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How Do Doctors Check For Prostate Cancer

What Is The Prostate

How to Test for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

The prostate is a walnut-shaped gland that is part of the male reproductive system. It has two or more lobes, or sections, enclosed by an outer layer of tissue. The prostate is located in front of the rectum and just below the bladder, where urine is stored. It surrounds the urethra at the neck of the bladder and supplies fluid that goes into semen.

Why Is Active Surveillancethe Wait

We utilize active surveillance for men who have been diagnosed with a low-grade prostate cancer. The reason we monitor low-grade prostate cancer using active surveillance, rather than treating it aggressively, is that there are cancers that dont need treatment.

With low-grade prostate cancer, youre more likely to have problems from the treatment than from the prostate cancer. Any treatment we do for prostate cancer is going to affect a mans urinary and sexual function. It may affect it a little bitor a lot. With this type of prostate cancer, we can tell you now that theres very little likelihood the cancer is going to cause you any problems. We have a good and growing amount of evidence that low-grade prostate cancers, on average, progress very slowly and do not appear to spread to the lymph nodes. Active surveillance lets us detect higher grade disease and treat it at that point.

For us to do anything and treat it is going to change your quality of life. I think thats a powerful thing.

Types Of Imaging Studies

If your healthcare provider suspects your cancer might be spreading, they will likely order more imaging tests. A common imaging workup may include a bone scan and a CT scan of the abdomen and pelvis. An MRI might be done as well. Some research centers are also using magnetic MRIs or PET scans to further refine the staging of prostate cancer.

Prostate Cancer Doctor Discussion Guide

Get our printable guide for your next doctor’s appointment to help you ask the right questions.

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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 cancer and colon cancer, 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
  • Complications and side effects from biopsies to confirm a diagnosis
  • The possibility that a prostate cancer diagnosis wont extend lifespan or improve quality of life

What Do You Want Men To Know About Prostate Cancer

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The important thing to know is that, if you live long enough, you will probably get prostate cancer. If you live into your 80s, about 80 percent of men have some sort of prostate cancer. That doesnt mean theyre going to die from prostate cancer because, as a percentage, very few men die from prostate cancer. It means its important to be aware of it and consider screening early, so if its a high-grade type, we can identify it and treat it.

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What Is The Chance Of A Diagnosis Of Prostate Cancer

Around 17,000 new cases of prostate cancer are diagnosed each year in Australia. It affects mostly men in older age groups and is rare in men under 50 years of age.

The chance of developing prostate cancer is significantly higher in men who have a close relative with prostate cancer the risks are higher if the relative was diagnosed before the age of 60.

If you have a family history of prostate cancer, talk to your doctor.

What Kind Of Treatment Will I Need

There are many ways to treat prostate cancer. The main kinds of treatment are observation, active surveillance, surgery, radiation, hormone therapy, and chemo. Sometimes more than one kind of treatment is used.

The treatment thats best for you will depend on:

  • Your age
  • Any other health problems you might have
  • The stage and grade of the cancer
  • Your feelings about the need to treat the cancer
  • The chance that treatment will cure the cancer or help in some way
  • Your feelings about the side effects that might come with treatment

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How Do I Screen For Prostate Cancer

There are two main early stage screening methods a digital rectal exam , and a blood test measuring PSA levels. PSA screening is regarded as the best method to screen for prostate cancer in men over 40 or those of a certain risk factor.

While men might be intimidated by a DRE, itâs a quick and safe screening technique used by a physician, and should cause no significant pain.

A Digital Rectal Exam is a simple, painless and quick procedure. A physician inserts a gloved and lubricated finger into the rectum and feels the prostate to identify if the prostate is enlarged, has lumps or is an abnormal texture compared to a healthy example.

Although this procedure is a very clear indicator of prostate health, the entire prostate canât be examined during a DRE. This is why physicians will also take into account PSA blood work, health history, and other risk factors. Overall, itâs often difficult to detect prostate cancer early, itâs mostly found through PSA testing – so PSA screenings should be done regularly, starting at the age of 40-50.

