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 180,890 new cases of prostate cancer in the United States in 2016. 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.
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.
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.
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How Is A Recurrence Detected
After prostate cancer treatment, you will go for medical check-ups every few months as determined by your doctor. At each follow-up appointment, your doctor will order a blood test to measure PSA levels. This test helps your doctor detect a cancer recurrence. You will also be examined. New symptoms should be reported to the doctor, as these may prompt other testing.
When PSA test results suggest that the cancer has come back or continued to spread, X-rays or other imaging tests may be done, depending on your situation and symptoms. Your doctor may use a radioactive tracer called Axumin with a PET scan to help detect and localize any recurrent cancer so that it could be biopsied or treated.
Your doctor may also use a new drug called Ga 68 PSMA-11 in the scan which binds to PSMA-positive prostate cancer lesions in the tissues of the body so they can be targeted for treatment.
Why The Increased Risk
Doctors do not fully understand why Black males have a higher risk of getting and dying from prostate cancer than other males. However, they believe that genetics plays a role. Some people with prostate cancer report having other family members with a history of prostate cancer.
A 2021 study into the heredity of prostate cancer found 86 new genetic risk variants. The study found that men of African ancestry had an estimated mean genetic risk score more than two times higher than men of European ancestry.
Below is a list of risk factors that might account for the more aggressive prostate cancer in Black people.
- Obesity: Non-Hispanic Black males are more likely than non-Hispanic white males to have
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External Beam Radiation Therapy
With EBRT, radiation usually in the form of X-ray photons is focused from a source outside the body onto the prostate and, if needed, surrounding lymph node areas. In preparation for the therapy, internal markers are implanted in the prostate, using a procedure similar to prostate biopsy they’re used to help align and target the prostate with the radiation beam. A planning CT scan is then performed to locate the prostate gland in relation to the surrounding structures and organs. The resulting images are used to make a treatment plan that targets the prostate gland while protecting healthy surrounding tissues .
Most radiation today is given as a type of EBRT known as intensity-modulated radiation therapy , in which the shape and intensity of several fine radiation beams can be varied during treatment to minimize damage to surrounding tissues. At UCSF, patients also benefit from image-guided radiation therapy , where the prostate is imaged immediately before the start of each treatment session to verify and adjust the position of the gland for added accuracy. Stereotactic body radiation therapy, or SBRT , is a special type of IMRT/IGRT in which high doses of radiation are given over a small number of treatments .
The schedule for EBRT treatments varies. Treatment may be delivered in one of the following ways:
What Have Randomized Trials Of Prostate Cancer Screening Found
Several large, randomized trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and digital rectal exam were evaluated for their ability to decrease a mans chances of dying from prostate cancer.
The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but had about the same rate of deaths from the disease . Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment.
A second large trial, the European Randomized Study of Screening for Prostate Cancer , compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer .
The United States Preventive Services Task Force has estimated that, for every 1,000 men ages 55 to 69 years who are screened for 13 years :
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Prostate Cancer Stages And Survival Rate
The prostate cancer survival rate depends on which stage you are at when the diagnosis was done. When a diagnosis is done early and cancer hasnt spread to other parts of your body, then you can expect a positive result because treatment can be started immediately. However, if the cancer has advanced to other parts of your body then it depends on how much the cancer has metastasized in your body.
The prostate cancer stage is used to indicate how far your cancer has advanced to and it helps your doctor determine the right course of action to take for your treatment. The prostate cancer stages are 1, 2, 3, and 4 where stage 1 of prostate cancer is considered in its early stage while stage 4 is considered the most advanced stage of cancer. The Grade Group is dependent on the Gleason score and this information along with PSA levels help determine the prostate cancer stage.
Stage 1
In the first stage of prostate cancer, the cancer is only in the prostate. Your doctor might feel the cancer growth during the digital rectal exam usually on a part of one side of the prostate. Else, your doctor can find cancer through needle biopsy that was done due to high PSA levels. In stage 1, PSA levels are below 10 and the Grade Group is 1.
Stage 2
In the second stage, the cancer is relatively advanced but is still limited to the prostate. This stage is further divided into three stages stage 2A, 2B, and 2C.
Stage 3
Stage 4
Psa Blood Test For Prostate Cancer
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.
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How Do Doctors Diagnose Prostate Cancer
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Prostate cancer is the second most common cancer diagnosis in men, behind non-melanoma skin cancer. Its also one of the leading causes of cancer death in men. As medical technology advances, doctors can more accurately diagnose cases of prostate cancer in their patients. But how does this process work? If youre experiencing the symptoms of prostate cancer, your doctor may use some of the following methods to determine whether or not you have prostate cancer.
