Prostate Cancer

Diagnosis

Screening tests are usually the first step in diagnosing prostate cancer. These tests may be conducted as part of a routine physical exam — especially in men past age 40 or 50 — or to check the cause of specific symptoms that may indicate a prostate problem. The following screening tests may be used initially.

Digital Rectal Exam
This is a basic and easy screening test for prostate cancer and other prostate diseases. The doctor gently inserts a gloved, lubricated finger into the rectum. Because the prostate gland is located adjacent to the rectum, the doctor can feel the back wall of the prostate. The outer portion of the prostate is where about 70 percent of cancerous tumors develop. But 30 percent of tumors are located deeper in the prostate gland and cannot be felt with an examining finger.

Prostate-Specific Antigen (PSA) Test
A small amount of blood is drawn and analyzed for PSA, a substance produced in the prostate gland to help liquefy semen. A small amount of it circulates in the blood. If higher than normal levels of PSA are detected or if levels rise over time, it could indicate prostate inflammation, prostate enlargement or prostate cancer.

Biopsy
Depending on the result of the DRE or PSA, a biopsy may be needed. In the biopsy, small tissue samples from several different areas of the prostate are taken for laboratory analysis.

Grading and Staging
If cancer cells are found, doctors will try to determine how fast the cancer is growing and if it has spread beyond the prostate.

Bone Scan
This test can show the spread of cancer to bone better than any other procedure. A low-grade radioactive solution is injected into the bloodstream, and the body is scanned to produce a skeletal image that shows areas of new bone growth.

Ultrasound
In addition to helping detect the presence of cancer within the prostate, ultrasound can show if the cancer has invaded nearby tissues around the prostate.

Chest X-ray
An X-ray can help show if the cancer has spread to the lungs. Although less than 5 percent of prostate cancer spreads this far, lung cancer will develop in about 25 percent of people with advanced prostate cancer.

Computed Tomography (CT) Scan
These images can help identify abnormal lymph nodes in the pelvis and abdomen, but cannot identify those with only microscopic levels of cancer. They also do not provide good information about the condition of the prostate itself or the stage of prostate cancer. For that reason, CT scans are most useful when combined with other tests.

Magnetic Resonance Imaging (MRI)
Like a CT scan, MRI produces a detailed, three-dimensional picture of the body that can detect the spread of cancer to lymph nodes and bone.

Lymph Node Biopsy (Lymphadenectomy)
During this surgical procedure, a urologist removes some of the nodes near the prostate and examines them under a microscope. If other tests, such as a bone or CT scan, show that the cancer has spread, then this procedure usually is not necessary. The procedure is most often used to confirm the results of tests indicating that the cancer is confined to the prostate.