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:
Risk Of Prostate Cancer
About 1 man in 8 will be diagnosed with prostate cancer during his lifetime.
Prostate cancer is more likely to develop in older men and in non-Hispanic Black men. About 6 cases in 10 are diagnosed in men who are 65 or older, and it is rare in men under 40. The average age of men at diagnosis is about 66.
Family History And Genetic Factors
It is estimated that about 20% of patients with prostate cancer report a family history, which may develop not only because of shared genes but also for a similar pattern of exposure to certain environmental carcinogens and common lifestyle habits . Several studies reported that inherited genetic background is associated with increased risk for prostate cancer, contributing to about 5% of disease risks . Particularly, this risk is increased by several folds when high-penetrance genetic âriskâ alleles are inherited, conversely to more common low-penetrance loci that increase the risk only modestly.
The X chromosome is also believed to have a role in prostate cancer inheritance, because it contains the androgen receptor and because small deletions in Xq26.3-q27.3 region were noted in sporadic and hereditary forms of prostate cancer . More recent studies in 301 hereditary prostate cancer affected families defined a number of other loci that may contribute to hereditary prostate cancer .
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Types Of Prostate Cancer
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Prostate cancer refers to an uncontrollable accumulation of cells in the prostate gland. When the cancer occurs it means the ability to control the multiplication, growth and death of prostate cells has been lost. The prostate cells form abnormal cells that join into masses known as tumors. Once formed, a tumor can remain at its original location and not spread to any location outside the prostate. Such a tumor is called a primary tumor. But some spread to other areas of the body outside the prostate and are called secondary tumors.
Screening For Prostate Cancer
There are no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer. However, early detection and treatment can significantly improve prostate cancer survival.
The test most commonly used to aid early detection of prostate cancer is the prostate specific antigen blood test. This is not a diagnostic test as it can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.
There are no proven measures to prevent prostate cancer.
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Questions You May Want To Consider Asking Your Doctor Include:
- What type of prostate problem do I have?
- Is more testing needed and what will it tell me?
- If I decide on watchful waiting, what changes in my symptoms should I look for and how often should I be tested?
- What type of treatment do you recommend for my prostate problem?
- For men like me, has this treatment worked?
- How soon would I need to start treatment and how long would it last?
- Do I need medicine and how long would I need to take it before seeing improvement in my symptoms?
- What are the side effects of the medicine?
- Are there other medicines that could interfere with this medication?
- If I need surgery, what are the benefits and risks?
- Would I have any side effects from surgery that could affect my quality of life?
- Are these side effects temporary or permanent?
- How long is recovery time after surgery?
- Will I be able to fully return to normal?
- How will this affect my sex life?
- How often should I visit the doctor to monitor my condition?
Aggressive Versus Indolent Prostate Cancer
While there are many types of prostate cancers, urologists usually break them down into aggressive and indolent categories to make it easier to determine the right treatment and to treat various types of cancers effectively. Aggressive cancer is a high-risk prostate tumor that if not treated remains highly active and very likely to spread to areas outside the prostate gland. The cancer grows quickly, spreads early, rapidly and widely, and causes increased damage in the body. Because aggressive cancer spreads as secondary deposits and can quickly result in widespread damage, it progresses rapidly to advanced stage cancer and can be very difficult to treat. So for aggressive prostate cancers to be treated successfully, they should be diagnosed early and treatment should be started when the tumors are still in their early stages.
On the other hand, indolent prostate cancer is a low-risk, slow-growing and low-volume tumor that can sit in the prostate gland for many years without causing any problems. An indolent cancer is not likely to spread outside the prostate even if not treated. But if it does, the spread will be local and slow. In fact, patients with indolent prostate cancers can live for 10-20 years without the cancer causing any serious effects on their lives.
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What Are Prostate Cancer Treatment Side Effects
Some prostate cancer treatments can affect the bladder, erectile nerves and sphincter muscle, which controls urination. Potential problems include:
- Incontinence: Some men experience urinary incontinence. You may leak urine when you cough or laugh, or you may feel an urgent need to use the bathroom even when your bladder isnt full. This problem can improve over the first six to 12 months without treatment.
- Erectile dysfunction : Surgery, radiation and other treatments can damage the erectile nerves and affect your ability to get or maintain an erection. Some men regain erectile function within a year or two . In the meantime, medications like sildenafil or tadalafil can help by increasing blood flow to the penis.
- Infertility: Treatments can affect your ability to produce or ejaculate sperm, resulting in male infertility. If you think you might want children in the future, you can preserve sperm in a sperm bank before you start treatments. After treatments, you may undergo sperm extraction. This procedure involves removing sperm directly from testicular tissue and implanting it into a womans uterus.
What Happens Without Treatment
Healthcare providers will sometimes talk about a particular diseases natural history or typical progression if it is left untreated indefinitely.
With regard to prostate cancer, most cases of the disease are discovered while the cancer is still confined to the prostate itself. This is called local disease or localized disease.
The disease is easiest to treat while it is confined to the prostate. At this stage, surgery and radiation are most likely to be curative and completely kill or remove whatever cancer cells are present.
If left untreated, however, prostate cancer can proceed on a number of different paths.
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Individualized Prostate Cancer Screening
Coltman says that men and their doctors can no longer rely on PSA levels alone when deciding whether to have a prostate biopsy.
The situation now is that the individual man with his individual urologist will have to assess what the person feels are his risk factors, he says. In consultation with his doctor, the individual man must come to grips with the question of whether or not a biopsy should be done. It will become a more personalized interaction.
Whos at high risk? Men with the following factors have the highest risk of prostate cancer:
- Age. A mans risk of prostate cancer increases with age.
- Race.African American men have the highest incidence of prostate cancer and the highest death rate from prostate cancer of any men in the world, Coltman says.
- Family history. A mans risk increases if his brother or father has had prostate cancer.
How Is Prostate Cancer Diagnosed
Medical interview and physical examination:
A proper medical interview eliciting a thorough medical history and a physical examination are essential in the diagnostic workup of any man in whom prostate cancer is suspected. He may be referred to a physician who specializes in urinary tract diseases or in urinary tract cancers . A man will be asked questions about his medical and surgical history, lifestyle and habits, and any medications he takes. Risk factors including family history of prostate cancer will be assessed .
Digital rectal examination is part of the physical examination: All men with firm swelling, asymmetry, or palpable, discrete, firm areas or nodules in the prostate gland require further diagnostic studies to rule out prostate cancer, particularly if they are over the age of 45 or have other risk factors for the disease .
Because urological symptoms can indicate a variety of conditions, a man may undergo further testing to pinpoint their cause. Initial screening tests include blood testing for PSA and urine testing for blood or signs of infection.
Prostate specific antigen :
PSA is an enzyme produced by both normal and abnormal prostate tissues. It may be elevated in noncancerous conditions, such as prostatitis and benign prostatic hypertrophy , as well as in cancer of the prostate. Therefore, confirmation of an elevated serum PSA is advisable prior to proceed to prostate biopsy.
The following standards have been set for PSA levels:
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Small Cell Prostate Cancer
Small cell prostate cancer is a subset of neuroendocrine cancer. It is made up of small round cells.
It is a high-grade malignant neoplasm, which is rare and affects less than 1% of the population. It is extremely lethal.
It is one of the most aggressive malignancies of the prostate with a survival rate of 1-2 years from the time it is diagnosed.
Where Prostate Cancer Spreads
If left untreated, diagnosed prostate cancer can grow and possibly spread outside of the prostate to local tissues or distantly to other sites in the body. The first sites of spread are typically to the nearby tissues.
The cancer can spread down the blood vessels, lymphatic channels, or nerves that enter and exit the prostate, or cancer could erode directly through the capsule that surrounds the prostate.
The seminal vesicles are a site of particularly common early spread. More extensive local spread can occur with cancer invading the nearby bladder or rectum.
Further advancement of cancer can occur when cancer cells enter the blood vessels and lymphatic channels. Once cancer has entered into these vessels, prostate cancer cells can seed into virtually any other part of the body.
Prostate cancer is known to have a particular affinity for spreading or metastasizing to the bones especially the lower spine, pelvis, and femur. Other organs such as the liver, brain, or lungs can also be the sites of spread, but these are much rarer.
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Basal Cell Prostate Cancer
You might hear this described as adenoid cystic prostate cancer, or basaloid carcinoma. These can be mixed with common prostate cancer.
Basal cell prostate cancer is very rare and we dont know very much about it.
Basal cells dont produce PSA, and most men with basal cell prostate cancer have normal levels of PSA in their blood. This means that a PSA test probably wont help to diagnose basal cell prostate cancer.
Basal cell cancer can grow big enough to cause the urethra to narrow. This can cause difficulty urinating and blood in your urine. So basal call prostate cancer is often diagnosed when men have surgery called transurethral resection of the prostate to treat their urinary problems, as the tissue removed during surgery is looked at under the microscope.
We dont know how aggressive it is. Some studies suggest it isnt very aggressive. But other studies suggest it might be more aggressive than common prostate cancer.
You may be offered surgery, chemotherapy or radiotherapy to treat basal cell prostate cancer. Your treatment options will depend on how much the cancer has grown and whether it has spread to other parts of the body.
Your doctor or nurse will tell you what treatment options are available to you. Read more about how these cancers are treated below.
Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead it groups cancers into localized, regional, and distant stages.
- Localized: There is no sign that the cancer has spread outside the prostate.
- Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
- Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.
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Patients Reports May Aid Prostate Cancer Treatment Choice
But the genetic tests are pricey, around $3,000 or $4,000, and not necessarily covered by insurance. More problematic, they do not give a yes/no answer to whether cancer cells are harmless. Instead, they indicate whether a man has a very low, low, intermediate, or high risk of harboring an aggressive, metastatic cancer.
The problem is, genetic tests dont necessarily shift the risk much, said Mayos Karnes. A man might have a 30 percent risk of an aggressive cancer, before a genetic test, and the test might shift that to 35 percent. What you want is a test that tells you the risk is more like 0 percent or 100 percent.
Even short of perfection, however, genetic tests are offering men reassurance that they can choose active surveillance rather than treatment. Duane Foulkes, 70, recently sold the manufacturing business he founded near Madison, Wis., when, in late 2015, his PSA test came back over 5. It rose to above 9 three months later, and he had a biopsy at Mayo. His Gleason score of 6 concerned me at first, Foulkes said.
But a genetic test indicated that he had at most a slow-growing, non-aggressive type of cancer, Foulkes said, giving him confidence to choose active surveillance.
What Is A 5
A relative survival rate compares people with the same type and stage of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of prostate cancer is 90%, it means that men who have that cancer are, on average, about 90% as likely as men who dont have that cancer to live for at least 5 years after being diagnosed.
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What Is The Prognosis For People Who Have Prostate Cancer
Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.
What Are The Symptoms Of Bph And Prostate Cancer
BPH and prostate cancer have similar symptoms, so its sometimes hard to tell the two conditions apart. As the prostate grows for any reason, it squeezes the urethra. This pressure prevents urine from getting down your urethra and out of your body. Prostate cancer symptoms often dont start until the cancer has grown large enough to put pressure on the urethra.
Symptoms of both BPH and prostate cancer include:
- an urgent need to urinate
- feeling the urge to urinate many times during the day and night
- trouble starting to urinate or having to push to release urine
- weak or dribbling urine stream
- urine flow that stops and starts
- feeling like your bladder is never fully empty
If you have prostate cancer, you might also notice these symptoms:
- painful or burning urination
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Diagnostic Radiologic Procedure And Ultraviolet Light Exposure
The radiation generated from X-ray, CT and nuclear imaging is ionizing radiation that penetrates the tissue to reveal the bodyâs internal organs. However, ionizing radiation can damage DNA, and although cells repair most of the damage, sometimes small area may remain altered consequently leading to DNA mutations that may contribute to cancer development years down the road. The first study investigating the connection between low-dose ionization radiation from diagnostic X-ray procedures and risk for prostate cancer reported that exposure to a hip/pelvic X-ray significantly increased prostate cancer risk independently of other known risk factors such as family history of cancer . However, unless men were exposed to high doses of radiation during cancer treatment in youth, any increase in the risk for cancer due to medical radiation appears to be slight. Considering that the increase in high-dose imaging has occurred only since 1980 and the effects of radiation damage typically take many years to appear, this may explain the weak association between ionizing radiation and prostate cancer risk observed thus far.
Finally, exposure to solar UV radiation is inversely associated with both the incidence and mortality of prostate cancer . The biological explanation of this fact is based on the synthesis and physiological actions of vitamin D .