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 | Prostate Cancer Tests & Staging |
Prostate cancer symptoms
A man with prostate cancer may or may not have symptoms. And the common symptoms of prostate cancer do not always mean the presence of the disease. However, a man who experiences one or more of the following symptoms, particularly if he is at higher risk for prostate cancer, should see his doctor.
• A need to frequently urinate, especially at night
• Difficulty starting urination or holding back urine
• Inability to urinate
• Weak or interrupted urine flow
• Painful or burning urination
• Difficulty obtaining an erection
• Painful ejaculation
• Blood in urine or semen
• Frequent pain or stiffness in the lower back, hips or upper thighs
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A variety of conditions may cause these symptoms. For example, as a man ages, his prostate may grow. An enlarged prostate, called benign prostatic hyperplasia (BPH), can block the flow of urine or interfere with sexual function. BPH is not prostate cancer, but can cause many of the same symptoms.
Only a doctor using appropriate tests can determine if a man has prostate cancer, BPH, or another condition with similar symptoms.
The PSA test and others: screening for prostate cancer
There are four major diagnostic tools for detecting prostate cancer, including the well-known PSA test. These tests fall into two categories: those that screen for the disease and those that help the doctor determine the stage of the disease when it is found. Screening tests for prostate cancer include:
• Prostate-specific antigen test (PSA test). The PSA test analyzes a blood sample drawn. It checks the sample for PSA, a substance only the prostate gland produces. A small amount of the PSA produced diffuses into the bloodstream and this is what is measured. If higher-than-normal levels of PSA occur (above a level of 4.0ng/ml), it may indicate prostate disease (infection, enlargement of the prostate gland or cancer).
• Digital rectal exam (DRE). The prostate is located next to the rectum. A doctor performs a digital rectal exam by inserting a gloved, lubricated finger into the rectum to examine the prostate. If the doctor finds any abnormalities in the texture, shape or size of the gland, more tests may be needed.
• Transrectal ultrasound. If the doctor has concerns, he or she may use transrectal ultrasound to further evaluate the prostate. This involves inserting a small probe into the rectum. The probe emits sound waves to produce an image of the prostate gland and its surroundings
• Prostate biopsy. Under ultrasound guidance the doctor removes 6-12 cores (tiny prostate bites) for further pathological evaluation. These tissue cores allow for definitive diagnosis of prostate cancer and for correct cancer grading (also called Combined Gleason Score or CGS). The biopsy and its resulting CGS are important tools of definitive diagnosis and help in choosing the appropriate treatment approach.
Staging of prostate cancer
If screening tests (i.e. PSA, DRE) indicate prostate cancer, the doctor may use additional tests to identify if the cancer:
• Is confined to the prostate
• Has grown beyond the prostate
• Has spread, and if so, where it has spread
This is called "staging" the disease. Determining the cancer stage is crucial to deciding the best treatment. (Visit the Treatments section for more information on various prostate cancer treatments.)
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Prostate cancer staging system
The prostate cancer staging system standardizes the description of the extent to which the cancer has spread. There are several different staging systems for prostate cancer. The most widely used system is the TNM system.
The TNM system describes the extent of the primary Tumor (T stage); whether or not the cancer has spread to nearby lymph Nodes (N stage), and the absence or presence of distant Metastasis (M stage). "Metastasis" refers to the spread of cancer cells from the prostate gland to another part of the body.
Four categories describe the prostate tumor's (T) stage, ranging from T1 to T4.
• T1: The cancer is microscopic, unilateral and non palpable. The doctor can't feel the tumor or see it with imaging such as transrectal ultrasound. Treatment for BPH may have disclosed the disease, or it was confirmed through the use of a needle biopsy done because of an elevated PSA.
• T2: The doctor can feel the cancer with a DRE. It appears the disease is confined to the prostate gland on one or both sides of the gland.
• T3: The cancer has advanced to tissue immediately outside the gland
• T4: The cancer has spread to other parts of the body
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Tests that help stage& grade prostate cancer
After detecting the possible presence of prostate cancer, a doctor can choose from several different tests to determine its stage.
• DRE -- can tell the doctor if the cancer is T1, T2, or beyond T2.
• Biopsy -- when prostate cancer is detected, a biopsy will take small samples of tissue from the prostate. A pathologist will evaluate the tissue and assign a Combined "Gleason grade" Score (CGS). The grade will range from 2 to 10. The higher the number, the more aggressive is the cancer. The Gleason grade is a major factor in deciding the best treatment for the cancer.
• Prostatic Acid Phosphatase (PAP) blood test -- helps determine if the cancer is most likely confined to the prostate or not.
• Computed tomography (CT) scan -- A computer controlled x-ray procedure that produces detailed cross-sectional images of the body using hundreds of x-ray like images. This test will help tell if prostate cancer has spread into other organs. CT scans have limitations; they are much better in determining skeletal structures than soft tissue structures, therefore they have a limited mass size resolution.
• Magnetic resonance imaging (MRI) -- MRI uses strong magnetic fields instead of x-rays to produce an image of the body based on cellular oscillation omitted energy. MRI scans can be very helpful in looking at prostate cancer. By producing a very clear picture of the prostate gland, the MRI can show whether the cancer has spread outside the gland into the seminal vesicles or bladder.
• Endorectal MRI -- Even more accurate than the whole body MRI, an Endorectal MRI helps to determine if the prostate cancer is confined to the gland. The test can also help detect the site of prostate cancer in men suspected of having prostate cancer that is eluding diagnosis with other routine tests.
• Radionuclide bone scan -- Helps show whether cancer has spread from the prostate to bones. It is very common for prostate cancer to spread first to skeletal structures (mostly long bones) before reaching other organs in the body.
• ProstaScintT scan -- Detects the spread of prostate cancer to lymph nodes and other soft (non-bone) organs. It can distinguish prostate cancer from other cancers and benign disorders. Both its sensitivity and specificity are relatively low.
• Lymph node sampling -- Conducted to find if cancer has spread from the prostate to nearby lymph nodes. Normally performed when there is a high suspicion of such spread.
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