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.
Thinking About Taking Part In A Clinical Trial
Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.
Imaging Tests For Prostate Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. One or more imaging tests might be used:
- To look for cancer in the prostate
- To help the doctor see the prostate during certain procedures
- To look for spread of prostate cancer to other parts of the body
Which tests you might need will depend on the situation. For example, a prostate biopsy is typically done with transrectal ultrasound and/or MRI to help guide the biopsy. If you are found to have prostate cancer, you might need imaging tests of other parts of your body to look for possible cancer spread.
The imaging tests used most often to look for prostate cancer spread include:
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Medical History And Physical Exam
If your doctor suspects you might have prostate cancer, you will be asked about symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors, including your family history.
Your doctor will also examine you. This might include a digital rectal exam , during which the doctor inserts a gloved, lubricated finger into your rectum to feel for any bumps or hard areas on the prostate that might be cancer. If you do have cancer, the DRE can sometimes help tell if its only on one side of the prostate, if its on both sides, or if its likely to have spread beyond the prostate to nearby tissues. Your doctor may also examine other areas of your body.
After the exam, your doctor might then order some tests.
When Should I Have A Prostate Check
Generally, if you aged 50 years or older and have any urinary symptoms, you should let your doctor know. They will discuss with you whether or not you should have a prostate check.
Symptoms include:
If you have no symptoms, it is recommended that you get checked if you:
- you are a man aged 5070 years old but dont have any family history
- you are a man aged 4070 years old and your father or brother has had prostate cancer
- you are a man aged more than 70 years old and you have family history of prostate cancer or you have had an abnormal PSA test previously, and you have a life expectancy of more than 10 years.
Having a prostate check is your decision. The tests for prostate cancer can be uncomfortable but they may reduce your chance of being harmed or dying from prostate cancer.
If your test results suggest you are at risk of cancer, you will need to decide whether to have further testing and possibly treatment. In making this decision, you will need to consider whether your quality of life will be better living with a slow growing cancer than having treatments, which may cause you more harm than the cancer ever will.
Your doctor can help you weigh up the benefits and risks of being tested, by taking into consideration factors such as your age and family history.
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What Is Screening For Prostate Cancer
Some men get a PSA test to screen for prostate cancer. Talk to your doctor, learn what is involved, and decide if a PSA test is right for you.
Cancer screeningexternal icon means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.
If you are thinking about being screened, learn about the possible benefits and harms of screening, diagnosis, and treatment, and talk to your doctor about your personal risk factors.
There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.
Transrectal Magnetic Resonance Imaging
This test is done to see whether the cancer has spread to other tissues that are nearby apart from the prostate. The test uses radio waves, a magnet, and a computer to create pictures of your bodys internal parts. This test uses a probe that is inserted inside your rectum. Through this test, your doctor can see your prostate and the tissues nearby.
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Mri Ultrasound Targeted Prostate Biopsy
Magnetic resonance imaging guided biopsies are also being used more frequently, with ultrasound or alone, to help guide a prostate biopsy. MRI scans are capable of revealing potentially cancerous areas in more detail than ultrasound.
Studies have emerged suggesting that fusing the two techniques using MRI to identify suspicious areas before the transrectal ultrasound and biopsy procedure might identify cancer more accurately than a TRUS biopsy alone. For example, a landmark study led by researchers at the National Cancer Institutes urologic oncology branch found that the MRI-fused ultrasound technique detected more aggressive prostate cancer and fewer low-risk prostate cancers.
A joint statement issued by the American Urological Association and Society of Abdominal Radiologists supports fused MRI-ultrasound for men on active surveillance men who, along with their doctors, have opted to watch a slow-growing cancer rather than treat it aggressively and for men who have received elevated PSA test result but whose previous biopsies have tested negative for cancer. 30659-0/fulltext” rel=”nofollow”> 4)
What Are The Prostate Cancer Symptoms I Need To Look Out For
In its early stages, prostate cancer may not show any symptoms. Symptoms of early prostate cancer can include:
- difficulty passing urine
- a slow, interrupted flow of urine
- frequent passing of urine, including at night
Symptoms associated with advanced prostate cancer include:
- pain during urination
- lower back or pelvic pain.
These symptoms are also found in men who may have benign prostatic hyperplasia , a common, non-cancerous enlargement of the prostate gland.
If you experience these symptoms, visit your doctor.
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Understanding Your Mri Results
A doctor who specialises in imaging scans gives the MRI scan a score based on the results. This score helps your doctor decide on the next step and whether you need to have a biopsy. This is where your doctor takes a sample of your prostate gland.
This score is called the Likert or PI-RAD system. It estimates the risk that an area seen on the MRI scan may be a cancer or not. The score is from 1 to 5.
| Likert score | |
|---|---|
| Its highly unlikely that you have prostate cancer | |
| 2 | Its unlikely that you have prostate cancer |
| 3 | Its difficult to tell from the scan if a prostate cancer is present or not |
| 4 | Its likely that you have prostate cancer |
| 5 | Its very likely that you have prostate cancer |
What Symptoms Should I Look Out For
If your cancer does come back, the first sign is likely to be a rise in your PSA level, rather than any symptoms. And problems will often be side effects of treatment rather than a sign that your cancer has come back.
