How Is Prostate Cancer Diagnosed
A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope.
A biopsy is a procedure that can be used to diagnose prostate cancer. A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope to see if there are cancer cells.
A Gleason score is determined when the biopsy tissue is looked at under the microscope. If there is a cancer, the score indicates how likely it is to spread. The score ranges from 2 to 10. The lower the score, the less likely it is that the cancer will spread.
A biopsy is the main tool for diagnosing prostate cancer, but a doctor can use other tools to help make sure the biopsy is made in the right place. For example, doctors may use transrectal ultrasound or magnetic resonance imaging to help guide the biopsy. With transrectal ultrasound, a probe the size of a finger is inserted into the rectum and high-energy sound waves are bounced off the prostate to create a picture of the prostate called a sonogram. MRI uses magnets and radio waves to produce images on a computer. MRI does not use any radiation.
Use In Men Already Diagnosed With Prostate Cancer
The PSA test can also be useful if you have already been diagnosed with prostate cancer.
- In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
- The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
- PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .
The Ajcc Tnm Staging System
A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The most widely used staging system for prostate cancer is the AJCC TNM system, which was most recently updated in 2018.
The TNM system for prostate cancer is based on 5 key pieces of information:
- The extent of the main tumor *
- Whether the cancer has spread to nearby lymph nodes
- Whether the cancer has spread to other parts of the body
- The PSA level at the time of diagnosis
- The Grade Group , which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy .
*There are 2 types of T categories for prostate cancer:
- The clinical T category is your doctors best estimate of the extent of your disease, based on the results of the physical exam and prostate biopsy, and any imaging tests you have had.
- If you have surgery to remove your prostate, your doctors can also determine the pathologic T category . The pathologic T is likely to be more accurate than the clinical T, as it is done after all of your prostate has been examined in the lab.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to get the overall stage of the cancer.
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How To Check Prostate Cancer
When youre checking for prostate cancer, its important to know the symptoms. When youre aware of the signs, prostate cancer can be caught early. Because prostate cancer doesnt typically show signs early on, prostate cancer testing typically involves a PSA blood test or digital rectal exams.
But, there are typically five major warning signs of prostate cancer however, as cancer progresses, symptoms typically involve the urinary system. Because the prostate is located close to the urethra and bladder, symptoms might include:
- Frequent urination
- Hip or back pain
- Leg swelling or weakness
Contact your doctor if you notice any of the above symptoms. And if you do catch any of these symptoms, try not to panic. These particular symptoms can often have to do with a non-cancerous prostate problem, as well as bladder infections.
Its important to know that there are also several different types of prostate cancer. The most common types found in prostate cancer patients include:
Should I Have A Prostate Cancer Screening Test
Routine testing for prostate cancer in all men without symptoms is not recommended in New Zealand at present. Being tested for prostate cancer is your choice. Learning about the pros and cons of prostate testing can help you decide if it is right for you.
To help you decide if a prostate check is right for you, the Ministry of Health has developed the Kupe website. It will help you understand the risks, benefits and implications of prostate testing, so you can have an informed conversation with your doctor.
If you are unsure about whether you need to get tested for prostate cancer, contact your GP for a discussion on the risks and benefits of testing.
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Research Into Prostate Cancer Screening
Research is ongoing to find other prostate cancer screening tests and ways to improve the current test. This includes:
- new blood and urine tests
- a combination of a blood test and other information such as age and family history
- MRI and other types of scans
More research is needed to find out whether these tests are reliable enough to detect prostate cancer.
Referrals From Your Gp
The symptoms of prostate cancer can be very similar to some other prostate problems, so it can be very difficult for GPs to decide who may have a suspected cancer and who may have something much more minor that will go away on its own.
There are particular prostate symptoms that mean your GP should refer you to a specialist straight away. The National Cancer Control Programme has produced guidelines for GPs in Ireland. The guidelines help GPs decide which patients need to be seen urgently by a specialist called a urologist. A urologist is a doctor who specialises in treating disorders of the urinary tract, including the kidney,, bladder and prostate.
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How Is The Psa Test Used In Men Who Have Been Treated For Prostate Cancer
The PSA test is used to monitor men after surgery or radiation therapy for prostate cancer to see if their cancer has recurred . If a mans PSA level begins to rise after prostate cancer treatment, it may be the first sign of a recurrence. Such a biochemical relapse typically appears months or years before the recurrence causes symptoms.
However, a single elevated PSA measurement in someone who has a history of prostate cancer does not always mean that the cancer has come back. Someone who has been treated for prostate cancer should discuss an elevated PSA level with their doctor. The doctor may recommend repeating the PSA test or performing other tests to check for evidence of a recurrence. The doctor may look for a trend of rising PSA level over time rather than a single elevated PSA level.
A rising trend in PSA level over time in combination with other findings, such as an abnormal result on imaging tests, may lead the doctor to recommend further cancer treatment.
Prostate Cancer: Advancements In Screenings
You may know thatprostate canceris one of the most common cancer types in men. The good news is that thereare many treatment and management options, even if the cancer is caught ata later stage.
