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)