However, its important to let your doctor or nurse know if you do get any new symptoms or side effects, or are worried that your cancer might have come back. If your cancer has come back and has spread from the prostate to other parts of the body, it can cause symptoms, such as extreme tiredness rel=nofollow> fatigue), bone pain and problems urinating.
Your doctor or nurse can help find out what might be causing your symptoms and help you manage any side effects. They can also look at your PSA level and do other tests to see whether or not your cancer might have come back.
What other tests might I have?
If your doctor or nurse is concerned about your PSA level or if you have new symptoms that suggest your cancer might have come back, they may recommend that you have some other tests, such as a prostate biopsy, MRI scan, CT scan, bone scan or PET scan.
Your doctor or nurse will explain these tests to you if you need them, or you can get in touch with our Specialist Nurses for more information.
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Growth Of Cancer Cells
Depending on different factors such as the health of the patient and side effects, the doctor can decide to check for the presence of cancer cells on the prostate. The prostate gland is located just close to the rectum.
The doctor will use a lubricated and gloved finger to feel the growth of the cells. The finger is driven through the rectum to the prostate for the doctor to feel if there are cells on the prostate gland. It is rather an uncomfortable but simple process.
What Do The Results Mean
PSA levels may be above the baseline for various reasons other than prostate cancer.
Other that can raise PSA levels include:
- an enlarged prostate because of benign prostatic hyperplasia , for example
- prostatitis, which is inflammation and swelling of the prostate
Also, people with obesity may have lower PSA readings.
In addition, some medications may reduce PSA levels, including:
- 5-alpha-reductase inhibitors, which can help treat BPH
- aspirin, which some people take regularly as a blood thinner
- statins, which help manage cholesterol levels
- thiazide diuretics, a kind of water pill that can help reduce high blood pressure
Some herbal medicines and supplements can also lower PSA levels. A person should tell their doctor about any medications and supplements they take before undergoing the test.
High PSA levels alone do not indicate cancer. However, if a DRE also reveals changes, a doctor may recommend a biopsy for a more accurate result.
Some newer tests the results of the PSA test. They can help assess the risk for people with borderline scores to decide if they need further intervention.
The Prostate Health Index combines the results of:
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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 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
- 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
Side Effects Of Radical Prostatectomy
The most common side effects of the procedure are incontinence and erectile dysfunction . The incontinence, though common early after surgery, usually goes away. Whether erectile function returns depends on whether the nerves surrounding the prostate can be spared at surgery, patient age and baseline function. Men who are older or already have erection problems are most likely to have erectile dysfunction afterward.
For more information on erectile dysfunction and treatment, see Managing Erectile Dysfunction A Patient Guide.
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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.
Should I Poop Before A Prostate Exam
You dont need to change any bathroom habits prior to your appointment. If you feel like you need to poop before your exam, then its fine to do so. But dont worry if you just dont have the urge. The prostate exam shouldnt make you feel like you need to go.
Theres no need to be embarrassed about fecal matter during your prostate exam. Your healthcare provider is experienced in performing this exam and will do everything to ensure your comfort during the process.
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The Number Of Diagnoses Is Falling
While prostate cancer can be a grim diagnosis, its important to know more and more individuals with prostate cancer recover, and that the annual rates of prostate cancer deaths have fallen steadily since 1999. From 1993 to 2016, the number of prostate cancer deaths dropped by more than half. Indeed, the 5-year survival rate for local or regional prostate cancer is nearly 100 percent.
How Prostate Cancer Is Diagnosed
There are many tests used for diagnosing prostate cancer. Not all tests described here are commonly used for every person. Your doctor may consider these factors when choosing a diagnostic test:
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The type of cancer suspected
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Your signs and symptoms
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Your age and general health
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The results of earlier medical tests
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What Is A Prostate/rectal Ultrasound
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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What Tests Might I Have At The Hospital
If youre given an appointment with a hospital specialist, they may do some of the tests you had at the GP surgery again. You may also have other tests, including the following.
Symptom questionnaire
You might be asked to fill in a short questionnaire about your symptoms. This is called the International Prostate Symptom Score and is used to see how bad your symptoms are and how much they are bothering you.
Urine flow test
Youll be asked to urinate into a machine that measures the speed of your urine flow. Men with an enlarged prostate usually have a slower flow than other men. Youâll need a full bladder for the test. The doctor or nurse will tell you how much to drink before you have the test. They may also ask you not to urinate for two to three hours before the test.
Ultrasound scan
This shows how much urine your bladder can hold, and if it is emptying properly. You may have the scan straight after the urine flow test to see how much urine is left in your bladder after you urinate. You may also have an ultrasound scan to look at your kidneys.
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