Diagnosis and Staging of prostate cancer
Tests that examine the prostate and blood are used to detect (find) and diagnose prostate cancer.
The following tests and procedures may be used:
-Medical history and physical exam
-Prostate-specific antigen (PSA) test
-Digital rectal exam (DRE)
-Biopsy
Transrectal ultrasound
Bone scan
CT scan (computed tomography)
MRI (magnetic resonance imaging)
Medical history and physical exam
If your doctor suspects you might have prostate cancer, he or she will ask you about any symptoms you are having, such as any urinary or sexual problems, and how long you have had them
Your doctor may also ask about bone pain, which could be a sign that the cancer might have spread to your bones
Your doctor will also do a physical exam and will check other parts of your body to see if the cancer has spread
Prostate-specific antigen (PSA) test
A test that measures the level of PSA in the blood
PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer
PSA levels may also be high in men who have an infection or inflammation of the prostate or BPH (an enlarged, but noncancerous, prostate)
Digital rectal exam (DRE)
An exam of the rectum
The doctor or nurse inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas
The removal of cells or tissues so they can be viewed under a microscope by a pathologist
The pathologist will check the biopsy sample to see if there are cancer cells and find out the Gleason score
The Gleason score ranges from 2-10 and describes how likely it is that a tumor will spread
The lower the number, the less likely the tumor is to spread
There are 2 types of biopsy procedures used to diagnose prostate cancer:
Transrectal biopsy
-The removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate
-This procedure is usually done using transrectal ultrasound to help guide the needle
-A pathologist views the tissue under a microscope to look for cancer cells
Transrectal biopsy: An ultrasound probe is inserted into the rectum to show where the tumor is. Then a needle is inserted through the rectum into the prostate to remove tissue from the prostate.
Transperineal biopsy
The removal of tissue from the prostate by inserting a thin needle through the skin between the scrotum and rectum and into the prostate
A pathologist views the tissue under a microscope to look for cancer cells
A procedure in which a probe that is about the size of a finger is inserted into the rectum to check the prostate
The probe is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes
The echoes form a picture of body tissues called a sonogram
Transrectal ultrasound may be used during a biopsy procedure
Transrectal ultrasound: An ultrasound probe is inserted into the rectum to check the prostate. The probe bounces sound waves off body tissues to make echoes that form a sonogram (computer picture) of the prostate.
After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body
The process used to find out if cancer has spread within the prostate or to other parts of the body is called staging
The information gathered from the staging process determines the stage of the disease
It is important to know the stage in order to plan treatment
The following tests and procedures may be used in the staging process:
Radionuclide bone scan
MRI (magnetic resonance imaging)
Pelvic lymphadenectomy
CT scan (CAT scan)
Seminal vesicle biopsy
A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone
A very small amount of radioactive material is injected into a vein and travels through the bloodstream
The radioactive material collects in the bones and is detected by a scanner
Bone scan: A small amount of radioactive material is injected into the patient's bloodstream and collects in abnormal cells in the bones. As the patient lies on a table that slides under the scanner, the radioactive material is detected and images are made on a computer screen or film.
A strong magnet linked to a computer is used to make detailed pictures of your lower abdomen
An MRI can show whether cancer has spread to lymph nodes or other areas
Sometimes contrast material is used to make abnormal areas show up more clearly on the picture
A surgical procedure to remove the lymph nodes in the pelvis
A pathologist views the tissue under a microscope to look for cancer cells
An x-ray machine linked to a computer takes a series of detailed pictures of your lower abdomen or other parts of your body
You may receive contrast material by injection into a blood vessel in your arm or hand, or by enema
The contrast material makes it easier to see abnormal areas
The pictures from a CT scan can show cancer that has spread to the lymph nodes or other areas
The removal of fluid from the seminal vesicles (glands that make semen) using a needle
A pathologist views the fluid under a microscope to look for cancer cells
The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate specific antigen (PSA) test and the original tumor biopsy
The biopsy is used to determine the Gleason score
The Gleason score ranges from 2-10 and describes how different the cancer cells look from normal cells and how likely it is that the tumor will spread
The lower the number, the less likely the tumor is to spread
Cancer is found in the prostate only.
Cancer is more advanced than in stage I, but has not spread outside the prostate
Stage II is divided into stage IIA and stage IIB
Cancer has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles
The PSA can be any level and the Gleason score can range from 2 to 10
The PSA can be any level and the Gleason score can range from 2 to 10
Cancer has spread beyond the seminal vesicles to nearby tissue or organs, such as the rectum, bladder, or pelvic wall; or
May have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. Cancer has spread to nearby lymph nodes; or
Has spread to distant parts of the body, which may include lymph nodes or bones. Prostate cancer often spreads to the bones
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