Prostate Cancer Diagnosis
Diagnosis of Prostate Cancer

Among American men, prostate cancer is the most common cancer and the second leading cause of cancer deaths. But for many men, a diagnosis of prostate cancer can be frightening not only because of the threat to their life but because of the threat to their sexuality. In fact, the possible consequences of treatment -- which include bladder control problems and impotence -- can be a greater worry for some men than the cancer itself.

The good news is that if prostate cancer is detected early -- when it's still confined to the prostate gland -- you have a better chance of successful treatment with minimal or short-term side effects. On average, an American man has a 30 percent risk of having prostate cancer in his lifetime, but only a 3 percent risk of dying of the disease.

Modern treatment methods are designed to cure prostate cancer and minimize adverse effects on urinary, bowel and sexual function. Curing cancer that has spread beyond the prostate gland is more difficult. But treatments exist that can help control the cancer.

If your have symptoms or test results that suggest prostate cancer, your doctor will ask about your personal and family medical history, perform a physical exam and may order laboratory tests. The exams and tests may include a digital rectal exam, a urine test to check for blood or infection and a blood test to measure prostate-specific antigen (PSA). In some cases, your doctor also may check the level of prostatic acid phosphatase (PAP) in the blood, especially if the results of the PSA indicate there might be a problem.

Your doctor may recommend exams to learn more about the cause of the symptoms. These may include:
Prostate-Specific Antigen (PSA) Test -- A small amount of blood is drawn from your arm and analyzed for PSA. The substance is naturally produced in your prostate gland to help liquefy semen. But a small amount of it circulates through your bloodstream. If higher than normal levels of PSA are detected in your blood or if levels rise over time, it could indicate prostate inflammation, prostate enlargement or prostate cancer.

Transrectal Ultrasonography -- Sound waves that cannot be heard by humans (ultrasound) are sent out by a probe inserted into the rectum. The waves bounce off the prostate, and a computer uses the echoes to create a picture called a sonogram. This sonogram can be used to visualize abnormal areas in the prostate and to direct a biopsy or sampling of tissue from the prostate. This tissue sample is used to determine if cancer is present.

If cancer is found in your prostate, your doctor needs to know the stage, or extent, of the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. Your doctor may use various blood and imaging tests to learn the stage of the disease. Treatment decisions depend on these findings. Prostate cancer staging is a complex process. Your doctor may describe staging using the Tumor-Nodes-Metastasis (TNM) system:

T1a/b -- The cancer cannot be felt during a rectal exam, but is discovered incidentally when prostate surgery is performed for another reason.

T1c -- The cancer cannot be felt during a rectal exam, but is discovered due to an elevated serum PSA level.

T2a -- The cancer is felt on one side of the prostate during a rectal exam.

T2b -- The cancer is felt on both sides of the prostate during a rectal exam.

T3a -- The cancer has spread outside the prostate to nearby tissues.

T3b -- The cancer has spread to the seminal vesicles, glands at the base of the bladder that are connected to the prostate.

T4 -- The cancer has spread to adjacent organs such as the bladder or rectum.

N0 -- Prostate cancer has not spread to lymph nodes.

N+ -- Lymph nodes are involved with prostate cancer.

M0 -- There is no evidence of distant spread or metastases from prostate cancer.

M+ -- The prostate cancer has spread or metastasized to other locations in the body such as the bones, liver or lung.

Reviewed by health care specialists at UCSF Medical Center.
Last updated April 19, 2007

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