Prostate Cancer (10)
Diagnostic tests (6)
If caught in the early stages, prostate cancer can be cured. There are a number of diagnostic tests, the most common are the prostate specific antigen (PSA) blood test and digital rectal examination (DRE).
Read morePSMA PET scanning is a relatively new diagnostic technology that greatly assists in localising the extent of prostate cancer. It can do this not only in the area of the prostate but also in the lymph glands and bones. As a result, therapy can be targeted more appropriately.
Recent developments in magnetic resonance imaging (MRI) have improved the ability of MRI to detect tumours, stage cancer and help in management decisions. They are also helping to more accurately target biopsies.
Cystoscopy is an endoscopic procedure where a tube is inserted into the urethra through the opening at the end of the penis. It allows me to visually examine the complete length of the urethra and the bladder for polyps, strictures, abnormal growths and other problems.
Urodynamic studies are performed to examine and assess the function and/or dysfunction of the lower urinary tract. Urinary assessment takes about 30-45 minutes to perform, and causes little discomfort. If cystoscopy is also performed the assessment takes approximately 60 minutes.
The current Gleason grading system recognises three patterns or grades of cancer. These are given a number 3 to 5. However, the pattern of any one cancer can be mixed and the prognosis for any patient depends upon this mixed pattern. The two most common patterns are each given a separate number and then the two numbers are added to give the Gleason grade, for example 3+4=7. The Gleason grade can therefore be between 6 and 10.
A Gleason grade or score 3+3=6 tumour has a relatively good prognosis and is often just monitored, a Gleason 7 tumour is intermediate and a Gleason 8 to 10 has a poor prognosis. In the Gleason 7 category a Gleason 4+3=7 tumour is a worse tumour than a Gleason 3+4=7 as there is more Gleason 4 pattern than 3 pattern.
As well as the pattern of the growth or tumour, the extent of the cancer felt on digital rectal examination (DRE) is also important in estimating a prognosis. The extent of cancer is referred to as the stage. Stage 1 (T1) cancers cannot be felt on DRE, stage 2 (T2) cancers can be felt, but still feel to be within the prostate, stage 3 (T3) are felt to have extended outside the prostate and stage 4 (T4) are felt to be well outside the prostate, invading adjacent organs such as the bladder or pelvic wall.
A prostate biopsy is the taking of tissue samples from the prostate gland and examining them under a microscope for cancer cells. This can be done using either the transrectal or transperineal technique. Approximately 25 to 35% of patients having a biopsy will have cancer, depending upon their risk factors.
Screening for prostate cancer attempts to diagnose serious cancers in those without symptoms earlier and improves the cure rate. Prostate Specific Antigen, also known as PSA is a simple blood test that is often used in the screening of prostate cancer. Individuals may request PSA screening or be selected for screening when they present with urinary symptoms.
Prostate cancer can be cured if detected and treated early. It is recommended that men at 50 with no family history of prostate cancer and men at 40 with a family history, should seek annual assessments or screening in the form of a Prostate Specific Antigen (PSA) blood test together with a Digital Rectal Examination (DRE).
The commonly quoted range for normal PSA is 0 to 4. In the range 4 to 10, only 25% of men will have cancer detected on biopsies. If the PSA is over 10, greater than 50% of men will have cancer. Around 25% of cancers detected in a screening program will have a PSA of less than 4. The cancers in these patients will only be picked up by a finger examination of the prostate (DRE) so it is important to have both the PSA test and the rectal examinations.
Around 15% of all men between the ages of 50 and 70 who are screened for prostate cancer will have an elevated PSA or abnormal DRE. If the DRE is abnormal or the PSA raised, a biopsy should take place.
Diagnosis of prostate cancer is made by an ultrasound guided needle biopsy of the prostate.
If one does not actively search for the cancer before symptoms begin then the vast majority of cancers detected at the time of diagnoses are incurable. Screening is the process to find cancer at an early potentially curable stage before symptoms have commenced.
Individual risks for developing prostate cancer include:
- Family history
- Age
- Race
Click here for the video, 'What increases the risk of getting prostate cancer? The factors'.
Australian researchers recently announced a world-first discovery. A gene that causes breast cancer can also cause prostate cancer. The confirmation of this new risk factor will help men determine whether they have a greater risk of developing prostate cancer and allows these men to be monitored more closely.
Symptoms
There are three main disorders of the prostate, prostate cancer, prostate enlargement (BPH) and prostatitis. With early prostate cancer most men have no symptoms.
The most common cancer in men, prostate cancer is a major health issue. In Australia alone, prostate cancer effects one in every six men and, sadly, two to three percent of all men will die of prostate cancer.
Prostate cancer can be cured if detected and treated while still confined to the prostate gland. The tests for prostate cancer are the prostate specific antigen (PSA) blood test and digital rectal examination (DRE). These tests do not give a conclusive diagnosis of cancer but can indicate its presence.
While prostate cancer is most common in men over the age of 50, younger men with a history of prostate cancer in their family are at risk. What is complicated with prostate cancer is that some cancers grow very slowly and are not life threatening, while others grow rapidly and are life threatening. A careful approach is needed to detect advanced cancer and avoid over treatment.
Screening is the process to find cancer at an early and potentially curable stage before symptoms have commenced. I urge you take an active role in your health. After all, it is your choice.
Key aspects
From diagnosis and treatment to rehabilitation and research, I believe my highly experienced team and I bring a multifaceted approach to understanding and helping our patients. A summary of these key aspects of that approach is available here in PDF format. If you are suffering from prostate cancer or have reason to believe you might be, you are welcome to contact us or, intially, complete our comprehensive second opinion form.
