kidney and urinary tract disorders
Prostate Cancer
Diagnosis of Prostate Cancer
Screening blood tests (with or without a digital rectal examination [DRE]) Biopsy Imaging tests Doctors may suspect prostate cancer based on the symptoms, the results of DRE, or the results of screening blood tests. The most commonly used screening blood test is a measurement of the prostate-specific antigen (PSA) level. PSA is a substance produced only by prostate gland tissue. In some men, doctors recommend an MRI that focuses on the prostate to obtain detailed images that could indicate more aggressive cancer. The radiologist reading the MRI identifies abnormal areas that may help doctors choose which areas to biopsy (the MRI does not make biopsy unnecessary). If results of these tests suggest cancer, Ultrasonography is usually done. In men with prostate cancer, ultrasonography may or may not reveal the cancer but is used to guide If the results of a digital rectal examination or PSA test suggest prostate cancer, tissue samples from the prostate are taken and analyzed ( Prostate biopsy ). When doing a biopsy, doctors usually first obtain images of the prostate by inserting an ultrasound probe (transducer) into the rectum (transrectal ultrasonography). The biopsy sample may be obtained through the rectal probe or through the skin between the rectum and the scrotum (transperineally). Usually, 10 to 12 samples are taken from the prostate. Taking many samples increases the likelihood of finding a small cancer. This procedure takes about 20 minutes, and men are usually given local anesthesia. If cancer is found in the biopsy sample, grading and staging of the tissue help doctors determine the likely course and the best treatment of the cancer. The Gleason Grade Group system is the most common way to grade prostate cancer (previously the Gleason Scoring system was used). Based on the microscopic examination of tissues obtained from the biopsy, a number is assigned based on how distorted the cells appear. The current version of this scoring system gives each cancer a grade between 1 and 5, while the older Gleason Scoring system assigned a score between 6 and 10. The higher the number (high grade), the more aggressive the cancer is and the more likely it is that the cancer will spread. Gleason Grade Group 1 = Gleason Score 6 (3+3) Gleason Grade Group 2 = Gleason Score 7 (3+4) Gleason Grade Group 3 = Gleason Score 7 (4+3) Gleason Grade Group 4 = Gleason Score 8 Gleason Grade Group 5 = Gleason Score 9 and 10 Gleason Grade, PSA level, and clinical stage together predict the prognosis better than any of them alone and help guide appropriate treatment decisions. Prostate cancers are staged according to 3 criteria: How far the cancer has spread within the prostate Whether the cancer has spread to lymph nodes in areas near the prostate Whether the cancer has spread to bones or other organs far from the prostate (metastatic cancer) Testing to stage the cancer is often done when cancer is diagnosed. However, such testing may not be necessary when the likelihood of spread beyond the prostate is extremely low. Likelihood of spread is low when cancers have a Grade Group of 2 or less, the PSA level is less than 10 ng/mL (10 mcg/L), and the cancer has not penetrated the surface of the gland. Results of the digital rectal examination, ultrasonography, and biopsy reveal how far the cancer has spread within the prostate. If likelihood of spread is not low, doctors usually do Computed tomography (CT) or If spread to the brain or spinal cord is suspected, CT or MRI of those organs is done. 