What Is A Prostate/rectal Ultrasound

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A prostate or rectal ultrasound is an imaging test that uses sound waves tolook at your prostate or your rectum.

The healthcare provider uses a small probe called a transducer to make theimages of your prostate or rectum. The transducer is about the size of afinger. It is gently placed into your rectum, where it sends out soundwaves that bounce off your organs and other structures. The sound waves aretoo high-pitched for you to hear. The transducer then picks up the bouncedsound waves. These are made into pictures of your organs.

Your provider can add another device called a Doppler probe to thetransducer. This probe lets your provider hear the sound waves thetransducer sends out. He or she can hear how fast blood is flowing througha blood vessel and in which direction it is flowing. No sound or a faintsound may mean that you have a blockage in the flow.

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Who Should Get A Prostate Exam

Starting at age 50, all men should discuss prostate cancer screening with their doctor. The American Cancer Society advises men at higher risk to have this conversation at age 45.

Youre considered to have an increased risk if youre African-American or if a first-degree relative had prostate cancer before age 65. If more than one first-degree relative had prostate cancer before age 65, you might want to consider beginning prostate cancer screening even earlier.

The ACS estimates there will be about 26,120 men will die from it.

Prostate cancer is easier to treat before it spreads. However, some prostate cancers are so slow-growing that they dont always require treatment. A lot depends on your age and other factors.

Discuss your risk factors with your doctor, and ask if you should have a prostate exam as part of your yearly checkup.

What Are The Limitations Of Prostate Ultrasound Imaging

Men who have had the tail end of their bowel removed during prior surgery are not good candidates for ultrasound of the prostate gland because this type of ultrasound typically requires placing a probe into the rectum. However, the radiologist may attempt to examine the prostate gland by placing a regular ultrasound imaging probe on the perineal skin of the patient, between the legs and behind the scrotum of the patient. Sometimes the gland can be examined by ultrasound this way, but the images may not be as detailed as with the transrectal probe. An MRI of the pelvis may be obtained as an alternative imaging test, because it may be obtained with an external receiver coil.

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Why Is A Prostate

A PSA blood test is performed to detect or rule out prostate cancer. The amount of PSA in the blood is often higher in men who have prostate cancer. However, an elevated PSA level does not necessarily indicate prostate cancer. The U.S. Food and Drug Administration has approved the PSA blood test for use in conjunction with a DRE to help detect prostate cancer in men age 50 or older and for monitoring men with prostate cancer after treatment. However, much remains unknown about how to interpret a PSA blood test, its ability to discriminate between cancer and problems such as BPH and prostatitis, and the best course of action if the PSA level is high.

When done in addition to a DRE, a PSA blood test enhances detection of prostate cancer. However, the test is known to have relatively high false-positive rates. A PSA blood test also may identify a greater number of medically insignificant lumps or growths, called tumors, in the prostate. Health care providers and patients should weigh the benefits of PSA blood testing against the risks of follow-up diagnostic tests. The procedures used to diagnose prostate cancer may cause significant side effects, including bleeding and infection.

Special Types Of Psa Tests

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The PSA level from a screening test is sometimes referred to as total PSA, because it includes the different forms of PSA . If you decide to get a PSA screening test and the result isnt normal, some doctors might consider using different types of PSA tests to help decide if you need a prostate biopsy, although not all doctors agree on how to use these tests. If your PSA test result isnt normal, ask your doctor to discuss your cancer risk and your need for further tests.

Percent-free PSA: PSA occurs in 2 major forms in the blood. One form is attached to blood proteins, while the other circulates free . The percent-free PSA is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not.

If your PSA test result is in the borderline range , the percent-free PSA might be used to help decide if you should have a prostate biopsy. A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy.

