Prostate Cancer – Diagnosis & Tests

Prostate cancer is the cancer of the prostate gland, and one of the most common cancers that affects older, adult men. Although this disease has been found in adult men of various ages, the risk of getting it increases considerably once men reach the age of 50. Which is why hospitals and doctors recommend getting checked for the risk of prostate cancer at least once, as early as the age of 40.  The standout feature of prostate cancer is that unlike other forms of cancer, it does not manifest itself in the form of any physical symptoms until it becomes too late. However, the argument for screenings for men is made of the fact that statistics show that those men that get diagnosed with prostate cancer early, have a nearly 90% survival rate. So what exactly do the tests for diagnosing prostate cancer entail?

Prostate cancer screening tests are two distinct types:

  • Digital Rectal Exam (DRE): Is a physical exam where the doctor inserts a gloved, lubricated finger into the patient’s rectum in order to examine the prostate gland. This test is carried out in order to find and identify any abnormalities in the shape, size or texture of the prostate gland.
  • Prostate Specific Antigen (PSA) test: In this test, a blood sample is drawn and analysed for the substance, PSA which is naturally produced in the body by the prostate gland. High levels of PSA in the bloodstream may be an indicator of prostate infection, inflammation, enlargement or cancer.

If the DRE and PSA tests lead to the detection of an abnormality, your doctor might recommend getting an MRI or a biopsy done. Both these additional tests are used to determine whether the initial abnormalities that were discovered are because of cancer or some other prostate disorder such as a prostate infection or prostatitis.

Once the presence of prostate cancer has been determined, it now becomes imperative to go forward and analyse the cancer cells for their degree of aggressiveness and their degree of spread during the time of diagnosis. In order to determine the degree of aggressiveness of the cancer cells, they are sent to be examined by a pathologist. Once examined, the cancer cells are then given a Gleason score. These scores range from 2 to 10 and indicate how likely it is that a tumour will spread. A low Gleason score indicates that the cancer cells are similar to normal prostate cells and are less likely to spread (less aggressive). Conversely, a high Gleason score indicates that the cancer cells are very different from the normal prostate cells and are more likely to spread (more aggressive).

Once a prostate cancer diagnosis has been made, your doctor works to determine the extent (stage) of cancer. If your doctor suspects your cancer may have spread beyond your prostate, imaging tests such as bone scan, CT scan, MRI, and PET scan might be recommended. Once the testing phase is complete, and the diagnosis and level of aggressiveness of cancer have been determined, the doctor then assigns cancer a stage. The stage at which cancer has reached is the most important factor in determining treatment options. The stages of prostate cancer are:

  • Stage 1 – This stage signifies very early cancer that’s confined to a small area of the prostate. When viewed under a microscope, the cancer cells aren’t considered aggressive.
  • Stage 2 – Cancer at this stage may still be small but may be considered aggressive when cancer cells are viewed under the microscope. Or cancer that is stage II may be larger and may have grown to involve both sides of the prostate gland.
  • Stage 3 – Cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
  • Stage 4 – Cancer has grown to invade nearby organs, such as the bladder, or spread to lymph nodes, bones, lungs or other organs.

Knowing the type and stage of cancer helps the doctor decide what treatment option would be best suited for a particular situation.

Dr.Rahul Bhatt 

Specialist Urologist 

Aster Clinic, Bur Dubai (AJMC) 

Dr.-Rahul-Bhatt

 

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Myths About Prostate Cancer

Prostate cancer is one of the most prevalent cancers among adult men in the UAE. In the larger conversation about male organs and glands, the prostate gland often gets overlooked. Part of the male reproductive system, located under the bladder in front of the rectum and surrounding the beginning of the urethra, the prostate is actually a small gland. As a key part of the male reproductive system, the prostate gland produces and secretes fluid into the semen. Despite its small size and limited function, however, the prostate gland too can become cancerous.

