Cancer screening exams can help find prostate cancer at its earliest stage, when the chances for successful treatment and optimal outcomes are greatest. These tests are usually done when a patient is healthy and has no specific symptoms.
Not only are expert cancer researchers at the OSUCCC — James continually working to detect and diagnose prostate cancer early, but they are also developing additional tests to detect and diagnose cancer even earlier.
Screening tests for prostate cancer include:
Prostate-Specific Antigen (PSA)
Prostate-specific antigen, or PSA, is a protein produced by the prostate gland. The PSA test measures the level of PSA in a man’s blood. For this test, a blood sample is sent to a laboratory for analysis. The blood level of PSA is often elevated in men with prostate cancer, though there is no specific normal or abnormal level of PSA in the blood.
Digital Rectal Exam (DRE)
A digital rectal exam (DRE) is an exam of the rectum. A doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel the prostate for lumps or anything else that seems unusual.
Prostate Cancer Risk Factors
Anything that increases your chances of developing prostate cancer is called a risk factor. The following factors may play a role in the development of prostate cancer:
Prostate cancer is rare in men younger than 50 years of age. The chance of developing prostate cancer increases as men get older.
Family History of Prostate Cancer
A man whose father, brother or son has had prostate cancer has a higher-than-average risk of prostate cancer.
Prostate cancer occurs more often in African American men than in white men. African American men with prostate cancer are more likely to die from the disease than white men with prostate cancer.
The prostate needs male hormones to work the way it should. The main male sex hormone is testosterone. Testosterone helps the body develop and maintain male sex characteristics.
Testosterone is changed into dihydrotestosterone (DHT) by an enzyme in the body. DHT is important for normal prostate growth but can also cause the prostate to get bigger and may play a part in the development of prostate cancer.
The Selenium and Vitamin E Cancer Prevention Trial (SELECT) found that vitamin E taken alone increased the risk of prostate cancer. The risk continued even after the men stopped taking vitamin E.
Folate is a kind of vitamin B that occurs naturally in some foods, such as green vegetables, beans and orange juice. Folic acid is a man-made form of folate that is found in vitamin supplements and fortified foods, such as whole-grain breads and cereals. A 10-year study showed that the risk of prostate cancer was increased in men who took 1 milligram (mg) supplements of folic acid. However, the risk of prostate cancer was lower in men who had enough folate in their diets.
Dairy & Calcium
A diet high in dairy foods and calcium may cause a small increase in the risk of prostate cancer.
(Source: National Cancer Institute)
Not everyone with risk factors will get prostate cancer. But having certain risk factors may increase your risk of developing the disease. If you are at high risk for prostate cancer, talk to your doctor about tests to find out if you have early signs of the disease.
Diagnosing Prostate Cancer
If symptoms suggest you might have prostate cancer, your doctor will examine you and ask you about your medical history, including any symptoms you may have.
If you have a history of prostate cancer in your immediate family, your doctor may order a blood test to check for the presence and level of certain substances known to play a role in prostate cancer.
Prostate-Specific Antigen (PSA) Test
PSA is a protein, or antibody, produced by the prostate gland and detectable in the semen or blood. The level of this antibody may rise in men with prostate cancer.There are, however, other reasons why the level of this protein may rise and some men with prostate cancer may not have detectable levels.
Doctors will use this test as a starting point and will most likely follow it up with other tests.
There are other noncancerous conditions that may cause an elevated PSA level, including a condition in which there is inflammation of the prostate (prostatitis) and a condition in which the prostate is enlarged (benign prostatic hyperplasia). Currently, there is no evidence to suggest that having one or both of these conditions lead to prostate cancer, but there is a slight increased risk.
Prostatic Acid Phosphatase (PAP) Test
PAP is an enzyme produced by the prostate gland that may rise above normal levels in many prostate cancer patients, especially if the cancer has spread beyond the prostate. The PSA test has mostly supplanted this test, but it is still used for some men who have had prostate cancer in the past, to monitor their condition.
