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How Prostate Cancer Is Diagnosed

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Diagnosis Of Prostate Cancer

Making Decisions After Being Diagnosed with Early Stage Prostate Cancer | UCLAMDChat

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.

Can Prostate Cancer Be Found Early

Screening is testing to find cancer in people before they have symptoms. For some types of cancer, screening can help find cancers at an early stage, when they are likely to be easier to treat.

Prostate cancer can often be found early by testing for prostate-specific antigen levels in a mans blood. Another way to find prostate cancer is the digital rectal exam . For a DRE, the doctor puts a gloved, lubricated finger into the rectum to feel the prostate gland. These tests and the actual process of screening are described in more detail in Screening Tests for Prostate Cancer.

If the results of either of these tests is abnormal, further testing is often done to see if a man has cancer.

Prevalence Of Prostate Cancer

Prostate cancer is the second most common cancer in U.S. men and is the second leading cause of cancer death in men. One in nine men born in the U.S. today will be diagnosed with prostate cancer during his lifetime. The risk of dying from prostate cancer, however, is much lower, at one in 41. Your individual risk depends on your risk factors. Continue reading this document to better understand your particular risk.

The American Cancer Society has estimated that more than 248,000 new cases of prostate cancer will be diagnosed each year in the United States and more than 33,000 men will die from the disease. The death rate for prostate cancer is twice as high for African American men as for the general population.

Most cases are diagnosed when men are in their 60s and 70s , although prostate cancer is sometimes detected in men in their 50s or younger. The good news is that the five-year survival rate for all stages of prostate cancer has increased from 69% to almost 99% over the past 20 years. These rates vary depending on the extent of disease. Reasons for this improvement include increased public awareness, earlier detection though screening with prostate specific antigen blood tests, and advances in the treatments for this cancer.

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Detecting Cancer Through Pet Imaging

In addition to a new biopsy approach, a new imaging test is now available through Lifespan Medical Imaging at Rhode Island Hospital.

Once a patient has been diagnosed with prostate cancer, the physician must also determine if disease has spread to other areas in the body. This is based on various factors . If a patient is found to be at high risk for metastatic disease or has already undergone prostate cancer treatment but demonstrates elevated serum prostate antigen levels during a follow up visit, he would qualify for a type of scan known as PSMA PET imaging prostate-specific membrane antigen positron emission testing.

PSMA PET imaging allows for more precise detection of prostate cancer in the body for better treatment planning and targeted care. This exam uses a new imaging agent that is far superior to earlier agents to detect prostate cancer that may have spread to other parts of the body. For more information on PSMA PET imaging and other imaging studies, visit our website.

What If I Am Diagnosed With Prostate Cancer

Prostate Cancer Stages

Many people have been where you are standing. Dont lose hope. More than 3.1 million American men have been diagnosed with prostate cancer and are alive today.

The first thing you should consider doing is to find out about the specifics of your cancer. You should know your stage and grade .

From there you can find out what treatment options you want to pursue, if any. Talk to your doctors. Choose a healthcare team of different specialists, or consult a second opinion. You can also do your own research, or talk to men who have been in your position. Many of our advocates are patients and survivors hear their stories at the video library. Or head to the rest of our website to start some research.

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Prostate Cancer Screening Controversy

The effectiveness of a cancer screening program depends on a number of factors. The malignancy must be detectable with minimal harm and cost, and early diagnosis must be able to improve the quantity and quality of the patient’s life. An effective treatment for the cancer must be available, and this treatment should have few side effects. Finally, treatment of the asymptomatic patient must provide a better outcome than treatment after the disease has become clinically evident.

At this time, prostate cancer screening does not fulfill all of the requirements for an effective screening program. Some evidence shows that, compared with screening by rectal examination alone, routine screening of asymptomatic patients with PSA testing and digital rectal examinations detects a higher percentage of cancers that are localized to the prostate.2 However, both the American Academy of Family Physicians3 and the U.S. Preventive Services Task Force4 recently recommended against the use of routine prostate cancer screening for two reasons: early prostate cancer detection has no proven benefit and the potential side effects of treatment may outweigh the benefits. In contrast, the American Cancer Society and the American Urological Association5 recommend the use of a PSA-based screening program to detect prostate cancer in men 50 years of age and older.

Take Time To Make A Treatment Decision

Most prostate cancers grow relatively slowly, so immediate treatment is rarely necessary. Many men can safely take months to decide what to do. The decision process can be complicated. The chosen treatment can significantly affect your life, which makes it especially important to take time to educate yourself and confidently choose the approach that is most appropriate for you.

