Diagnosis of prostate cancer

The diagnosis of prostate cancer can be made onclinical suspicion of the disease, followingscreening, or as an incidental finding duringtransurethral resection for suspected benigndisease (TURP). Clinically suspected prostate cancer Prostatecancer can be completely asymptomatic or presentwith symptoms similar to benign prostaticenlargement (see symptoms). It can also presentwith the symptoms of metastatic disease. Ondigital rectal examination prostate cancer feelsrock hard and nodular. Invasion into thesurrounding structures may be palpable as a hardmass. Spread to the lymph glands may be palpablein the groins or pelvis. Bony metastases to thelumbar spine or pelvis are often tender topalpation. PSA (Prostate Specific Antigen) is asubstance excreted by all prostate cells. Theblood level of PSA is elevated in prostate cancerand the level of elevation correlates with theextent of disease. The PSA level can also beelevated by benign diseases such as prostatitisand benign prostatic hyperplasia. The normalrange for PSA is 0 - 4 ng/ml. The higher the PSAthe greater is the chance of having prostatecancer. Somebody with a PSA of 4 - 10 ng/ml has a25% chance of having prostate cancer, while a PSAof greater than 10 carries a 50% risk of thedisease. Very high levels of PSA (>100ng/ml)almost invariably indicate widespread metastaticdisease. The diagnosis of prostate cancer isconfirmed by needle biopsy and histologicalanalysis of the biopsy specimens. A transrectalultrasound scan is performed via a probe insertedinto the rectum, and ultrasound guided needlebiopsies of the prostate are taken. The procedureis performed under local anaestheticScreening All healthy men over the age of 50years should have annual prostate cancer checks.

Black men and men with a positive family historyshould start at age 40. The aim of screening isto diagnose the disease at an early stage whileit is still potentially curable. By the timeprostate cancer becomes symptomatic it is usuallybeyond cure. The screening tests consist of adigital rectal examination and a PSA blood test.

The prostate gland may feel entirely normaldespite the presence of an early cancer. Thecombination of PSA and digital rectal examinationis more sensitive than either test alone. If oneor both of these tests are abnormal a transrectalultrasound and needle biopsies of the prostategland are performed.

Incidental finding following TURP Whenever atransurethral resection of the prostate gland isperformed for suspected benign disease theremoved tissue is sent for histological analysis.

Occasionally evidence of unsuspected prostatecancer is found in the tissue. In a young manwith an otherwise long life expectancy this isobviously significant. A tiny focus of cancer inan elderly man is probably not significant, sincethe prostate cancer will not have sufficient timeto become bothersome.

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