Diagnosis Of Prostate Cancer
When a digital rectal exam or a PSA test reveal abnormal results, the next step is further testing to determine whether prostate cancer is present, or another cause may be to blame.
Your doctor will evaluate your test results and any symptoms you may be experiencing and recommend the next tests you may need. The most common diagnostic tests for the prostate include:
Ultrasound: A transrectal ultrasound involves inserting a small ultrasound probe into the rectum. The ultrasound machine sends out sound waves and then measures the echoes that bounce back off body structures to create an image of the landscape of the structure. It can provide images that show the extent of prostate enlargement or abnormalities.
MRI: Magnetic resonance imaging is sometimes used to create a more detailed set of images than an ultrasound can provide. Results will be reported as a PI-RADS score.
- PI-RADS 1: very lowclinically significant cancer is highly unlikely to be present
- PI-RADS 2: lowclinically significant cancer is unlikely to be present
- PI-RADS 3: intermediatethe chance of clinically significant cancer is neutral
- PI-RADS 4: highclinically significant cancer is likely to be present
- PI-RADS 5: very highclinically significant cancer is highly likely to be present
Regardless of which procedure is used to take a sample, the prostate tissue is then examined under a microscope by a pathologist, to confirm the presence or absence of cancerous cells.
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A Doctors Failure To Diagnose Prostate Cancer
Your physician may be responsible for failing to diagnose prostate cancer if he or she failed to follow up with any of these symptoms and order additional testing:
If your cancer is now harder or even impossible to treat because of a delayed diagnosis, The Buchanan Firm may be able to help you hold your doctor accountable.
With a variety of medications available to treat some of the symptoms of prostate cancer, a doctor may just write a prescription for the symptoms rather than try to find out the real cause of your symptoms. If you told your doctor about any of the above symptoms and were prescribed medication for the symptom but later discovered you had prostate cancer, it may be grounds for a medical malpractice action.
If abnormal results are detected with a DGE or PSA test, your doctor should follow up with a biopsy to rule out prostate cancer. This is the only accepted test for confirming prostate cancer and should be performed after an abnormal DGE or PSA. There are also some other tests that may be performed to determine whether the cancer has spread, including:
A bone scan Blood tests Computerized tomography scan and An MRI .
If your doctor failed to follow up with a biopsy or additional tests to determine if you have prostate cancer and if it had spread, it may have impacted your ability to successfully fight cancer.
Should I Have A Psa Test
If you have no symptoms of prostate cancer and are thinking about having a PSA test, you should ask your doctor about the risks and benefits.
While some studies suggest PSA reduces mortality on a population basis, the test picks up large numbers of cancers that would have caused no symptoms or harm in the patient. This is known as overdiagnosis. Overdiagnosis of prostate cancer can lead to unnecessary treatments that have side effects such as sexual impotence, urinary incontinence and bowel problems.
It is important to balance the potential benefit of detecting a prostate cancer early against the risk that detection and treatment may not be necessary. Treatment may affect your lifestyle but it may also save your life.
Make your own decision about whether to be tested after a discussion with your doctor. Ensure you get good quality information to make an informed decision.
Screening tests for breast, bowel and cervical cancer can save lives, but there is still confusion around PSA testing for prostate cancer. Find more information here.
Remember, if you have any concerns or questions, please contact your doctor.
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What If My Test Results Are Abnormal
If the results of early detection tests like the PSA test or the digital rectal exam suggest that you might have prostate cancer, your doctor will conduct further testing. The PSA may be repeated, or you may be sent to a specialist for more tests such as a transrectal ultrasound and a prostate biopsy.
In a prostate biopsy, a tissue sample is taken from your prostate. Cancer can only be diagnosed with a tissue sample.
In addition to a PSA test, DRE , and a biopsy, research has yielded additional tests that can detect if cancer is present, and if so, how aggressive that cancer might be:
- The Prostate Health Index combines three blood tests that give a more accurate Phi Score, which gives accurate information based on a high PSA to better determine the probability of finding cancer during a biopsy.
When Is A Psa Test Needed
If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.
Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.
- You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
- Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
- If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
04/2014
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How Is A Digital Rectal Exam Performed
A DRE is a physical exam of the prostate. The health care provider will ask the patient to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies next to it. The DRE may be slightly uncomfortable, but it is brief. This exam reveals whether the prostate has any abnormalities that require more testing. If an infection is suspected, the health care provider might massage the prostate during the DRE to obtain fluid to examine with a microscope. This exam is usually done first. Many health care providers perform a DRE as part of a routine physical exam for men age 50 or older, some even at age 40, whether or not the man has urinary problems.