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Trus Prostate Biopsy: The Key For Pca Diagnosis

TRUS-guided systematic biopsy has been the standard diagnostic test for PCa since a landmark study in 1989 which showed that it was superior to digitally directed biopsy sampling of the prostate . However, because needle positioning relative to tumor location is essentially random, TRUS biopsy has a false negative rate of 15%46% and a tumor undergrading rate of up to 38% when compared with the final Gleason score at radical prostatectomy . It has been also shown that random TRUS biopsy detects low grade indolent cancer and this may lead to overtreatment.

Thus urologists need to improve the selection of patients requiring a biopsy and evaluate their technique to identify and hit potential aggressive lesions.

A Note On Suspicious Results

Mayo Clinic Q& A podcast: What happens after a prostate cancer diagnosis?

A suspicious result indicates that the biopsy sample contained some abnormalities but no cancer was found. There are a couple of potential explanations for a suspicious prostate biopsy result, including:

  • Prostatic intraepithelial neoplasia refers to changes within prostate cells that are abnormal, but not indicative of cancer. This condition is low-grade or high-grade, depending on how abnormal the cells are. Low-grade PIN is very common and isn’t associated with prostate cancer. High-grade PIN, however, is associated with a higher risk of prostate cancer. If you have high-grade PIN after a prostate biopsy, your doctor may recommend that biomarker tests be performed on the sample to learn more about the cells. Alternatively, another prostate biopsy may be suggested.
  • Atypical small acinar proliferation indicates that the biopsy sample contains some cells that appear to be cancerous, but not enough to confirm the diagnosis. In most cases, this finding suggests that another prostate biopsy is needed.
  • Proliferative inflammatory atrophy describes a prostate biopsy that reveals inflammation in the prostate and abnormally small prostate cells. While these cells arent cancerous, having PIA may be associated with an increased risk of developing prostate cancer.

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Prostate Health Index Testing

The Prostate Health Index test is a diagnostic blood test that combines free and total PSA and the pro-PSA isoform . The PHI test is intended to reduce the number of unnecessary prostate biopsies in PSA-tested men. In prospective multicenter studies, the PHI test has outperformed free and total PSA for detection of prostate cancer and has improved prediction of clinically significant prostate cancer in men with a PSA of 2 or 4 ng/mL to 10 ng/mL.

Tests To Diagnose And Stage Prostate Cancer

Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.

If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.

The actual diagnosis of prostate cancer can only be made with a prostate biopsy .

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Recent Advances: Molecular Markers

Currently, risk stratification for men who have recently been diagnosed with prostate cancer by biopsy is accomplished with the combination of prostate-specific antigen level, clinical stage, and Gleason score or Grade Group. The limitation of using these parameters for risk stratification is that collectively they do not address specific biologic features of prostate cancer, specifically the aggressiveness of tumor cells. In addition, many studies have shown that localized prostate malignancy can vary in potential for progression in different patients, despite similar risk-stratifying characteristics.

This problem has sparked the advent of research and use of biological/genomic assays to help risk stratify men diagnosed with localized prostate cancer. The theory behind utilizing genomic assays is to identify genes in biopsy specimens that potentiate cellular proliferation.

Cooperberg et al aimed to validate the application of the cell cycle progression score in identifying men at risk for recurrent disease after radical prostatectomy. The CCP score identifies genes that promote cellular proliferation. In this study, the CCP score was compared with the Cancer of the Prostate Risk Assessment post-Surgical , which risk stratifies recurrence after prostatectomy based on pre-procedural PSA, Gleason score, and clinical staging, and has been shown to have good accuracy.

References

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Prostate Cancer: the common type of cancer in men

Net survival represents the probability of surviving cancer in the absence of other causes of death. It is used to give an estimate of the percentage of people who will survive. Stage Iv D2 Prostate Cancer Life Expectancy Overview Stage Iv D2 Prostate Cancer Life Expectancy A large prostate affects the way the bladder empties. This causes problems such as urinary tract infections, bladder stones, incontinence, and acute urinary retention. An acute inability to urinate can be a medical emergency and should be treated by a. The five-year life expectancy for those with advanced stages varies considerably, but the five-year overall survival rate is 98% after surgery. Lung Cancer Life Expectancy.

