Doug is a real person. In 2002, he was 49 years old. When he went for his annual check-up, his family physician found a “pebbly” lump in his prostate with a digital rectal exam (DRE). The doctor assured him that he probably had nothing to worry about, but, being a thorough physician, he sent Doug for a follow-up prostate-specific antigen (PSA) test. Doug’s PSA score was very low and safely outside the cancer range. Just to be sure, however, the doctor sent him to a urologist, who ordered a biopsy a month later. That’s when Doug’s nightmare began. He had prostate cancer, and it was on the brink of spreading beyond his prostate.
Doug had had no warning signs, nothing more than a bit of feeling of urgency and frequency of urination. He was only 49; the average age a man is diagnosed with prostate cancer is 65. Nobody in his family has ever had prostate cancer. He was in total shock. “It can destroy your confidence when you get cancer,” Doug explains. “Most of time you do a test and it comes back negative – you get used to getting the all-clear.”
Prostate cancer is considered a slow-growing cancer, so screening is the number one way that a man can win the battle. Prostate cancer shares many of the symptoms of benign prostatic hyperplasia (BPH), a generally harmless condition, but it can often have no symptoms at all.
The DRE – the first screening
The digital rectal exam (DRE) is a simple, painless examination. Your doctor inserts a gloved finger into the rectum to feel the prostate for changes in size, density, texture, and any other abnormalities. An enlarged prostate does not necessarily mean there are any cancer tumours present; it may just be a sign of BPH. BPH is not related to prostate cancer, and about half of all men over 50 have it. However, enlargements and other irregularities such as lumps and hardening should still be investigated and may require more tests.
The PSA – follow-up to a DRE
The prostate-specific antigen (PSA) blood test is used to detect prostate cancer by measuring levels of PSA. Men with prostate cancer often have more PSA, so their score is higher. There are some cases where some men with prostate cancer will have normal PSA levels, like Doug. This test is considered a better indicator of whether a man may have prostate problems. However, there are other conditions that can cause elevated PSA levels. PSA testing is best done in conjunction with a DRE.
Biopsies confirm cancer
The next step of diagnosis is to perform a biopsy of the prostate. This is the only way to confirm cancerous tissue. A biopsy is a simple procedure that involves the removal of tissue so it can be further analyzed to determine if cancer cells are present and to estimate how aggressive it is. If cancer is present in the prostate, you will begin to discuss treatment options with your doctor.
Other tests are also available to help diagnose prostate cancer and/or rule out other conditions.
Analyzing prostate cancer
The most common cancer
The cancer Doug was diagnosed with is the most common cancer in Canada. 1 in 7 men will be diagnosed with it over their lifetime. In 2011, about 25,500 men were diagnosed with prostate cancer and about 4,100 men died of it.
Prostate cancer is uncontrolled growth of the cells of the prostate gland. The prostate plays an important role in sexual functioning, urination, and reproduction. In prostate cancer, the cells within the walls of the prostate begin to multiply and eventually leave the prostate gland, spreading to invade the body parts close to the prostate – the lymph nodes and bladder – or elsewhere, particularly to the spine. About 30% of men diagnosed with prostate cancer end up dying of it. Men have about the same chance of dying of prostate cancer as women have of dying of breast cancer.
The Gleason score
When a biopsy shows that a man has prostate cancer, the pathologist will apply a “Gleason score” to it. The Gleason score is an important number, as it defines how aggressively the tumour is growing and will reflect the treatment options available. The lower the score, the better a patient’s chance of survival. When Doug’s cancer was biopsied, it was assigned a Gleason score of 7 – a score of 8 or higher is considered “very aggressive.”
The stages of prostate cancer
Prostate cancer is also “staged” – assigned a stage based on the tumour’s characteristics, such as its size and whether there is evidence that it has spread. Staging also helps determine the prognosis and treatment options.
- In Stage T1, the cancer tumour is microscopic and actually can’t be detected by a DRE. A biopsy is needed to find traces of the tumour.
- In Stage T2, the tumour has grown but is still confined to the prostate itself and can be removed by taking out the whole prostate. The doctor can detect it at this stage by DRE.
- By Stage T3 or T4, the cancer is deadlier because it has spread outside the prostate gland to the seminal vesicles (which produce semen) or to the bladder (where urine is stored).
All material © 1996-2014 MediResource Inc. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.