Your doctor can check you for prostate cancer before you have any symptoms. Screening can help doctors find and treat cancer early. However, studies so far have not shown that screening tests reduce the number of deaths from prostate cancer. You may want to talk to your doctor about the possible benefits and harms of being screened. The decision is a personal one. You should decide after learning the pros and cons of screening.
Prostate cancer may be suspected because of symptoms, finding a nodule or lump on digital rectal examination, or abnormal blood test results. If you have a symptom or test result that suggests cancer, your doctor must find out whether it is due to cancer or to some other cause. These exams and tests may be used to check for prostate cancer:
History and Physical Exam:
- You will be asked about your personal and family health history
- In addition to checking for general health, your exam will include a digital rectal exam (DRE). For this test, the doctor inserts a lubricated, gloved finger into the rectum to feel the prostate through the rectal wall for any hard or lumpy areas.
Lab Tests:
- A urine test can show the presence of blood or a possible infection
- A blood test called a PSA (prostatic specific antigen) test measures the level of PSA in the blood. Prostate Specific Antigen (or PSA) is a protein produced by the cells of the prostate gland. When the prostate gland enlarges, PSA levels in the blood tend to rise. PSA levels can rise due to cancer or benign (not cancerous) conditions. Because PSA is produced by the body and can be used to detect disease, it is sometimes called a biological marker or tumor marker. Learn more about the PSA test.
- A Transrectal Ultrasound (TRUS) is an exam that allows the doctor to see an image of the prostate on a video screen. The doctor or technician inserts a probe slightly larger than a pen into the rectum. The probe directs high-frequency sound waves at the prostate. A computer uses the echoes to create a picture (sonogram) of the gland that shows how big the prostate is and whether there are any irregularities that could be a tumor. The procedure usually takes about 15-25 minutes.
- You will be asked to lie on your left side to allow for easier insertion of the rectal probe.
- The probe will be coated with a clear lubricating jelly to allow for easier insertion into the rectum.
- The technician will adjust the console on the ultrasound machine to get a baseline for normal prostate tissue.
- When the sensor is put into the rectum, you will feel some pressure that resembles the feeling you have before a bowel movement.
- Imaging is usually begun at the base of the bladder, as the probe is rotated to provide a full picture of the prostate.
If any suspicious areas are seen, the doctor will need to do a transrectal biopsy to find out if cancer is present.
- A biopsy removes a small amount of prostate tissue with a needle positioned in the prostate through the rectal wall. TRUS may be used to guide the placement of the needle. Your doctor will usually take samples from several areas of the prostate gland. This can help lower the chance of missing any areas of the gland that have cancer cells. The biopsy takes only a few minutes and causes minimal discomfort. After the biopsy, you will be given two days' worth of antibiotics. Your first dose will be given at the time of the procedure. The samples are sent to the pathology lab for analysis. Most men who have biopsies after routine exams do not have cancer.
If cancer is found, the doctor will need to know the stage (whether the cancer has spread and, if so, what parts of the body are affected) so the correct treatments can be offered. These tests may be used to learn the stage of prostate cancer:
- Blood tests (Including alkaline phosphatase, complete blood count and liver function tests), if abnormal, may suggest that cancer has spread to the bones, bone marrow or liver.
- Imaging tests create pictures of internal organs and may show cancers that have spread to other parts of the body
- A Bone Scan identifies changes or problem areas in the bones that may occur if the cancer has spread to the bones. It is a reliable and painless test in which images of all the bones in your body are taken after injecting a medication that contains a small amount of radioactive material into a vein. After about three hours, the bone cells have collected the medication from the circulating blood. Radiation rays from the medication make an image on photographic film. A Nuclear Medicine doctor studies this picture and notes any changes or problem areas in the bones.
The bone scan is often done as part of a check-up after treatment Is completed to be sure that the bones are free of cancer and to determine the effects of cancer treatment.
- A CT Scan uses a computer and x-rays to create detailed pictures of your internal organs. A tumor in the liver or elsewhere and enlarged pelvic lymph nodes may be due to prostate cancer that has spread.
- An MRI scan uses a computer and strong magnets to show your internal organs. CT's and MRI's are usually used as pre-treatment staging tests only if there Is reason to believe the cancer has spread to the lymph nodes.
