Medical History And Physical Exam
If your doctor suspects you might have prostate cancer, you will be asked about symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors, including your family history.
Your doctor will also examine you. This might include a digital rectal exam , during which the doctor inserts a gloved, lubricated finger into your rectum to feel for any bumps or hard areas on the prostate that might be cancer. If you do have cancer, the DRE can sometimes help tell if its only on one side of the prostate, if its on both sides, or if its likely to have spread beyond the prostate to nearby tissues. Your doctor may also examine other areas of your body.
After the exam, your doctor might then order some tests.
What Causes Prostate Cancer
Experts arent sure why some cells in the prostate gland become cancerous . Genetics appear to play a role. For example:
- Youre two to three times more likely to get prostate cancer if your father, brother or son has the disease.
- Inherited mutated breast cancer genes and other gene mutations contribute to a small number of prostate cancers.
What Is Cancer Screening
Screening means testing people for early stages of a cancer, or for early changes that could develop into cancer if left untreated. For screening to be useful the tests:
- need to be reliable at picking up cancers that need treatment
- overall must do more good than harm to people taking part
- must be something that people are willing to do
Screening tests are not perfect and have some risks. The screening programme should also be good value for money for the NHS.
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The Future Of Prostate Cancer Testing
An initial 2020 study with 72 participants found that a new blood test can diagnose prostate cancer, and identify its stage, with 99 percent accuracy.
This new test detects changes in the immune system which are identified in the blood of the patient. Alterations in the white blood cells are the primary signal for prostate cancer. Computer analysis of the blood sample can detect small changes which can indicate cancer.
Further research is needed into this method, before it becomes a recommended test. The next step is a larger study with more participants. If larger clinical studies verify the initial findings we may see this test come into use in the future.
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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Private Prostate Cancer Testing
Are you considering getting a private prostate cancer test? We can help.
to learn about how we diagnose and treat prostate cancer at The Royal Marsden, Private Care at Cavendish Square.
We offer consultant-led appointments, assessments and diagnostics all on the same day. Do you want to book a consultation at our one-stop urological cancer service? .
Psa Test: The Current Prostate Screening Standard
Before recommending when you should be screened for prostate cancer, yourdoctor will consider many factors, such as:
- Family history, particularly whether any of your family members have had prostate cancer
- Race, as African-American men have a higher risk of developing prostate cancer
If your doctor determines you should undergo screening, he or she will mostlikely recommend the PSA test. For more than 30 years, the PSA test hasbeen the gold standard in prostate cancer screening. This simple blood testmeasures how much prostate-specific antigen is in your blood.
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Radiation Therapy For Prostate Cancer
Radiation therapy is an effective treatment that kills prostate cancer cells by using high energy rays or particles. The radiation can be delivered in several ways, including brachytherapy and external beam radiation that projects the energy through the skin. Radiation therapy for prostate cancer is best delivered by experienced radiation oncologists who work in high volume centers of excellence.
Radiation therapy can:
- Treat both early stage cancers of the prostate gland and more advanced cancers that may have spread beyond the prostate
- Be used alone or with other treatments such as hormone deprivation
- Treat recurrent prostate cancer following surgery
- Treat men with limited spreading prostate cancer to reduce the tumors size and improve survival and quality of life
- Slow cancer growth, reduce fracture risk
- Be used as a palliative treatment to address pain from advanced cancer
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What Are The Risks Of Prostate Cancer Screenings
Because prostate cancer is often such a slow-growing disease, its possible that even if the cancer is found, it may not affect the length or quality of your life.
False positives can also be a concern. Its possible to have high PSA levels even though theres no cancer. So, for some patients, screening may lead to unclear results and ultimately unnecessary evaluation.
This is why its important to talk with your doctor about whether prostate cancer screenings are right for you. Theyll walk you through the risks and benefits of screening to help you make your decision.
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An enlarged prostate can also be the cause of other problems. If the enlarged prostate is causing symptoms, the best treatment would be a natural remedy. In the meantime, there are treatments for a wide range of conditions that cause a man to experience pain. A common surgical procedure involves an electric loop, laser, or electro-stimulation. The procedure is a safe and effective option for treating enlarged or symptomatic BPH.
Dre And Psa Screening Guidelines
Fred Hutchâs prostate cancer specialists recommend the following:
- Men under 40 â DRE and PSA screenings are not recommended for men at average risk.
- Men 40 to 54 â DRE and PSA screenings are not recommended for men at average risk.
- Men 55 to 69 â DRE, PSA or both screenings may be right for you. Talk with your doctor about the risks and benefits.
- Men 70 or older â DRE and PSA screenings are generally not recommended, but older men who are in excellent health may benefit from screening.
Talk with your doctor about screenings if:
- You have any questions about whether DRE or PSA is right for you.
- You have risk factors, such as a family history of certain cancers or inherited genetic mutations that may increase risk.
Fred Hutch prostate cancer doctors are well equipped to discuss the benefits and risks of screening and whether regular screenings are right for you.
A protein made by the prostate gland and found in the blood. Prostate-specific antigen blood levels may be higher than normal in men who have prostate cancer, benign prostatic hyperplasia , or infection or inflammation of the prostate gland.
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Finding Prostate Cancer Early
There is no national screening program for the early detection of prostate cancer. Doctors have different opinions about whether all men without symptoms of prostate cancer should be tested.
There is concern that testing healthy men will cause unnecessary harm and lead to treatments that may not offer long-term benefits. Treatment for prostate cancer can leave men with side effects such as erectile dysfunction and continence issues, which can affect their quality of life.
