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Diagnosis
If you have a symptom or test result that suggests cancer, your doctor must
find out whether it is due to cancer or to some other cause. Your doctor will
ask about your personal and family medical history. You will have a physical
exam. You may have lab tests. Your visit may include a digital rectal exam, a
urine test to check for blood or infection, and a blood test to measure PSA
level.
You also may have other exams:
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Transrectal ultrasound:
The doctor inserts a probe into the man's rectum
to check for abnormal areas. The probe sends out sound waves that people cannot
hear (ultrasound). The waves bounce off the prostate. A computer uses the
echoes to create a picture called a
sonogram.
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Cystoscopy:
The doctor uses a thin, lighted tube to look into the
urethra and bladder.
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Transrectal biopsy: A
biopsy
is the removal of tissue to look for cancer
cells. It is the only sure way to diagnose prostate cancer. The doctor inserts
a needle through the rectum into the prostate. The doctor takes small tissue
samples from many areas of the prostate. Ultrasound may be used to guide the
needle. A
pathologist
checks for cancer cells in the tissue.
You may want to ask the doctor these questions before having a biopsy:
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Where will the biopsy take place? Will I have to go to the hospital?
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How long will it take? Will I be awake? Will it hurt?
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What are the risks? What are the chances of infection or bleeding after the
biopsy?
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How long will it take me to recover?
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How soon will I know the results?
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If I do have cancer, who will talk to me about the next steps? When?
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If the
physical exam and test results do not suggest cancer, your doctor may suggest medicine to reduce
symptoms caused by an enlarged prostate. Surgery also can relieve these
symptoms. The surgery most often used in such cases is
transurethral resection of the prostate
(TURP or TUR). In TURP, an instrument is inserted through the
urethra to remove prostate tissue that is pressing against the upper part of
the urethra and restricting the flow of urine. You should talk to your doctor
about the best treatment option.
If cancer is present, the pathologist studies tissue samples from the prostate
under a microscope to report the
grade
of the tumor. The grade tells how much
the tumor tissue differs from normal prostate tissue. It suggests how fast the
tumor is likely to grow. Tumors with higher grades tend to grow faster than
those with lower grades. They are also more likely to spread.
One system of grading prostate cancer uses G1 through G4. Another way of
grading is with the
Gleason score.
The pathologist gives each area of cancer a
grade of 1 through 5. The pathologist adds the two most common grades together
to make a Gleason score. Or the pathologist may add the most common grade and
the highest (most abnormal) grade to get the score. Gleason scores can range
from 2 to 10.
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