Prostate Cancer
Diagnosis
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 recommends that men be screened for prostate cancer
regularly beginning at age 50. Men at high risk should begin testing
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 text 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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