How Prostate Cancer Is Diagnosed And Staged
Cancer staging helps you and your doctor understand how advanced your cancer is and how much it has spread at the time of diagnosis. Knowing your cancer stage also helps your doctor determine the best treatment options for you and estimate your chance of survival.
The most widely used staging system for cancer is the TNM system that classifies cancer from stage 1 to stage 4.
TNM stands for:
- Tumor: the size and extent of the tumor
- Nodes: the number or extent of nearby lymph node involvement
- Metastasis: whether cancer has spread to distant sites in the body
The TNM scale is used for many types of cancer. When a doctor uses it to determine your prostate cancer stage, theyll consider several other factors as well, including:
Bladder And Urinary Troubles
A prostate tumor that has grown significantly in size may start to press on your bladder and urethra. The urethra is the passage the carries urine from your bladder out of your body. If the tumor is pressing on your urethra, you might have trouble passing urine.
One of the common areas for prostate cancer to spread to is the bladder, because the two organs are close. This can cause additional problems with urination and bladder function.
Some symptoms your bladder and urethra are being affected by cancer include:
- urinating more frequently
- getting up in the middle of the night to pee
- feeling like you have to urinate often and not actually passing anything
Its not as common, but prostate cancer can also spread to your bowel. The cancer first spreads to the rectum, which is the part of your bowel closest to the prostate gland.
Symptoms of cancer thats spread to the bowels include:
Soreness In The Groin
When prostate cancer spreads, its common for cancer cells to go to your lymph nodes and then move to more areas of your body. The lymph nodes are a network of glands that help your body filter fluids and fight infections.
There are several lymph nodes in your groin. These are the ones closest to your prostate, so its common for the cancer to spread to them first. Cancer cells prevent your lymph nodes from draining fluid and working properly. When this happens, your lymph nodes swell. As a result, you might experience pain or soreness in the area.
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Options For Dealing With Recurrence
With a persistently increasing PSA, the suspicion for recurrence increases. The most important factor in assessing your long-term outcome is determining the location of the prostate cancer cells producing the PSA. Advanced imaging techniques, such as MRI and PSMA PET/CT, are often helpful in learning where the cancer is located, and in the case of post-radiation recurrence, repeat biopsy may be required.
If a man underwent surgery as an initial treatment, revisiting the post-operative pathology report may help to identify what contributed to the recurrence. If there was still cancer present , the cancer was aggressive , or genomic profiling of the tumor showed high-risk features, several options are available:
- EBRT to the prostate bed with or without the pelvis.
- EBRT accompanied by hormone therapy. The duration of hormone therapy will depend on the PSA level just prior to radiation and to a lesser extent on the Gleason score and staging of the cancer.
- Systemic treatment using hormone therapy, other treatments for those at risk for metastatic disease, or a combination.
- Active surveillance if the remaining cancer appears insignificant. You and your doctor can decide whether to intervene more aggressively and, if so, when.
If you’re seeking additional or different approaches, you may be eligible to participate in an appropriate clinical trial . You can research this with the help of your doctor.
Prognosis For Prostate Cancer
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
Prostate cancer often grows slowly and even more aggressive types tend to grow more slowly than other types of cancer. If diagnosed early, prostate cancer has one of the highest five year survival rates.
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Living With Prostate Cancer
As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.
Nevertheless, it can have an effect on your life. As well as causing physical problems such as erectile dysfunction and urinary incontinence, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.
You may find it beneficial to talk about the condition with your family, friends, a family doctor and other people with prostate cancer.
Financial support is also available if prostate cancer reduces your ability to work.
Read more about living with prostate cancer
Does Prostate Cancer Have Any Symptoms
Most men with early prostate cancer dont have any signs or symptoms.
One reason for this is the way the cancer grows. Youll usually only get early symptoms if the cancer grows near the tube you urinate through and presses against it, changing the way you urinate . But because prostate cancer usually starts to grow in a different part of the prostate, early prostate cancer doesnt often press on the urethra and cause symptoms.
If you do notice changes in the way you urinate, this is more likely to be a sign of a very common non-cancerous problem called an enlarged prostate, or another health problem. But its still a good idea to get it checked out. Possible changes include:
- difficulty starting to urinate or emptying your bladder
- a weak flow when you urinate
- a feeling that your bladder hasnt emptied properly
- dribbling urine after you finish urinating
- needing to urinate more often than usual, especially at night
- a sudden need to urinate you may sometimes leak urine before you get to the toilet.