Testing may identify fast-growing or aggressive cancers that have the potential to spread to other parts of the body and would benefit from treatment. It may also detect very slow-growing cancers that are unlikely to be harmful.
Weigh up all the risks and benefits before deciding whether to be tested for prostate cancer, particularly if you dont have symptoms. Talking to your doctor can help.
How Is Prostate Cancer Treated
Lorenzo asked his doctors about survival and side effects and talked to friends and family members before deciding on treatment. He shares his story in this blog post.
Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are
- Expectant management. If your doctor thinks your prostate cancer is unlikely to grow quickly, he or she may recommend that you dont treat the cancer right away. Instead, you can choose to wait and see if you get symptoms in one of two ways:
- Active surveillance. Closely monitoring the prostate cancer by performing prostate specific antigen tests and prostate biopsies regularly, and treating the cancer only if it grows or causes symptoms.
- Watchful waiting. No tests are done. Your doctor treats any symptoms when they develop. This is usually recommended for men who are expected to live for 10 more years or less.
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When Should I Call My Healthcare Provider
If youre 50 and you havent had your first prostate exam yet, call your healthcare provider to set up an appointment. If youre at higher risk, such as if you’re Black or prostate cancer runs in your family, you should have your first prostate exam by age 45.
Furthermore, if you develop symptoms of urinary tract obstruction, schedule a visit with your provider right away. This may indicate an enlarged prostate, benign prostatic hyperplasia or a urinary tract infection.
A note from Cleveland Clinic
Most people are understandably apprehensive about their first prostate exam. Learning all you can about the process can help abate any fears or uncertainties you have. Talk to your healthcare provider about your screening options. A prostate exam is the first step in the early detection of prostate cancer and early detection is key to successful treatment.
Last reviewed by a Cleveland Clinic medical professional on 04/04/2022.
References
Other Items To Consider:
Should I choose surgery or radiation for my prostate cancer?
For men deciding between surgery and radiation for prostate cancer treatment, that may help you weigh the pros and cons of each option.
Genomic testing and prostate cancer
Genomic tests can help determine how aggressive your prostate cancer is, and this may influence your treatment decisions. Genomic testing can also help you and your doctor learn more about how your cancer might behave. By looking at the genetic makeup of the cancer, these tests may help predict whether your prostate cancer grows slowly or aggressively, therefore influencing treatment decisions.
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Seven Types Of Standard Treatment Are Used:
Watchful waiting or active surveillance
Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test.
Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life.
Active surveillance is closely following a patientâs condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer.
Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management.
Surgery
Patients in good health whose tumor is in the prostategland only may be treated with surgery to remove the tumor. The following types of surgery are used:
How Is Prostate Cancer Detected
There is no single test to detect prostate cancer. The two most common tests are the prostate specific antigen blood test and the digital rectal examination .
The PSA test measures the level of PSA in your blood. It does not specifically test for cancer. Virtually all PSA is produced by the prostate gland. The normal range depends on your age. A PSA above the typical range may indicate the possibility of prostate cancer. However, two-thirds of cases of elevated PSA are due to noncancerous conditions such as prostatitis and BPH.
A DRE is generally conducted by a urologist to feel the prostate. While DRE is no longer recommended as a routine test for men who do not have symptoms of prostate cancer, it may be used to check for any changes in the prostate before doing a biopsy.
If either of these tests suggest an abnormality, other tests are necessary to confirm a diagnosis of prostate cancer, usually a magnetic resonance imaging scan and transrectal ultrasound biopsy.
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When Should You Start Screening
First, talk to your doctor at your next checkup to go over your particular risk factors. You may have more than one risk factor at play and thus have a greater chance of developing prostate cancer than other men.
In general, discussions with your doctor about screening for prostate cancer should begin in your 40s. Here are some rough guidelines:
| Do you have family history of prostate,ovarian, breast, colon, or pancreatic cancers,or do you know that gene mutations are present in your family? | Discuss screening with your doctor startingaround age 40. |
Medium Risk Localised Prostate Cancer
You usually have treatment straight away. You might have:
- radiotherapy, usually with hormone therapy
You might have active surveillance if you dont want treatment straight away. This is an option if surgery or radiotherapy would be suitable treatments for you in the future. If they wouldnt be possible for you, you might have watchful waiting instead.
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Green Tea Coffee And Red Wine
The health benefits of green tea are thought to come from polyphenols, which include catechinsâpowerful antioxidants. Laboratory and preclinical studies have shown catechins slow the spread of prostate cancer by blocking the stimulating effect of androgen , and they may block a protein involved in the growth of prostate cancer. Catechins also make prostate cancer cells more susceptible to radiation and hormone therapy.
Coffee consumption has been associated with a lower risk of prostate cancer recurrence and progression. In a study reported by Fred Hutchinson Cancer Research Center in August 2013, men who drank four or more cups of coffee a day experienced a 59 percent reduced risk of prostate cancer recurrence and progression compared with men who drank only one or fewer cups of coffee per week. While more studies are needed to determine the mechanisms for this effect, researchers believe that the phytochemical compounds found in coffee have anti-inflammatory and antioxidant effects and modulate glucose metabolism.
Also, according to a study by researchers at the Hutch, men who drank four or more glasses of red wine per week reduced their risk of prostate cancer by half and had a 60 percent lower incidence of more aggressive types of the disease. This may be due to the anti-inflammatory and antioxidant properties of resveratrol, found in red grape skins, peanuts, and raspberries. Resveratrol is also available as a dietary supplement.
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Help Getting Through Cancer Treatment
People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.
Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.
Different types of programs and support services may be helpful, and can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.
The American Cancer Society also has programs and services including rides to treatment, lodging, and more to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.