The diagnosis of prostate cancer can be made on
clinical suspicion of the disease, following
screening, or as an incidental finding during
transurethral resection for suspected benign
disease (TURP).
Clinically suspected prostate cancer Prostate
cancer can be completely asymptomatic or present
with symptoms similar to benign prostatic
enlargement (see symptoms). It can also present
with the symptoms of metastatic disease. On
digital rectal examination prostate cancer feels
rock hard and nodular. Invasion into the
surrounding structures may be palpable as a hard
mass. Spread to the lymph glands may be palpable
in the groins or pelvis. Bony metastases to the
lumbar spine or pelvis are often tender to
palpation. PSA (Prostate Specific Antigen) is a
substance excreted by all prostate cells. The
blood level of PSA is elevated in prostate cancer
and the level of elevation correlates with the
extent of disease. The PSA level can also be
elevated by benign diseases such as prostatitis
and benign prostatic hyperplasia. The normal
range for PSA is 0 - 4 ng/ml. The higher the PSA
the greater is the chance of having prostate
cancer. Somebody with a PSA of 4 - 10 ng/ml has a
25% chance of having prostate cancer, while a PSA
of greater than 10 carries a 50% risk of the
disease. Very high levels of PSA (>100ng/ml)
almost invariably indicate widespread metastatic
disease. The diagnosis of prostate cancer is
confirmed by needle biopsy and histological
analysis of the biopsy specimens. A transrectal
ultrasound scan is performed via a probe inserted
into the rectum, and ultrasound guided needle
biopsies of the prostate are taken. The procedure
is performed under local anaesthetic
Screening All healthy men over the age of 50
years should have annual prostate cancer checks.
Black men and men with a positive family history
should start at age 40. The aim of screening is
to diagnose the disease at an early stage while
it is still potentially curable. By the time
prostate cancer becomes symptomatic it is usually
beyond cure. The screening tests consist of a
digital rectal examination and a PSA blood test.
The prostate gland may feel entirely normal
despite the presence of an early cancer. The
combination of PSA and digital rectal examination
is more sensitive than either test alone. If one
or both of these tests are abnormal a transrectal
ultrasound and needle biopsies of the prostate
gland are performed.
Incidental finding following TURP Whenever a
transurethral resection of the prostate gland is
performed for suspected benign disease the
removed tissue is sent for histological analysis.
Occasionally evidence of unsuspected prostate
cancer is found in the tissue. In a young man
with an otherwise long life expectancy this is
obviously significant. A tiny focus of cancer in
an elderly man is probably not significant, since
the prostate cancer will not have sufficient time
to become bothersome.
With our next information - we will inform you
about the "Diagnosis of prostate cancer" - so you
should have a look on this site in the next 2
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Fritz Frei Admin
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