Testing and Diagnosis
Caught in its early stages whilst still confined to the prostate gland prostate cancer can be cured. Testing through a Prostate Specific Antigen (PSA) blood test and Digital Rectal Examination (DRE) and subsequent prostate biopsy is currently the best available way to detect the presence of cancer.
Early detection is the key to enabling better outcomes and potential cure of prostate cancer. Accordingly, PCFA recommends that men over age 50, or 40 with a family history of prostate cancer, should talk to their doctor about testing for prostate cancer using the PSA test and DRE as part of their annual health check-up. Men should make an individual informed decision about testing based on the latest available evidence on the benefits and potential harms of testing and subsequent treatment for prostate cancer.
It can be life threatening to wait for symptoms to appear before seeking assessment.
For a full copy of PCFA's policy on testing for prostate cancer click here.
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 blood test looks for the presence in the blood of a protein that is produced specifically by prostate cells called Prostate Specific Antigen (PSA). The presence of an elevated PSA does not necessarily mean prostate cancer is present as there are other medical conditions that can lead to a PSA result outside the normal range.
The result of a PSA test needs expert evaluation by an experienced doctor. As a general rule, the higher the PSA result the greater the chance that prostate cancer is present. Where cancer is present, the PSA can predict the volume of disease. Where the PSA is less than 10, the cancer is commonly confined to the prostate. If the PSA is above 30, it is very likely the cancer has spread beyond the prostate and is therefore less likely to be curable.
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 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.
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:
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 intraepithelial 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