For the 43% of people who are diagnosed at an early stage, the 5-year survival rate is 31%. If liver cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 11%.

The five-year life expectancy for those with advanced stages varies considerably, but the five-year overall survival rate is 98% after surgery. Lung Cancer Life Expectancy. Prostate Enlargement . Symptoms of prostatitis also can signal more serious conditions, including prostatecancer. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses.

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What To Expect During A Prostate Biopsy

Your biopsy will be performed by a urologist in an outpatient surgery center. The entire procedure usually takes about 15 minutes or less and you’ll receive a local anesthetic for minimal discomfort. While lying on your side, an ultrasound probe will be inserted into the rectum. This probe provides a clear visual of the prostate and allows the physician to guide the very fine biopsy needle into the prostate.

Using the needle, the physician will take tiny tissue samples-called cores-from different areas of the prostate. These cores are the width of only four threads. The samples are sent to a uropathologist, who determines if there is cancer present. If cancer is present, the uropathologist gives the cancer a Gleason score.

Approach To Prostate Cancer Screening

Patients generally should be evaluated by a urologist if physical examination of the prostate reveals any area of asymmetry, nodularity or induration, because up to 50 percent of these findings will be caused by prostate cancer.8 The problem with using only the digital rectal examination as a screening tool is that it does not detect cancers before they have spread beyond the prostate. More than 50 percent of prostate cancers diagnosed by digital rectal examination have spread locally or have metastasized to lymph nodes or bone.

The approach to screening has been revolutionized by the discovery of PSA as a serum marker that is 70 to 80 percent sensitive for prostate cancer. This serum marker is a protein made only by prostate cells. Serum PSA levels are proportional to either the total volume of prostate tissue or the amount of irritation in the prostate . Either increased volume or irritation causes PSA to spill from the prostate into the bloodstream.

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Once a patient reaches 70 years of age or competing comorbid conditions limit survival beyond 10 to 15 years, consideration can be given to terminating prostate screening as long as the patient remains asymptomatic.

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Gleason Score And Grade Group

Grading Your CancerOne important component of staging your cancer is the grade of the cancer. While the stage of your cancer looks at where the cancer is present in your body , the grade describes what the actual cancer cells …

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Does It Matter Where Treatment Is Performed

Life Expectancy with Prostate Cancer Diagnosis

A large body of evidence shows that in the case of surgery for prostate cancer, surgical experience matters greatly. Medical centers and surgeons performing a high number of prostatectomies per year demonstrate better outcomes in terms of both cancer control and quality of life than those performing relatively low numbers. We don’t have similar data regarding radiation outcomes, but performing brachytherapy well certainly requires expertise and experience, particularly in prostate ultrasound. Planning and administering EBRT effectively has many subtleties, which likely translate to better outcomes with more experienced doctors. No matter what the practice volume of specific surgeons or radiation oncologists, they should be able to discuss their own demonstrated outcomes both in terms of cancer control and quality of life.

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Concerns About Prostate Cancer Screening

If prostate cancer is found as a result of screening, it will probably be at an earlier, more treatable stage than if no screening were done. While this might make it seem like prostate cancer screening would always be a good thing, there are still issues surrounding screening that make it unclear if the benefits outweigh the risks for most men.

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:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

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When Further Treatment Is Needed

While prostate cancer diagnosis and treatment have improved significantly in recent years, the cancer can still recur. That’s why it is essential that you and your doctor continue to monitor your PSA on a quarterly basis for some period of time, no matter how successful your treatment seems to be. Patients usually can consider a number of treatment options to treat or control recurrent cancer. Choosing among them requires a new decision-making process.

Understanding Your Biopsy Results

Prostate cancer

A specialist doctor called pathologist looks at the prostate samples under a microspore. The results usually take about 2 to 4 weeks.

You might have a negative biopsy. This means that no cancer cells were found. Your doctor might recommend another biopsy even if the first was negative. They’ll discuss this with you. This is because in some cases biopsies can miss cancer.

A positive biopsy means that they have found cancer cells. A pathologist then grades each sample of prostate cancer cells based on how quickly they are likely to grow or how aggressive the cells look. You may hear this being called the Gleason score or Grade Group.

Doctors now use the Gleason score and other information to divide prostate cancer into 5 groups. This is called the Cambridge Prognostic Group .

It can be difficult to understand what the Gleason score, Grade Group and CPG mean in your situation. We have more information about this, and you can ask your doctor and specialist nurse if you have any questions.

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