If prostate cancer breaks out of the prostate or spreads to other parts of the body , it can cause other symptoms, including:
- back pain, hip pain or pelvis pain
- problems getting or keeping an erection
- unexplained weight loss.
These symptoms can all be caused by other health problems. But its still a good idea to tell your GP about any symptoms so they can find out whats causing them and make sure you get the right treatment, if you need it.
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Prostate Cancer Caregiver Podcast Series
We are proud to announce a new podcast series geared toward helping give support, hope and guidance to prostate cancer caregivers. The goal of this Prostate Cancer Caregiver Podcast Series is to help others connect with a diverse group of people who have felt the impact of prostate cancer in their lives and empower them on their journey.
Basic Information About Prostate Cancer
Cancer is a disease in which cells in the body grow out of control. When cancer starts in the prostate, it is called prostate cancer. Except for skin cancer, prostate cancer is the most common cancer in American men.
Many men with prostate cancerespecially those with tumors that have not spread beyond the prostatedie of other causes without ever having any symptoms from the cancer. Overall, about 96% of men who are diagnosed with prostate cancer are still alive five years later.
Cancer screening means looking for cancer before it causes symptoms. There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are a prostate specific antigen test and a digital rectal examination .
Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you.
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It’s About More Than Just Cancer
Jerry Deans knows this feeling all too well. Itâs been more than 22 years since Deans found out that he had prostate cancer. In 1999, when Deans was 55, a gut feeling to get a physical led to the diagnosis.
Nobody he knew had prostate cancer. Deans asked his doctor if he knew anyone he could connect with. Turns out, there were several people, but none of them were telling anyone about their condition.
âIf men are afraid of it, they’re not going to share it. just don’t call up on other men and say, âHey, I’ve got prostate cancer and I’m scared to death. What do I do about this?â They just don’t do that,â Deans says.
Instead, the tendency is to look it up on the internet. Deans says that can be overwhelming.
âIt’s like drinking out of a fire hose — you’re just overwhelmed by it all. So, you do need support of other people.â
Finding out that you have prostate cancer can take a toll on your mental health and cause:
- Feelings of isolation
- Lower self-worth
Right after his diagnosis, Deans underwent surgery, and the doctor told him he might have beaten this for good. So, Deans says he didnât bother reaching out to a support group.
Unfortunately, the cancer came back about a year later.
Despite radiation and chemotherapy, Deansâs levels of protein-specific antigen — a type of protein produced by prostate cells that can measure a cancer’s progression — kept climbing.
High Intensity Focused Ultrasound
HIFU is sometimes used to treat men and anyone with a prostate with localised prostate cancer that has not spread beyond their prostate.
An ultrasound probe inserted into the rectum releases high-frequency sound waves through the wall of the rectum. These sound waves kill cancer cells in the prostate gland by heating them to a high temperature.
The risk of side effects from HIFU is usually lower than other treatments.
However, possible effects can include impotence or urinary incontinence . Back passage problems are rare.
Fistulas are also rare, affecting less than 1 in every 500. This is because the treatment targets the cancer area only and not the whole prostate.
However, HIFU treatment is still going through clinical trials for prostate cancer. In some cases, doctors can carry out HIFU treatment outside of clinical trials. HIFU is not widely available and its long-term effectiveness has not yet been conclusively proven.
Read further information:
- Cancer Research UK: high intensity focused ultrasound for prostate cancer
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How Is Prostate Cancer Diagnosed
Screenings are the most effective way to catch prostate cancer early. If you are at average cancer risk, youll probably have your first prostate screening at age 55. Your healthcare provider may start testing earlier if you have a family history of the disease or are Black. Screening is generally stopped after age 70, but may be continued in certain circumstances.
Screening tests for prostate cancer include:
- Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum and feels the prostate gland, which sits in front of the rectum. Bumps or hard areas could indicate cancer.
- Prostate-specific antigen blood test: The prostate gland makes a protein called protein-specific antigen . Elevated PSA levels may indicate cancer. Levels also rise if you have BPH or prostatitis.
- Biopsy: A needle biopsy to sample tissue for cancer cells is the only sure way to diagnose prostate cancer. During an MRI-guided prostate biopsy, magnetic resonance imaging technology provides detailed images of the prostate.
