Prostate Cancer Diagnosis

According to the American Cancer Society prostate cancer is the most common type of cancer in men in the U.S. They estimate that about 200,000 new cases will be diagnosed every year and about 27,000 men will die of the disease. Prostate cancer is the second leading cause of cancer death in men, exceeded only by lung cancer and it occurs in 1 out of every 6 men. However, only about 1 out of every 10 men is actually diagnosed with the disease. This means that more men actually have it than are being diagnosed with it. While the number of diagnosed cases have risen over the years, mortality rates are actually declining, which is probably due to increased screening and early diagnosis. The numbers of deaths would further decline if more men went for tests and could be diagnosed in the early stages of prostate cancer.

There are several different tests which are used in the diagnosis of prostate cancer. Some of these tests are scans or examinations, and some require small surgical processes.

Digital rectal examination is performed on more patients than any other examination. It is a quick and easy way for the doctor to find if there’s anything wrong without a lab test. The physician inserts a lubricated gloved finger into the rectum and feels the surface of the prostate. Healthy tissue is soft, but malignant tissue is hard and granular. Although this test is fast and inexpensive, as many as one-third of patients’ tumors are too small to be felt by the digital rectal examination, so some patients who actually have prostate cancer are told that they don’t.

Another physical screening tool is a transrectal ultrasound (TRUS) examination which is used to measure the size of the prostate and visually identify tumors. A probe is inserted into the rectum and emits ultrasonic impulses against the prostate. The images are projected onto a monitor, so the physician can examine the gland and surrounding tissue for tumors. TRUS and the digital rectal examination are generally accepted prostate-cancer screening tools.

The prostate naturally produces a protein called prostate-specific antigen (PSA), but when cancer cells begin to grow, the level of PSA rises. The blood of a man with no prostate cancer has 4ng/mL (four nanograms per milliliter) of PSA, whereas when cancer begins to grow, they have between 4 and 10 ng/mL. However, if a man has benign hyperplasia (non-cancerous enlarged prostate) or an infection called prostatitis, his blood tests results will show an increased level of PSA. A PSA test can produce false results. A false positive can occur when the PSA level is elevated, but there is no cancer. A false negative can occur when the PSA level is normal, but there is cancer. Because of this, it is important to have a biopsy performed to confirm or rule out cancer if the blood shows a high level of PSA.

If a patient’s physical examination finds abnormalities or if his blood test shows a high level of PSA, the doctor will need a biopsy to determine if cancer is present. A biopsy is performed with the patient lying on his side with his knees drawn up to his chest. A biopsy needle, similar to one used to draw blood or administer injections, is inserted through the area of skin between the rectum and the scrotum. A probe is inserted into the rectum to help the physician properly place the needle. Guided by the transrectal ultrasound probe, the biopsy needle locates the area of the suspected tumor and extracts cell sample from the area. If there is doubt about the area, several areas may need a biopsy. The samples which were removed from the patient are sent to a laboratory to be analyzed by a pathologist who will determine if the cells are cancerous or not. If cancer is found, the pathologist will determine what type of cancer the patient has.

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