Initial Screening
Prostate cancer is known as a silent killer because it often does not produce any symptoms. That is why it is recommended to have screening tests performed annually when a man reaches age 50 or earlier if he is at higher risk.
Initial screening for prostate cancer consists of a digital rectal exam (DRE) and a prostate specific antigen (PSA) test.
If either of these tests raise concerns, the doctor may perform a transrectal ultrasound (TRUS) to more closely study your prostate. During this test, a small, cigar sized probe is inserted into your rectum and sound waves are used to get views of your prostate gland on a monitor.
A physician may also order a urine test if you are having symptoms in order to rule out those other prostate problems including BPH and prostatitis.
Further Evaluation
If initial screening and examination suggest prostate cancer, your healthcare professional may order a prostate biopsy. During a biopsy, small tissue samples are taken and analyzed at a lab to determine if cancer cells exist. To do a biopsy, the doctor inserts an ultrasound probe into your rectum as in the TRUS described above. Looking at images on the ultrasound monitor, the doctor looks for and hones in on any suspicious areas. He then takes a small hollow needle with a spring is aimed at these areas is "fired" which retrieves a small "core" of suspicious tissue.
Eight or more "cores" are usually acquired and sent to a pathology lab for study. These cores are studied by a pathologist who specializes in diagnosing cancer and other tissue abnormalities. The pathologist is able to determine if the core samples contain cancer and also is able to estimate how aggressive any cancer may be.
If a cancer diagnosis is determined, a doctor may recommend further testing to see how far the prostate cancer has spread or, if it has spread. Many don't require further studies, because it is found that the prostate cancer is a type and size that has not yet spread to other tissues. These men can now be evaluated for treatment.
Determining the Extent of Cancer
If biopsies indicate the need for further testing to determine the spread of the cancer, one or several tests may be ordered. These include:
- Bone scan;
- Ultrasound of surrounding tissues;
- Lymph node biopsy;
- Chest X ray;
- CT scan;
- MRI.
Bone scan
A bone scan is an xray style running picture of your skeleton to used to determine if the cancer has spread to the bones as prostate cancer often metastasizes to the bones.
Ultrasound
An ultrasound of the surrounding tissues may be performed to show if cancer may have spread to the nearby tissue.
Lymph Node Biopsy
When cancer spreads, it often does so through the nearby lymph nodes. Therefore the doctor may order a biopsy of those lymph nodes to look for cancer cells. During this procedure, one or several lymph nodes near your prostate may be removed and examined by a pathologist.
Chest X ray
A chest X ray may show if cancer has spread to your backbone, ribs, or lungs. These are all common places for prostate cancer to spread.
CT scan
Often called a "cat scan", the CT (computerized tomography) scan takes cross-sectional Xrays of your body and uses a computer to make a three-dimensional image for your doctor to study. They can show swollen lymph nodes or abnormalities in organs, but cannot determine if cancer is the culprit for these abnormalities. A CT is therefore used in combination with other examinations.
MRI (Magnetic Resonance Imaging)
Something like a CT scan, the MRI takes cross-sectional pictures of your body and uses a computer to make a three dimensional image. The MRI uses magnets and radio waves instead of the Xrays used by a CT.
MRIs can help look for evidence of the spread of prostate cancer to other tissues.
Next Steps
A physician uses many tools to diagnose and determine an individual's prostate cancer situation. Your cancer will be graded, staged, and a Gleason score obtained in order to determine the proper course of treatment.