Cancer begins when cells in one part of the body grow uncontrollably and then start spreading to other areas. The spread of the cancerous cells may be slow or rapid depending on the type of cancer and the body’s response to it. Just like other forms of cancer, prostate cancer too begins when the cells in the prostate gland begin to grow uncontrollably. Although the prostate gland functions as part of the reproductive system in men, its close proximity to the bladder results in individuals with prostate cancer exhibiting many urinary symptoms such as burning sensation or pain during urination; difficulty urinating; loss of bladder control; blood in the urine (hematuria) etc. However, these are not definitive symptoms, hence, it is strongly advised for adult male’s post the age of 40 to get themselves screened regularly for prostate cancer.

Despite the wide prevalence of prostate cancer, the conversation about it is only limited within the medical community, which has led to the perpetuation of many myths and a serious lack of awareness about the condition in this region. Myths and misconceptions about such a serious medical condition can be harmful to those who might be at risk for prostate cancer but ignore their symptoms as signs of a less detrimental condition. Some common myths regarding prostate cancer include:

  • Prostate cancer only affects older men: Statistics show that the probability of getting prostate cancer is higher in older men, however, middle aged and men in their late 40’s are also at risk for prostate cancer. The risk factors for prostate cancer extends beyond age including race, family history, physical health, geography and lifestyle.
  • Lack of symptoms implies the absence of prostate cancer: Unlike other forms of cancer, prostate cancer can be completely asymptomatic, particularly in its early stages. In such cases, a diagnosis can only be made by a doctor during a checkup and follow-up tests.
  • Prostate cancer is a slow-growing cancer: This isn’t always the case. There are different types of prostate cancer often present in different parts of the prostate. There are those that advance slowly as well as those that advance rapidly and can be fatal in their outcome.
  • Since prostate cancer doesn’t run in my family, the odds are that I will not get it: Although the probability of developing prostate cancer is higher if it runs in the family, the fact remains that even those without a predisposed hereditary risk factor can develop prostate cancer.
  • The Prostate-specific antigen (PSA) test is a cancer test: The PSA test only determines the amount of PSA/ protein present in the bloodstream and not cancer. If an abnormal level of PSA is found, then the doctor recommends further tests to determine if the cause is prostate cancer. PSA test is not a prostate cancer determining test, for instance sometimes a high number may not mean you have the disease and a low number may not mean you don’t.
  • Vasectomy can cause prostate cancer: After extensive research, it has been concluded that vasectomy does not increase a man’s chances of getting prostate cancer.
  • Prostate cancer treatment results in incontinence or impotence: Although chemotherapy might have some side effects such as erectile dysfunction and urinary incontinence, these effects are subject to the patient’s age and physical health.
  • Prostate cancer is contagious: The chances of having prostate cancer increases in men who have a family history of the condition. But in no way, shape or form is prostate cancer contagious among men.

Despite the widespread prevalence of prostate cancer, early detection and treatment have led to a complete recovery for a majority of the patients. To put things into perspective, the 5-year, 10-year and 15-year survival rates are nearly 100%, 98% and 95% respectively. But it is important that men get regular screening involving either a Digital rectal exam (DRE) or the PSA test if they notice any unusual symptoms or urinary functions. It is also recommended that all men above the age of 40 get prostate cancer screening despite not showing any symptoms because it will help identify cancer early when the treatment is most effective. Prostate cancer is one of the few cancers that can be neutralised completely, once detected. All that is required is the right knowledge about the condition and the initiative to get yourself tested regularly.

Dr.Rahul Bhatt

Specialist Urologist

Aster Clinic, Bur Dubai (AJMC)

Dr.-Rahul-Bhatt

*Aster Clinics are currently running a 50% discount on prostate cancer screening in line with the aim of promoting awareness about the importance of regular screening especially for men over 40. For more information, visit – http://asterclinic.ae/prostate-cancer-screening/

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The Papanicolaou test (Pap Test, Cervical Smear, Pap Smear or Smear Test)

What is Pap smear?

