The following is excerpt from the
Prostate Cancer Foundation's website. I have reproduced the information here, but encourage all readers to visit the above website.
Caught in its early stages prostate cancer can be cured especially when the cancer is still confined within the prostate gland. Testing through a blood test - the Prostate Specific Antigen (PSA ) or DRE (digital rectal examination) offers the best opportunity to determine the presence of cancer.
Early detection is the key to enabling better outcomes and potential cure of prostate cancer. Accordingly, it is recommended that men at 50 with no family history of prostate cancer, and men at 40 with a family history, should seek voluntary annual assessments in the form of a Prostate Specific Antigen (PSA) blood test together with a Digital Rectal Examination (DRE). It can be life threatening to wait for symptoms before seeking assessment.
What are the common reasons to get tested Most men will seek testing for prostate cancer for the following reasons:
(1) As part of a general check up - usually after 50 years of age.
(2) Due to a recent experience with a relative or friend who has suffered from prostate cancer.
(3) A family history of prostate cancer.
(4) A recent onset of urinary symptoms
Some men, when enquiring about prostate cancer, may be confused by conflicting views expressed about methods of diagnosing and treating the disease. Perhaps the most controversial is the view, that it would be better for men not to know whether they have the disease and therefore they should not be tested be treated.
The thinking behind this is...
(1) Because the disease can be relatively slow to develop, most men would die
with, rather than of, the disease.
(2) Because treatment has potentially serious side effects such as impotence and incontinence, treatment may be worse than the disease. It as the right of all men to make decisions for themselves about whether to be tested. It is your choice.
What Test Could I Have?
The PSA
The PSA blood test looks for the presence in the blood of a protein that is produced specifically by prostate cells called Prostate Specific Antigen.
The result of a PSA test needs expert evaluation by an experienced doctor but the following provides a guide in regards to PSA levels.
* Below a PSA of 4 the chance of prostate cancer being confined to the prostate gland is 65%.
* Between 4 and 10, the chance is 50%.
* Between 10 and 20, 35% and,
* Beyond 20, 20% and less.
Once the PSA is above 30, it is very likely the cancer has spread beyond the prostate and therefore cannot be cured surgically. If your test reveals a slightly elevated PSA, your doctor may recommend the test be repeated from time to time to establish the rate of change, if any, before recommending a biopsy.
The DRE
About 90% of all prostate cancers arise in the outer part of the prostate where they may be detected by a digital rectal exam (DRE), which is the simplest and most widely-performed screening procedure. The doctor inserts a gloved and lubricated finger into the patient's rectum and feels the prostate for bumps or other abnormalities. The exam is quick and painless but some men find it embarrassing. It is not very accurate in detecting early cancers, but studies indicate that regular DREs still save lives.
Biopsy
A Biopsy is a small tissue sample taken with a spring loaded needle. This normally conducted by a urologist. A small probe containing an ultrasound generator and sampling needles (known as Trans Rectal Ultra Sound or TRUS) is inserted in the anus. The ultrasound generates an image of the prostate on a computer screen and guides the doctor to insert the sampling needles into selected areas of the prostate. Your doctor may recommend an anaesthetic for the procedure and a course of antibiotics before or afterwards.
The biopsy samples will be analysed by a pathologist to determine the stage and grade of the cancer. If cancer is detected, two further assessments will be made:
Biopsy outcomes
There are four likely results...
* The tissue is normal benign prostate tissue.
* A condition called atypia or dyspalasia where the cells do not look typical of either normal or cancerous cells.
* Prostatic interpitelial neoplasia (PIN) where the cells appear to be in the transitional stage between normal and cancer.
* Prostate cancer - which are currently graded on a numerical scoring system call the Gleason Score and the Stage of cancer.
Gleason Score
Utilising the 'Gleason Grade', the Urologist rated the two most common types of cancer cells present in the samples, numbering each type from 1 for the least affected up to 5 for the most affected.
Gleason Score Agressiveness of prostate cancer
2-4 Low
5-6 Moderate
7 Intermediate
8-10 High
A score of 2 to 5 indicates the cancer is relatively slow growing and probably not very agressive. A score from 5 to 7 indicates the cancer is faster growing and moderately aggressive. A score of 8 or higher indicates an aggressive cancer.
Stage - how far the cancer has developed.Stage 1 - The cancer is small and contained within the prostate.
Stage 2 - The cancer is larger and may be in both lobes of the prostate, but is still confined to the organ.
Stage 3 - The cancer has spread beyond the prostate and may have invaded the adjacent lymph glands or seminal vesicles.
Stage 4 - The cancer has spread to other organs, or to bone.
Note: Each stage has up to 4 sub-groupings (a, b, c, & d) for more accurate definition. Frequently the letter “T” (for tumour) is placed before the stage number, which then appears, for example, as T2(c), or similar. If in doubt, ask your doctor to explain the meaning to you fully. It is vital information for you to understand.
If you have the misfortune to be diagnosed, be sure to ask your doctor for the exact grade and stage of your cancer and discuss their meaning and implications. Be sure to note this information for future reference, as stage and grade are important indicators when choosing treatment. Your doctor may call for additional tests like a bone scan, CT scan and a MRI to check the extent of the disease.
