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Thursday, March 23, 2017
If you or a loved one experience any of the symptoms or signs associated with prostate cancer, you must immediately make an appointment with a physician. There's a range of tests to determine whether you have prostate cancer:
See this NetWellness feature for more information on the diagnosis and staging of prostate cancer.
Sometimes a physician will be able to suspect cancer based on an ultrasound image. But more commonly, a biopsy must be performed.
The physician guides a needle using images generated by transrectal ultrasound (TRUS) which is on the end of the probe device. The procedure is relatively simple, and can be performed in the office without anesthesia and takes 20-30 minutes. Your doctor will remove several small sections of the prostate for microscopic examination.
The diagnosis of cancer is ultimately made after the sampled tissue has been viewed by a pathologist. This is called the examination phase. The pathologist will be able to determine whether the prostate is cancerous, and the stage of development. The pathologist assigns a score to the tissue sample based on his interpretation of how the cells look - this is called grading. This score lets the treating physician know the potential aggressiveness of the tumor.
Ultimately, this information coupled with more information the physician has collected from physical examination, blood tests, and possibly imaging, will determine the method of treatment - this process is called staging.
The Gleason score is assigned by the pathologist examining the tissue removed during the biopsy procedure. The Gleason score is a measure of severity of the prostate cancer, and is based on the characteristics of the cells as determined by a pathologist reviewing the biopsy material. A low score (e.g. 5) means a less aggressive tumor and a higher score (e.g. 9) means a more aggressive tumor. The lowest possible score is 2, and the highest possible score is 10.
The "triggered needle" method of prostate biopsy is the method most commonly used and is a significant advancement over prior methods that were much more painful.
There is no evidence to indicate that a prostate biopsy is associated with spread of cancer. Any potential risk is far outweighed by the necessity for the study to establish the diagnosis and, if cancer is detected, to begin the start of appropriate treatment.
The need for repeat biopsy in the face of previous negative biopsies is based on the patient's age, changes in PSA, the ratio of free PSA to total PSA, the actual PSA level, changes in the prostate itself, and physical examination.
An elevated PSA can be caused by prostate cancer, but also by benign enlargement of the gland or an infection of the prostate. A biopsy is often needed to establish a correct diagnosis. A continually rising PSA, even in the absence of cancer by previous biopsy, would warrant another biopsy. This continual increase is often associated with prostate cancer. Some men have multiple biopsies before a diagnosis is established.
Even in older age, an elevation in PSA may still warrant a biopsy to establish a diagnosis for further follow-up regardless of whether treatment is sought. Many men in their 80's have evidence of prostate cancer. Without a substantially elevated PSA, a biopsy may not be performed because treatment would not be required. With a substantially elevated PSA (for example, >100), however, a biopsy may be indicated because this may indicate spread of the disease that should be treated.
This article is a NetWellness exclusive.
Last Reviewed: Mar 10, 2006
Martin I Resnick, MD
Formerly, Professor of Urology
School of Medicine
Case Western Reserve University