Testing and Diagnosis
Caught in its early stages prostate cancer can be cured especially when the cancer is still confined within the prostate gland. Testing through a blood test - the Prostate Specific Antigen (PSA ) or DRE (digital rectal examination) offers the best opportunity to determine the presence of cancer.
This Prostate Cancer Foundation of Australia (PCFA) policy on testing for prostate cancer is based on the unique experiences and observations provided by many thousands of Australians directly affected by prostate cancer and being diagnosed at the rate of over 12,000 per annum.. It is advised by foremost experts from the medical and scientific community and expert representatives of those sectors have participated in the formulation of this PCFA Policy:
Early detection is the key to enabling better outcomes and potential cure of prostate cancer. Accordingly, PCFA recommends that men at 50 with no family history of prostate cancer, and men at 40 with a family history, should seek voluntary annual assessments in the form of a Prostate Specific Antigen (PSA) blood test together with a Digital Rectal Examination (DRE).
It can be life threatening to wait for symptoms before seeking assessment.
What are the common reasons to get tested
Most men will seek testing for prostate cancer for the following reasons:
- As part of a general check up - usually after 50 years of age
- Due to a recent experience with a relative or friend who has suffered from prostate cancer
- A family history of prostate cancer
- A recent onset of urinary symptoms
PCFA recommends you speak with your doctor and make up your own mind in regards to testing.
Some men, when enquiring about prostate cancer, may be confused by conflicting views expressed about methods of diagnosing and treating the disease. Perhaps the most controversial is the view - which PCFA disputes absolutely - that it would be better for men not to know whether they have the disease and therefore they should not be tested be treated.
The thinking behind this is
- because the disease can be relatively slow to develop, most men would die with, rather than of, the disease.
- because treatment has potentially serious side effects such as impotence and incontinence, treatment may be worse than the disease
PCFA have a Position Statement in regards to testing. PCFA holds that it as the right of all men to make decisions for themselves about whether to be tested. It is your choice.
What Test Could I Have?
The PSA
The PSA blood test looks for the presence in the blood of a protein that is produced specifically by prostate cells called Prostate Specific Antigen.
The result of a PSA test needs expert evaluation by an experienced doctor but the following provides a guide in regards to PSA levels
- Below a PSA of 4 the chance of prostate cancer being confined to the prostate gland is 65%
- Between 4 and 10, the chance is 50%
- Between 10 and 20, 35% and
- Beyond 20, 20% and less.
Once the PSA is above 30, it is very likely the cancer has spread beyond the prostate and therefore cannot be cured surgically. If your test reveals a slightly elevated PSA, your doctor may recommend the test be repeated from time to time to establish the rate of change, if any, before recommending a biopsy.
The DRE
he DRE involves the doctor inserting a gloved finger in the anus, where it is possible to feel part of the surface of the prostate. Irregularities include swelling or hardening of the prostate, or lumps on the surface that may indicate development of a tumour, or other problems. The drawback to this test is that the doctor can feel only part of the prostate, so may miss irregularities beyond reach. Recent studies conducted by PCFA found that less than 6% of men who had had a DRE found the procedure painful or embarrassing.
Biopsy
A Biopsy is a small tissue sample taken with a spring loaded needle. This normally conducted by a urologist. A small probe containing an ultrasound generator and sampling needles (known as Trans Rectal Ultra Sound or TRUS) is inserted in the anus. The ultrasound generates an image of the prostate on a computer screen and guides the doctor to insert the sampling needles into selected areas of the prostate.Your doctor may recommend an anaesthetic for the procedure and a course of antibiotics before or afterwards.
The biopsy samples will be analysed by a pathologist to determine the stage and grade of the cancer. If cancer is detected, two further assessments will be made:
Biopsy outcomes
There are four likely results
- The tissue is normal benign prostate tissue
- A condition called atypia or dyspalasia where the cells do not look typical of either normal or cancerous cells
- Prostatic interpitelial neoplasia (PIN) where the cells appear to be in the transitional stage between normal and cancer
- Prostate cancer - which are currently graded on a numerical scoring system call the Gleason Score and the Stage of cancer