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Prostate Cancer: Diagnosis

Most men will not experience any symptoms of prostate cancer if it is caught early. However, some men do, and these symptoms may include the following.

  • A need to urinate frequently, especially at night
  • Difficulty starting urination or holding back urine
  • Weak or interrupted flow of urine
  • Painful or burning urination
  • Difficulty in having an erection
  • Painful ejaculation
  • Blood in urine or semen
  • Frequent pain or stiffness in the lower back, hips, or upper thighs

Men who experience any of these symptoms should speak to their doctor. Although most patients will have urinary symptoms related primarily to BPH, a workup for prostate cancer may be indicated by a DRE or an abnormal Prostate Specific Antigen (PSA) blood test.

Diagnosis of Prostate Cancer

Prostate Specific Antigen (PSA) Tests: prostate specific antigen is a glycoprotein produced by prostate cells and is a normal component of semen. When abnormal events occur in the prostate, such as prostate cancer, the overabundance of prostate cells, the overproduction of PSA, or the leaking of PSA into the bloodstream may result in a measurable increase in the level of PSA in the blood. Blood tests are used to assess the level of PSA in the blood. A higher-than-normal level of PSA might indicate a problem with the prostate, including cancer.

Digital Rectal Exam (DRE): a physician inserts a lubricated, gloved finger into the rectum to feel for abnormalities of the prostate.

An abnormal age-adjusted prostate specific antigen (PSA) test or abnormal digital rectal (DRE) exam is an indication of prostate cancer, but does not mean cancer is present. Abnormal findings should be followed by a biopsy of the prostate cells to determine whether they are in fact cancerous.

Biopsy: a biopsy is a procedure in which a sample of tissue is taken from the prostate and then viewed under a microscope to check for abnormalities. In some patients a high normal or borderline PSA may also warrant a biopsy, especially if it is accompanied by changes in urinary or sexual function. Occasionally, patients with extremely elevated PSA also report bone pain and have abnormal bone X-rays indicating extra bone growth, or osteoblastic metastases. This situation also requires a biopsy of the prostate.

Staging and Grading of Prostate Cancer

After examination and biopsy, doctors will "stage" and "grade" prostate cancer with a system of letters and numbers.

Grade: Grade refers to the expected aggressiveness of the tumor based on the biopsy. The most common grading system is the Gleason system. Grades 1 and 2 are closer in appearance to normal glands, and are the slowest growing, better behaving tumors. Grades 4 and 5 have more variations in size of tumor cells and loss of glandular appearance, and are the more aggressive tumors.

Stage: The clinical stage of a cancer is the extent of disease, whether it is localized, spread regionally, or spread more widely to lymph nodes or bones.

A system of staging used by the National Cancer Institute and most doctors is called TNM Staging. This stands for:

  • Tumor size - how big the tumor is and has it spread in the area
  • Lymph Nodes - are any lymph nodes positive for cancer and how many
  • Metastasis - has the cancer spread to any other parts of the body