Prostate Cancer

If you are having problems urinating, your doctor may use tests to see if you have an enlarged prostate (benign prostatic hyperplasia). This condition is the most common cause of urination problems.

Initial tests include:

• A digital rectal exam, in which the doctor inserts a gloved finger into your rectum to feel your prostate gland. Some prostate tumors can be found this way.
• A urine test, in which some of your urine is sent to a lab and checked for blood, infection, or abnormal cells. Prostate cancer can cause blood in the urine.
• A PSA test to measure the levels of prostate-specific antigen (PSA) in your blood. A higher level of PSA may be a sign of an enlargement, infection, or cancer of the prostate. If it is possible that an infection is raising your PSA, you may first have 4 to 6 weeks of antibiotics. Your doctor may suggest a second PSA test before thinking of doing a biopsy.
• AUA symptom score. This is a series of questions from the American Urological Association (AUA) that measures how bad your urinating problems are. Sometimes these problems are caused by prostate cancer that is blocking your urine flow.
• Urine-flow rate test. This test measures your urine and how fast it comes out. Sometimes a low flow rate is caused by prostate cancer.

If tests point to prostate cancer, your doctor may recommend a prostate biopsy, in which tissue is taken from the prostate and examined under a microscope. A biopsy is the only way to confirm whether you have prostate cancer.

After treatment for prostate cancer, you have regular checkups to check for any signs that the cancer has come back or spread. Tests that are done to evaluate the spread of the cancer and to plan further treatment may include:

• Blood tests. Different types of blood tests are used to see whether cancer has spread to your bones or liver.
• A bone scan. Radioactive material that shows up on X-rays is injected into your arm. An X-ray camera passes over your body, taking pictures as the radioactive material moves into your bones. Areas of bone damage show up in the pictures. Prostate cancer that has spread to the bones can cause this kind of damage.
• A CT scan. A CT scanner directs a series of X-rays through your body. CT scans can show tissue damage or diseases, such as an infection or tumor.
• A pelvic lymphadenectomy. This is an operation in which the lymph nodes near your prostate are removed and checked under a microscope to see if they contain cancer. It may be done at the same time as surgery to remove your prostate.
• An MRI. An MRI uses a strong magnetic field to make pictures of the prostate. The MRI can show tissue damage or disease, such as infection or a tumor.
• ProstaScint scan. This scan may be used to look for cancer cells after you have had surgery to remove cancer. Radioactive material that attaches itself to prostate cancer cells and shows up on X-rays is injected into a vein. Four days later, your body is scanned with a special camera, and lymph nodes and other areas that have been invaded by prostate cancer cells show up in the picture.
• PET scan. This kind of scanner produces 3-D images that give a better view of tumors. In rare cases, it is used to look at advanced prostate cancer.

Early Detection

Screening for prostate cancer—checking for signs of the disease when there are no symptoms—is done with the digital rectal exam and the PSA test. In the United States, about 75% of men who are age 50 or older have had a PSA test.¹⁰

Should I have a PSA test to screen for prostate cancer?

The number of deaths caused by prostate cancer has dropped over the past 20 years. This has been linked to more early diagnosis with PSA testing and to better cancer treatment.¹

Finding prostate cancer early leads you to some big decisions. Most prostate cancer grows slowly. And the side effects of treatment can change your quality of life—mainly not being able to have an erection (impotence) and not being able to control urination (incontinence). If you are around age 70 or older, these side effects may seem worse than early-stage cancer that may not grow much during your lifetime. But, especially for men 65 or younger, treatment makes the cancer less likely to grow and spread.⁹

Because your age and medical history are unique, it is important to learn the pros and cons of PSA testing and talk to your doctor before making a decision.

What to think about

It is expected that prostate cancer will account for 29% (218,890) of new cancer cases in men in the United States in 2007. About 90% of those will be discovered in the early stages, and the overall 5-year survival rate for men whose cancer is found early is almost 100%.¹