What About Other Treatments I Hear About
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.
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Recurrent Prostate Cancer Symptoms
Prostate cancer that returns after treatment is considered recurrent. When it returns to the area around the prostate, the disease is classified as a local recurrence. If the cancer is found in another part of the body, the recurrent cancer is considered metastatic. If the cancer metastasizes outside the prostate, it most likely develops in bones first. Metastatic prostate cancer most often spreads to the liver, bones and lungs.
After initial treatment for prostate cancer, PSA levels are expected to drop dramatically. The first sign of recurrent prostate cancer may be a rise in the PSA level. Other symptoms of recurrent cancer may depend on whether and where the cancer has spread. Symptoms include:
- Blood in the urine
- Difficulty breathing
Patients should discuss any symptoms with their doctor and ask about scheduling regular PSA tests after treatment.
What Your Doctor Isnt Telling You About Prostate Cancer
For the last 2 years, while a panel of 16 scientists sat on its finding that prostate cancer is wildly overtreated, Ive been trying to persuade my friends not to listen to their doctors. It hasnt been easy.
Last week, the U.S. Preventative Services Task Forces recommendation finally hit the news: The group no longer recommends routine PSA testing for men.
Im glad the word is out. It makes my message easier to hear. And that message is: Are you confused? Good. Sos everybody.
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Seeking Help from PSA HellI underwent robotic surgery for prostate cancer 3 years ago, and wrote about my experience in Mens Health 2 years ago.
Since then Ive heard from several old friends whove been thrown into PSA Hell and want my advice. And why do they want my advice? Because each new doctor they see gives them a different story.
My friend John is a perfect case in point. Hed been getting an annual PSA test since the late 1990s, and when his number jumped up to 6.7nearly 3 points above normalback in January, his family doctor sent him to a urologist for a biopsy. As with many urologists, the Lack of Full Disclosure started here: The doctor didnt tell John that the standard procedure is sticking a hypodermic needle up your rectum and stabbing your prostate half a dozen times. John asked about a less painful alternative and was told he could get propofol beforehandthe IV drug used to induce anesthesia.
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Risk Factors For Prostate Cancer
Some risk factors have been linked to prostate cancer. A risk factor is something that can raise your chance of developing a disease. Having one or more risk factors doesn’t mean that you will get prostate cancer. It just means that your risk of the disease is greater.
- Age. Men who are 50 or older have a higher risk of prostate cancer.
- Race. African-American men have the highest risk of prostate cancerâthe disease tends to start at younger ages and grows faster than in men of other races. After African-American men, prostate cancer is most common among white men, followed by Hispanic and Native American men. Asian-American men have the lowest rates of prostate cancer.
- Family history. Men whose fathers or brothers have had prostate cancer have a 2 to 3 times higher risk of prostate cancer than men who do not have a family history of the disease. A man who has 3 immediate family members with prostate cancer has about 10 times the risk of a man who does not have a family history of prostate cancer. The younger a man’s relatives are when they have prostate cancer, the greater his risk for developing the disease. Prostate cancer risk also appears to be slightly higher for men from families with a history of breast cancer.
- Diet. The risk of prostate cancer may be higher for men who eat high-fat diets.
Questions To Ask The Doctor
- What treatment do you think is best for me?
- Whats the goal of this treatment? Do you think it could cure the cancer?
- Will treatment include surgery? If so, who will do the surgery?
- What will the surgery be like?
- Will I need other types of treatment, too?
- Whats the goal of these treatments?
- What side effects could I have from these treatments?
- What can I do about side effects that I might have?
- Is there a clinical trial that might be right for me?
- What about special vitamins or diets that friends tell me about? How will I know if they are safe?
- How soon do I need to start treatment?
- What should I do to be ready for treatment?
- Is there anything I can do to help the treatment work better?
- Whats the next step?
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Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the ‘stage’ of your prostate cancer . The stage of the cancer will determine which types of treatments will be necessary.
A widely used method of staging is a number staging system. The stages are:
- stage 1 the cancer is very small and completely within the prostate gland
- stage 2 the cancer is within the prostate gland, but is larger
- stage 4 the cancer has spread into the lymph nodes or another part of the body, including the bladder, rectum or bones about 20 to 30% of cases are diagnosed at this stage
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
Read further information:
- Cancer Research UK: the stages of prostate cancer