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Prostate Cancer Diagnosis & Detection


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Prostate Cancer Detection and Diagnosis | Holy Cross Hospital | Silver Spring, MD

Prevention and early detection of prostate cancer are by far the most effective ways to fight this disease. Holy Cross Hospital offers a wide range of diagnostic tools to help doctors discover cancer and to target therapies effectively.

The American Cancer Society recommendations on the early detection of prostate cancer encourages men to make an informed decision with their doctor about whether to be tested for prostate cancer. Starting at age 50, men should talk to a doctor about the pros and cons of testing so they can decide if testing is the right choice for them. Men at high risk should have this discussion with their doctor at age 45. Men at high risk include African American men and men who have a close relative (father, brother or son) who had prostate cancer before age 65.

Digital rectal exam (DRE)
Digital rectal exam (DRE) allows doctors to explore the prostate and the rectum for abnormalities that could be cancerous.

Prostate-specific antigen testing (PSA)
Prostate-specific antigen testing (PSA) is a blood test that looks for specific "markers" in the blood that can indicate the presence of cancer in the prostate. The test helps to determine how much cancer is present. In general, the higher the PSA, the larger or more advanced is the cancer. However, the PSA level also can be elevated because of other factors, such as benign prostatic hyperplasia (BPH), and the presence of inflammation or infection in the prostate gland. On the other hand, some medications, such as Finasteride (Proscar) or Dutasteride (Avodart), can lower the PSA by as much as 50 percent creating a false impression that the PSA is okay. For patients on these medications, it is best to double their PSA value to get a more accurate indication of what their PSA really is.

The PSA is valuable in determining the likelihood that you will be cured, also known as prognosis. For example, if the PSA is lower than 4, the cure rate is very high. When the PSA is 4 to 10, the prognosis is usually very good. For patients with a PSA of 10 to 20, the prognosis is fair. For a PSA greater than 20, the prognosis is less favorable. The cure rate for patients with a PSA greater than 30 is very low, unless a special kind of prostate cancer, called a transition zone cancer, is present. Your PSA also helps your physicians determine the most appropriate treatment for you.

In general, the higher the PSA, the more aggressive the treatment. If the PSA is very low, careful follow-up without any treatment can be considered (watchful waiting). If the PSA is very high, hormone therapy alone may be indicated.

Transrectal Ultrasound (TRUS)
If your PSA is elevated, or if you have an abnormal DRE, your urologist may perform a transrectal ultrasound (TRUS) and multiple biopsies of the prostate. The TRUS uses sound waves to image the prostate. Sometimes abnormal areas within the prostate can be seen with TRUS and your urologist will target these at the time of biopsy. Once the procedure is completed, the biopsy tissue is sent to a pathologist for analysis. The tissue is then examined under a microscope, and the pathologist may make a diagnosis of prostate cancer.

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