Prostate Cancer Detection, Diagnosis and Staging

• Detection
  Men should have annual prostate screenings when they turn 50. Men at higher risk, including African Americans, men with a family history of the disease and obese men, should start being screened when they're 45. Screening can detect prostate cancer early, before symptoms develop. Prostate cancer caught then can almost always be treated effectively.
  • Prostate-Specific Antigen Test
    Prostate-specific antigen, or PSA, is a substance produced in the prostate and found in the blood. PSA is tested by drawing a sample of blood. Levels under 4 nanograms per milliliter are normal, 4 to 10 nanograms per milliliter are intermediate and more than 10 nanograms per milliliter high. Elevated PSA levels can indicate prostate inflammation, infection and benign prostatic hyperplasia in addition to prostate cancer. The test simply indicates a problem that should be examined more closely.

  • Digital Rectal Examination
    In a digital rectal exam the physician inserts a gloved finger in the rectum and feels the prostate to detect lumps or abnormal areas indicating possible prostate cancer.

• Diagnosis
  • Transrectal Ultrasound
    Transrectal ultrasound bounces sound waves off the prostate and measures the echoes to produce a sonogram image of the prostate. The procedure is usually performed in conjunction with a biopsy.

  • Biopsy
    Biopsy is the removal of some of the suspected mass for examination by a pathologist who checks for cancer cells and, if they are found, determines how aggressively the cancer is growing.
    • Transrectal Biopsy - In a transrectal biopsy a needle guided by an ultrasound image is inserted through the rectum into the prostate to remove a small sample of suspected tissue.
      
    • Transperineal Biopsy - In a transperineal biopsy a needle is inserted in the skin between the scrotum and rectum and into the prostate to retrieve a sample of suspected tissue.

  • Gleason Grading
    Tissue removed through transrectal or transperineal biopsies is microscopically examined by a pathologist. Because healthy prostate cells all have the same shape and appearance, the pathologist can determine how far the disease has progressed by how much the cancer cells' appearance differs from the appearance healthy cells. The Gleason grading system assigns levels of one through five to the degree of difference. Cancer most like healthy cells is ranked one and the most changed cancer cells are ranked five. The pathologist assigns Gleason grades the most common pattern of cancer cells and the next most common. The two grades are added together to get the Gleason score. Generally, the higher the number of the Gleason score, the more aggressive the cancer.

  • Staging diagnostics
    After prostate cancer is confirmed, tests and scans are often used to determine if, and how far, the cancer has spread to other parts of the body. This determines the stage of the cancer, and is used to help doctors decide on the appropriate treatment.
    • Radionuclide Bone Scan - Radionuclide bone scans are used to find out if there are rapidly-dividing cells (such as cancer cells) in the bones. A small amount of radioactive material is injected intravenously and concentrates in the bones where it is detected by a scanner.

  • CT Scan
    A computerized tomography (or CT or Cat) scan can provide a more-detailed image of prostate. CT scans are a series of X-rays combined by a computer in a cross-section view. They can be performed with injected contrast material to highlight suspicious masses. Since the basic imaging mechanism of a CT scan is X-rays, patients receive a low dose of radiation during the procedure. The radiation dosage is significantly lower with low-dose helical CT scans, but masses detected with this technology must be reexamined.

  • A computerized tomography (or CT or Cat) scan can provide a more-detailed image of prostate. CT scans are a series of X-rays combined by a computer in a cross-section view. They can be performed with injected contrast material to highlight suspicious masses. Since the basic imaging mechanism of a CT scan is X-rays, patients receive a low dose of radiation during the procedure. The radiation dosage is significantly lower with low-dose helical CT scans, but masses detected with this technology must be reexamined.

  • MRI
    Magnetic resonance imaging (or MRI) uses magnetism, radio waves and computer image manipulation to produce an extremely detailed image without radiation. Because of the extremely powerful magnetism of MRI scanners they cannot be used on patients with any metal implants or pacemakers.

  • PET Scan
    Positron-emission tomography (or PET) scans are three-dimensional images of the metabolic functioning of body tissues. PET scans can be used to determine the type of cells in a mass and to detect whether or not a tumor is growing. Patients receiving PET scans are injected with a radioactive drug with about as much radiation as two chest X-rays.
    • Seminal Vesicle Biopsy - In seminal vesicle biopsy a needle is inserted into the glands that produce semen to extract liquid which is examined for the presence of cancer cells.

• Staging
  • Stage I
    Cancer is in the prostate only, and too small to be felt in a digital rectal examination. Stage I prostate cancer is most often discovered during surgery for some other condition, such as benign prostatic hyperplasia. The Gleason grading system score of stage I prostate cancer is usually low.

  • Stage II
    Cancer is in the prostate only, but larger than stage I.

  • Stage III
    Cancer has spread beyond the prostate to nearby tissue such as the seminal vesicles.

  • Stage IV
    Cancer has spread to other parts of the body. Metastatic prostate cancer often invades the bones, bladder, rectum, liver or lungs.