate produces. Higher PSA levels could indicate cancer is present.
- Digital Rectal Exam :This test examines the lower rectum and the prostate gland to check for abnormalities in size, shape or texture. The term digital refers to the doctors use of a gloved, lubricated finger to conduct the exam.
If screening test results are abnormal, your doctor may perform the following imaging tests:
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What Else Should I Know About This Test
- Although a CT scan is sometimes described as a slice or a cross-section, no cutting is involved.
- The amount of radiation you get during a CT scan is a good deal more than that with a standard x-ray.
- People who are very overweight may have trouble fitting into the CT scanner.
- Be sure to tell your doctor if you have any allergies or are sensitive to iodine, seafood, or contrast dyes.
- Tell your doctor if you could be pregnant or are breastfeeding.
- CT scans can cost up to 10 times as much as a standard x-ray. You may want to be sure your health insurance will cover this test before you have it.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
American College of Radiology/Radiological Society of North America. Body CT/CAT scan. September 23, 2014. Accessed at www.radiologyinfo.org/en/info.cfm?pg=bodyct on November 13, 2015.
American College of Radiology/Radiological Society of North America. Computed Tomography Abdomen and Pelvis. August 13, 2014. Accessed at www.radiologyinfo.org/en/info.cfm?pg=abdominct on November 13, 2015.
American College of Radiology/Radiological Society of North America. Computed Tomography landing page. Accessed at www.radiologyinfo.org/en/submenu.cfm?pg=ctScan on November 13, 2015.
Last Revised: November 30, 2015
How Prostate Cancer Is Diagnosed
A diagnosis of prostate cancer can involve screening tests such as a serum PSA or digital rectal exam, as well as procedures that can include MRI-TRUS fusion with targeted biopsy, or an ultrasound-guided random 12-core biopsy.
Based on biopsy findings, a Gleason score is used to describe the aggressiveness of the tumor.
Further tests, such as a CT scan, magnetic resonance imaging , bone scan, or PET scan may be done to stage the tumor. Since prostate cancers can differ in their tendency to grow or spread, staging is important in choosing the best treatments, determining the risk of recurrence, and estimating the prognosis of the disease.
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Finding Out If The Cancer Has Spread
To find out if cancer has spread outside of the prostate, doctors may perform the imaging tests listed below. Doctors are able to estimate the risk of spread, called metastasis, based on PSA levels, tumor grade, and other factors, but an imaging test can confirm and provide information about the cancers location.
Imaging tests may not always be needed. A CT scan or bone scan may not be necessary for those with no symptoms and low-risk, early-stage prostate cancer, as determined with information from the PSA test and biopsy. Learn more about when these tests are recommended to find out if the cancer has spread.
For people with advanced prostate cancer, ASCO recommends that 1 or more of the imaging tests below be done to provide more information about the disease and help plan the best treatment. This includes when there is a newly diagnosed, high-risk cancer if metastasis is suspected or confirmed if the cancer has returned following treatment or when the cancer grows during the treatment period. Learn more about this guideline on the ASCO website.
Magnetic resonance imaging . An MRI scan uses magnetic fields, not x-rays, to produce detailed images of the body. An MRI can be used to measure the tumors size, and a scan can focus specifically on the area of the prostate or on the whole body. A special dye called contrast medium is given before the scan to create a clearer picture, which is injected into a patients vein.
A Negative Ct Scan For Prostate Cancer Isnt Anything To Get Too Hopeful About Because A Ct Scan Can Actually Miss Prostate Cancer
Yes, a CT scan can miss prostate cancer, says Jonathan W. Simons, MD, President and Chief Executive Officer of the Prostate Cancer Foundation, David H. Koch Chair.
Dr. Simons explains, A CT scan is fundamentally a three-dimensional X-ray of the body. It does not intrinsically distinguish between cancer and normal tissue.
We therefore rely on anatomical changes to tell us the probability something is normal or is cancer.
For example, if a lymph node is normal in size it still has the potential to have cancer in it.
However, if a lymph node is enlarged it has a much higher probability there is cancer present, although not guaranteed.
Any imaging modality cant identify microscopic disease, so a CT scan, MRI scan and PET scan can miss prostate cancer that may have spread.
The presence of prostate cancer can be indicated by an abnormally elevated PSA blood test result or by a digital rectal exam .
These tests do not diagnose a malignancy they can only raise suspicion. Diagnosis is made only via a biopsy of tissue extracted from the prostate gland.
Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11 and 18F-DCFPyl , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body.
The pictures from a PET scan arent as detailed as MRI or CT scan images, but they can often show areas of cancer anywhere in the body. Some machines can do a PET scan and either an MRI or a CT scan at the same time, which can give more detail about areas that show up on the PET scan.
What Tests Can Find Prostate Problems
Some tests are routine, others need an appointment
The prostate is a walnut-sized gland in men that produces fluid that is a component of semen.
The gland has two or more lobes-or sections-enclosed by an outer layer of tissue. Located in front of the rectum and just below the bladder, where urine is stored, the prostate surrounds the urethra, which is the canal through which urine passes out of the body.
The most common prostate problem in men under 50 is inflammation or infection, which is called prostatitis. Prostate enlargement is another common problem.
Because the prostate normally continues to grow as a man matures, prostate enlargement, also called benign prostatic hyperplasia or BPH, is the most common prostate problem for men over 50. Older men are at risk for prostate cancer as well, but it is much less common than BPH.
Sometimes, different prostate problems have similar symptoms. For example, one man with prostatitis and another with BPH may both have a frequent, urgent need to urinate. Other men with BPH may have different symptoms. For example, one man may have trouble beginning a stream of urine, while another may have to get up to go to the bathroom frequently at night. A man in the early stages of prostate cancer may have no symptoms at all. This confusing array of symptoms makes a thorough medical examination and testing very important. Diagnosing the problem may require a series of tests.
Talking with your doctor or nurse
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