Many doctors recommend a prostate biopsy for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. Using these cutoffs detects most cancers and helps some men avoid unnecessary biopsies. This test is widely used, but not all doctors agree that 25% is the best cutoff point to decide on a biopsy, and the cutoff may change depending on the overall PSA level.

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Getting A Prostate Biopsy

For some men, getting a prostate biopsy might be the best option, especially if the initial PSA level is high. A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. This test is the only way to know for sure if a man has prostate cancer. If prostate cancer is found on a biopsy, this test can also help tell how likely it is that the cancer will grow and spread quickly.

For more details on the prostate biopsy and how it is done, see Tests to Diagnose and Stage Prostate Cancer.

For more information about the possible results of a prostate biopsy, see the Prostate Pathology section of our website.

There Are Risks To Getting Prostate Cancer Tests And Treatments

If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.

Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.

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Screening Information For Prostate Cancer

Screening for prostate cancer is done to find evidence of cancer in otherwise healthy adults. Two tests are commonly used to screen for prostate cancer:

  • Digital rectal examination . A DRE is a test in which the doctor inserts a gloved, lubricated finger into the rectum and feels the surface of the prostate through the bowel wall for any irregularities.

  • PSA blood test. There is controversy about using the PSA test to look for prostate cancer in people with no symptoms of the disease. On the one hand, the PSA test is useful for detecting early-stage prostate cancer, especially in those with many risk factors, which helps some get the treatment they need before the cancer grows and spreads. On the other hand, PSA screening may find very-slow-growing prostate cancers that would never threaten someone’s life. As a result, screening for prostate cancer using PSA may lead to treatments that are not needed, which can cause side effects and seriously affect a person’s quality of life.

ASCO recommends that people with no symptoms of prostate cancer and who are expected to live less than 10 years do not receive PSA screening. For those expected to live longer than 10 years, ASCO recommends that they talk with their doctor to find out if the test is appropriate for them.

Other organizations have different recommendations for screening:

Treatment Risks And Benefits

Tests to Diagnose and Monitor Prostate Cancer

There are risks and benefits of each type of therapy.

Radiation therapy. Older studies show that about one-half of patients develop erectile dysfunction within 5 years of having radiation therapy. However, newer forms of radiation may have different outcomes.

  • Many men feel very tired at the end of the treatment period.
  • Erectile dysfunction is a common side effect and often gets worse over time.
  • Some men have side effects like urinary burning, urinary bleeding, frequent urination, rectal bleeding, rectal discomfort, or diarrhea during or shortly after the treatment.
  • More serious complications are rare. However, a degree of uncertainty goes along with radiation treatment. Since the prostate gland and the lymph nodes arent taken out, your doctor cant tell the exact size of the tumor. The cancer could come back many years after radiation treatment.

Radical prostatectomy. The short-term risks of this surgery are low if youre young and in good health.

The main risks of radical prostatectomy are incontinence and impotence.

Hormone therapy. Hormone therapy often is used in combination with other treatments. It does have side effects.

Chemotherapy. Chemotherapy has been shown to help some people who have advanced prostate cancer live longer.

Chemotherapy can have many side effects, including hair loss, nausea, fatigue, and loss of taste.

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Surgery For Prostate Cancer

There are many types of surgery for prostate cancer. Some are done to try to cure the cancer others are done to control the cancer or make symptoms better. Talk to the doctor about the kind of surgery planned and what you can expect.

Side effects of surgery

Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know so they can help you.

Psa Test: The Current Prostate Screening Standard

Before recommending when you should be screened for prostate cancer, yourdoctor will consider many factors, such as:

  • Age
  • Family history, particularly whether any of your family members have had prostate cancer
  • Race, as African-American men have a higher risk of developing prostate cancer

If your doctor determines you should undergo screening, he or she will mostlikely recommend the PSA test. For more than 30 years, the PSA test hasbeen the gold standard in prostate cancer screening. This simple blood testmeasures how much prostate-specific antigen is in your blood.

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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:

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