What are My Screening Options?
Your doctor can check for prostate cancer before you have any symptoms. During an office visit, your doctor will ask about your personal and family medical history. You'll have a physical exam. You may also have one or both of the following tests:
- Digital rectal exam: Your doctor inserts a lubricated, gloved finger into the rectum and feels your prostate through the rectal wall. Your prostate is checked for hard or lumpy areas.
- Blood test for prostate-specific antigen (PSA): A lab checks the level of PSA in your blood sample. A high PSA level is commonly caused by BPH or prostatitis (inflammation of the prostate). Prostate cancer may also cause a high PSA level.
The digital rectal exam and PSA test can detect a problem in the prostate. However, they can't show whether the problem is cancer or a less serious condition. If you have abnormal test results, your doctor may suggest other tests to make a diagnosis. For example, your visit may include other lab tests, such as a urine test to check for blood or infection. Your doctor may order other procedures:
- Transrectal ultrasound: The doctor inserts a probe into the rectum to check your prostate for abnormal areas.
- Transrectal biopsy: The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles.
If Cancer Is Not Found
If cancer cells are not found in the biopsy sample, ask your doctor how often you should have checkups.
If Cancer Is Found
If cancer cells are found, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow.
Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with your age and other factors to suggest treatment options.
The most important feature of any prostate cancer is its aggressiveness as measured by the Gleason score. This is named after Dr. Gleason, a pathologist who 40 years ago described prostate cancer tumor features that can be seen under the microscope and that distinguish slower growing prostate cancers (low Gleason score, such as Gleason 6 or less) from faster growing cancers (Gleason score 7 or greater) that are more likely than low-grade tumors to grow quickly and spread.
Equally as important as the Gleason score are the clinical stage of the cancer and the PSA. These measure the extent of cancer. Cancers with stage T1 or T2 are localized to the prostate. Stage T3 reflects extension around the prostate, and T4 stage or any metastases indicate widespread cancer. Cancer with PSA less than 20 are typically curable, while those with PSA over 20 are more extensive and more difficult to control.
Up to one-third of prostate cancers are detected so early as to present no immediate or foreseeable danger. These are cancer with Gleason score 6 or less, PSA less than 10, and having only a miniscule amount of caner (less than 1 or 2 millimeters) seen on the biopsy. Such cancers can be monitored for many years before treatment is needed, and in many cases treatment if such cancer might never be necessary. These are so-called “indolent” or “minimal risk” cancers.
Above content provided by the National Cancer Institute in partnership with Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted September 2009