A Pap smear is a simple test to check your cervix to make sure it is healthy. Your cervix is the opening of the womb. The Pap test (or Pap smear) looks for precancerous cell changes on the cervix that might become cervical cancer if they are not treated appropriately.

 

Why are cervical screening tests advised?

Cervical cancer is a disease that can often be prevented. Early changes can be detected in the neck of the womb (cervix), which indicate that cancer may develop. It usually takes 3–7 years for high-grade changes in cervical cells to become cancer. Cervical cancer screening may detect these changes before they become cancer. Since screening started, the numbers of cases of cervical cancer have dramatically dropped. It is one of the few types of cancer which can be detected and stopped before it ever begins.

 

What causes cervical cancer?

An infection with a virus called HPV (human papillomavirus) is the cause of almost all cervical cancers. There are more than 100 different types of HPV. Two of these types are known to cause most of cervical cancer. HPV is very common. Most people (four out of five) will have HPV at some time in their lives. Anyone who has ever had sex can have HPV. In most cases, HPV clears up by itself in a few years. This means that most women who are infected with HPV do not develop cancer. Sometimes the virus can stay in your body longer and can lead to cervical cancer. This usually takes a long time.

 

How is Pap smear done?

During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to widen your vagina. This helps the doctor examine the vagina and the cervix, and collect a few cells and mucus from the cervix and the area around it. The cells are then placed on a slide or in a bottle of liquid and sent to a laboratory. The laboratory will check to be sure that the cells are normal. If the test shows any abnormality, you will have treatment to stop you ever getting cancer of the cervix. So, an abnormal test does not mean you have cancer. It means you should have some treatment to stop you getting cancer. Cervical screening tests are not painful, although some women find the speculum uncomfortable. It generally helps if you can relax – this makes the experience better for you and easier for the person taking the sample.

 

When does Pap smear need to be done?

The screening guidelines vary from country to country. In general, the Pap test is recommended for all the women about the age of 21 – 25 years and continuous until the age of 65 years. It can be done in a doctor’s clinic. Screening is typically recommended every 3 to 5 years as long as the results are normal.

Pap smear screening is also recommended for those who have been vaccinated against HPV. As the vaccines don’t cover all types of HPV and the vaccine does not protect against HPV exposure before vaccination.

Only cancer for which the Pap test screens is cervical cancer. It does not screen for ovarian, uterine, vaginal, or vulvar cancers. So even if you have a Pap test regularly, if you notice any signs or symptoms that are unusual for you, see a doctor find out why you’re having them. If your Pap test results are normal, your doctor may tell you that you can wait three years until your next Pap test.

 

What do the results of the cervical screening test mean?

In most women, the cells that are taken are found to be normal. Abnormal cells are found in some women. An abnormal result does not mean cancer in the vast majority of cases. Abnormal cells indicate that cancer may develop sometime in the future. About 6 women in 100 will have an abnormal result that requires further testing or treatment.The results are reported as one of the following:

  • Normal.
  • Inadequate.
  • Abnormal – of which there are several grades or degrees of abnormalities from low grade to high grade.
  • Possible cancer cells: invasive or glandular neoplasia.

Most of these changes will not lead to cervical cancer. Treatment can be given to prevent cancer from developing in women with abnormal cells. Depending on your test results, your health care provider may recommend:

Routine follow-up testing. Depending on your age and tests received, this may be every 3-5 years.

Follow-up testing with a Pap test and an HPV test.

Colposcopy and cervical biopsy

Like a lot of medical testing, it’s not very pleasant to do a pap smear but the brief discomfort isn’t a good reason to neglect your wellbeing. Getting regular pap smear is the best way to protect your health from cervical cancer.

Dr.Usha Sethi

Specialist Gynaecologist 

Aster Clinic, Tecom (Barsha Heights) 

Dr.-Usha-Sethi1

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