What you may not know: There are several options when it comes toprostate cancer screening. After considering multiple factors, your doctor may recommend theprostate-specific antigen test, and/or one of the newer screeningtests that are now available.
Johns Hopkins urologistChristian Pavlovich, M.D., explains what you should know.
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Improving The Accuracy Of Psa
The need for an accurate marker is driven by the fear of unnecessary biopsies on the one hand, and the more danger risk of missing a treatable cancer on the other. Given the scepticism about the utility of aggressive screening programmes, we would certainly appreciate something more accurate than what we have.
There is no consensus on using any of the PSA modifications, and none of them has been shown to reduce the number of unnecessary biopsies or improve clinical outcomes. The total PSA cut-off of 4.0 ng/mL has been the most accepted standard because it balances the trade-off between missing important cancers at a curable stage and avoiding detection of clinically insignificant disease and subjecting men to unnecessary prostate biopsies . Ongoing efforts are targeted at identifying new serum markers that will have greater diagnostic accuracy for prostate cancer, particularly those that can predict aggressive tumours whose treatment will save lives .
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.
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Stages Of Prostate Cancer
Any T, any N, M1
Any Grade Group
The cancer might or might not be growing into tissues near the prostate and might or might not have spread to nearby lymph nodes . It has spread to other parts of the body, such as distant lymph nodes, bones, or other organs . The Grade Group can be any value, and the PSA can be any value.
Prostate cancer staging can be complex. If you have any questions about your stage, please ask someone on your cancer care team to explain it to you in a way you understand.
While the stage of a prostate cancer can help give an idea of how serious the cancer is likely to be, doctors are now looking for other ways to tell how likely a prostate cancer is to grow and spread, which might also help determine a mans best treatment options.
How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:
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Who Should Get A Psa Test
Not everyone should get a PSA test. Why? Because many in this country are treated for low-risk prostate cancer that is discovered through the PSA test, even when it is unlikely that the disease will ever cause symptoms or lead to death. And treatment is associated with significant side effects, including impotence and incontinence . You should discuss whether prostate cancer early detection is right for you with your personal primary care physician.
To avoid the risks of over-treatment, Roswell Park follows the guidelines established by the National Comprehensive Cancer Network . The NCCN brings together world-renowned experts from 30 of the nations top cancer centers to write guidelines that specify the best ways of preventing, detecting and treating cancer. The guidelines are updated at least every year, on the basis of the latest research.
Michael Kuettel, MD, PhD, MBA, Chair of Roswell Park’s Department of Radiation Medicine, serves on the NCCN Prostate Cancer Panel.
If you decide that Prostate Cancer Early Detection is right for you, the NCCN recommends PSA testing as follows:
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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.
Pros And Cons Of The Psa Test
- it may reassure you if the test result is normal
- it can find early signs of cancer, meaning you can get treated early
- PSA testing may reduce your risk of dying if you do have cancer
- it can miss cancer and provide false reassurance
- it may lead to unnecessary worry and medical tests when thereâs no cancer
- it cannot tell the difference between slow-growing and fast-growing cancers
- it may make you worry by finding a slow-growing cancer that may never cause any problems
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The Test Is Often Not Needed
Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:
- An enlarged prostate gland.
- Recent sexual activity.
- A recent, long bike ride.
Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.
Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.
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What Is A Dangerous Psa Level
PSA levels are measured as a number of nanograms in each milliliter of fluid tested. This is written as ng/mL.
- PSA level 2.5 ng/mL or lower: This is a normal PSA level for those under age 60, but in some cases, prostate cancer may still be present.
- PSA level between 2.5 and 4 ng/mL: This is a normal PSA level for most people.
- PSA level between 4 and 10 ng/mL: This indicates that prostate cancer might be present. At this level, there is about a 25% chance that you have prostate cancer.
- PSA level 10 ng/mL or above: There is a 50 percent chance that prostate cancer is present. The higher the PSA rises above 10 ng/mL, the greater the chance that you have prostate cancer.
Your doctor may also monitor your PSA velocity, or doubling time, which means recording your baseline PSA the level at your very first PSA test and seeing how fast the PSA level increases over time. Rapid increases in PSA readings can suggest cancer. If your PSA is slightly high, you and your doctor may decide to keep an eye on your levels on a regular basis to look for any change in the PSA velocity.
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Who Needs Screenings
Measuring the PSA level can increase the chance of finding prostate cancer when it is very early. But there is debate over the value of the PSA test for detecting prostate cancer. No single answer fits all men.
If you’re 55 through 69 years old, before having the test, talk to your provider about the pros and cons of having a PSA test. Ask about:
- Whether screening decreases your chance of dying from prostate cancer.
- Whether there is any harm from prostate cancer screening, such as side effects from testing or overtreatment of cancer when discovered.
- Whether you have a higher risk of prostate cancer than others.
If you are age 55 or younger, screening is not generally recommended. You should talk with your provider if you have a higher risk for prostate cancer. Risk factors include:
- Having a family history of prostate cancer
- Being African American