The PSA test is used as a prostate cancer screening tool, particularly for men at high risk or for men who may have a history of prostate cancer in their family.
The results of these blood tests alone cannot make the determination of whether or not you have prostate cancer. But the results are taken into account when the doctor is deciding whether or not to order further testing.
If the results of the above blood tests are abnormal, or if cancer is suspected, the doctor may order the following tests to further detect and diagnose prostate cancer:
Digital Rectal Exam
A physical exam in which the physician or nurse inserts their gloved and lubricated finger into your rectum and feels the prostate to identify any lumps or other abnormalities.
A procedure in which a small probe is inserted into the rectum to check the prostate using high-energy sound waves. This procedure may be used in conjunction with a biopsy.
A biopsy confirms a prostate cancer diagnosis. A specially trained pathologist analyzes the sample tissue from the prostate under a microscope. The pathologist will check for the presence of cancer cells and assign a Gleason score.
A Gleason score rates the likelihood of a tumor spreading beyond the prostate gland. The lower the score, the less likely the tumor is to spread.
One of two biopsy procedures may be used to obtain prostate tissue. In both cases, a transrectal ultrasound is often used to help guide the surgeon from where to take the samples.
Tissue from the prostate is removed using a thin needle inserted through the rectum into the prostate.
Tissue from the prostate is removed using a thin needle through the skin between the scrotum and rectum and into the prostate.
Staging Prostate Cancer
If you receive a prostate cancer diagnosis, staging is a way of determining the amount and location of your cancer. Staging is a key factor doctors use to choose treatment options.
The stage is based on several factors including the Gleason score, PSA levels and any other tests used during the diagnosis process.
The staging classification remains the same through treatment.
Prostate cancer may be classified in one of four stages:
In stage I, cancer is found in the prostate only. The cancer:
- Is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 10 and the Gleason score is 6 or lower; or
- Is found in one-half or less of one lobe of the prostate. The PSA level is lower than 10 and the Gleason score is 6 or lower; or
- Cannot be felt during a digital rectal exam and cannot be seen in imaging tests. Cancer is found in one-half or less of one lobe of the prostate. The PSA level and the Gleason score are not known
In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. Stage II is divided into stages IIA and IIB.
In stage IIA, cancer:
- Is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 20 and the Gleason score is 7; or
- Is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is at least 10 but lower than 20 and the Gleason score is 6 or lower; or
- Is found in one-half or less of one lobe of the prostate. The PSA level is at least 10 but lower than 20 and the Gleason score is 6 or lower; or
- Is found in one-half or less of one lobe of the prostate. The PSA level is lower than 20 and the Gleason score is 7; or
- Is found in more than one-half of one lobe of the prostate
In stage IIB, cancer:
- Is found in opposite sides of the prostate. The PSA can be any level and the Gleason score can range from 2 to 10; or
- Cannot be felt during a digital rectal exam and cannot be seen in imaging tests. The PSA level is 20 or higher and the Gleason score can range from 2 to 10; or
- Cannot be felt during a digital rectal exam and cannot be seen in imaging tests. The PSA can be any level and the Gleason score is 8 or higher
In stage III prostate cancer, the disease has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles. The PSA can be any level and the Gleason score can range from 2 to 10.
In stage IV, the PSA can be any level and the Gleason score can range from 2 to 10. Also, cancer:
- Has spread beyond the seminal vesicles to nearby tissue or organs, such as the rectum, bladder or pelvic wall; or
- May have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder or pelvic wall. Cancer has spread to nearby lymph nodes; or
- Has spread to distant parts of the body, which may include lymph nodes or bones. Prostate cancer often spreads to the bones.
(Source: National Cancer Institute)
If you’ve been diagnosed with prostate cancer, would like a second opinion or would like to speak with a prostate cancer specialist, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment.