Diagnosis of Prostate Cancer

Every year, thousands of men receive the diagnosis of prostate cancer. Because of the high number of men afflicted with this disease, annual screening tests have been put into place to hopefully catch prostate cancer in its early stages. A number of tests also exist to confirm the presence of prostate cancer after an abnormality is found through screening.

Regular Screening

All men over the age of 50 should be screened annually for prostate cancer. African-American men and men with a strong family history of prostate cancer have been shown to have higher rates of prostate cancer and need to start their screening at age 40 (or even earlier if family members have developed prostate cancer at younger ages).

Additionally, any men who have symptoms suggestive of prostate cancer need to undergo testing.

Appropriate screening involves both a yearly digital rectal exam and prostate specific antigen blood test.

Digital Rectal Exam (DRE)
During this exam, the physician inserts a lubricated, gloved finger (digit) into the rectum. Because of the prostate’s location just in front of the rectum, the physician is able to feel the edge of the prostate where the majority of cancers begin. Abnormalities such as bumps or hardness of the prostate can be detected in this way.

This test is usually completed in 5 to 10 seconds and most men have little discomfort during it.
Prostate Specific Antigen (PSA) Blood Test
A small sample of blood is taken and then sent to a lab for analysis. PSA is a protein that is only produced by prostate cells. As the prostate enlarges, whether due to cancer or another cause, the amount of PSA produced increases.

High levels of PSA or rapid increases in the PSA level can alert the physician to a possible underlying cancer.
Prostatic Biopsy

If an abnormality is found on the DRE or the PSA test, the physician will typically order a biopsy of the prostate.

A biopsy involves taking a very small sample of tissue from the prostate. This is done using a thin needle that is placed into the prostate. A tiny amount of tissue is trapped in the needle while it is in the prostate and then the needle is pulled out. This is repeated in a number of locations throughout the prostate so as to minimize the chance of missing an area where cancer may is present.

This procedure is usually done by an urologist or other surgeon in their office and involves using local anesthesia to minimize pain.

The tissue samples are then sent to a pathologist (a specialized physician who diagnoses diseases based on their appearance under a microscope) who makes the final diagnosis of prostate cancer.

At this time, the pathologist can also look at the cancer cells to determine how abnormal they are. This is called cancer’s “grade”. A high grade means that the cells are very abnormal and that the cancer is more likely to spread.