Prostate Cancer Services

If you and your physician decide that you should get screened for prostate cancer, the doctor will likely perform certain tests to help identify prostate cancer at an early stage. The results of these screenings can help you and your physician make decisions about your care.

Screenings include:

• Digital rectal exam: The prostate is the size of a walnut and located underneath the bladder in front of the rectum. Because the prostate is close to the rectum, your physician can perform a physical exam that detects lumps, enlargement or other abnormalities. Your doctor will recommend further testing, if necessary.
• Prostate-specific antigen (PSA) blood test: The prostate produces PSA, which is a protein primarily found in semen and in minimal amounts in the blood. Changes to PSA levels in a PSA test could signify the presence of prostate cancer. However, elevated PSA levels can also stem from other problems such as age, inflammation, urinary tract infections, an enlarged prostate or benign prostatic hyperplasia (BPH), or biopsies.

Diagnostic Tests

If your screening test results indicate prostate cancer, your doctor will likely recommend further tests to make a diagnosis, including:

• Transrectal ultrasound: This test uses a small probe, about the size and shape of a cigar. The probe is inserted into the rectum to take images of the prostate.
• Prostate biopsy: Your doctor will use ultrasound images as a guide to insert a needle to retrieve six to 12 thread-like pieces of prostate gland tissue. A pathologist evaluates the samples, determines if cancer is present and grades the aggressiveness of the cancer using a scoring system called the Gleason score. The score ranges from two (non-aggressive) to 10 (very aggressive). Scores between four and six are most common. The higher the number, the more likely the cancer will spread.

Tests to Guide Your Treatment

If you receive a diagnosis of prostate cancer, your doctor may recommend additional tests to stage the cancer, unless it is unlikely that your cancer will spread beyond the prostate.

Prostate cancers are staged using three criteria:

• How far the cancer has spread beyond the prostate
• If cancer has spread to the lymph nodes in areas near the prostate
• If cancer has spread to organs distant from the prostate

If your cancer has spread, our urologists and cancer specialists may immediately recommend treatment strategies specific to your situation, or additional tests to determine the best treatment approaches. These include:

• Bone scan: This test evaluates the skeleton in order to determine whether cancer has spread to the bone.
• Computerized tomography (CT) scan: This test evaluates if prostate cancer has spread to the tissues adjacent to the prostate gland, the pelvic lymph nodes, the skeleton, or other organs such as the brain or spinal cord.
• Magnetic resonance imaging (MRI): An MRI is another imaging strategy that your doctor may recommend and is similar to the CT scan.

Most prostate cancers grow very slowly and do not cause symptoms until the disease has advanced; so many men never know they have prostate cancer or experience symptoms related to it.

Some men develop symptoms when the cancer reaches an advanced stage, spreading beyond the prostate. The areas most affected when prostate cancer spreads are bone, including the pelvis, ribs or vertebrae. Other areas that may be affected are the kidneys, brain or spinal cord.

Prostate cancer begins as a small hard bump or lump on the prostate gland. Your doctor may detect the cancer through routine screening, such as digital rectal exam (DRE) or prostate-specific antigen (PSA) blood test. A biopsy is the only way to confirm the presence of prostate cancer. Typically conducted in the doctor’s office, this test removes tissue samples to examine under a microscope.

Early signs of prostate cancer may include urinary problems; however, most urinary issues are related to an enlarged prostate, a common condition in older men called benign prostatic hyperplasia (BPH). BPH is a normal part of aging caused by hormone and cell growth changes. The prostate gland surrounds the urethra, which carries urine from the bladder out of the body. As the prostate gets bigger, it can block or squeeze the urethra, which causes urination problems. As men age, they frequently experience BPH-related symptoms.

Less than 5% of men with prostate cancer have urinary problems as the initial symptom. If an individual does experience urinary symptoms, they may include:

• Blood in semen
• Blood in urine
• Decreased force of the urine stream
• Starting and stopping while urinating
• Trouble urinating

Prostate cancer that has spread to the lymph nodes in the pelvis may cause:

• Blockage of the ureters that drain urine from the kidneys, causing kidney failure
• Discomfort in the pelvic area
• Swelling in the legs

Advanced prostate cancer that has spread to bones may cause:

• Bone fractures
• Bone pain that does not go away
• Compression of the spine

Our Cancer Institute's specialists are available to discuss your personal risk factors for prostate cancer. We encourage men in our community to make informed decisions about their options for screening, diagnosis and treatment.

The American Cancer Society recommends that men at average risk of prostate cancer begin discussing their options with their primary care physician when they are age 50 and expect to live at least 10 more years. Men at higher risk, including certain ethnic groups and men with a family history of the disease, should start discussing their options with their physician before age 50.

The following are the major risk factors associated with prostate cancer:

• Age: A man's age is the leading risk factor for prostate cancer. More than 70 percent of men diagnosed with prostate cancer are over age 65. According to the National Cancer Institute, one in six men will get prostate cancer in their lifetime, and the risk increases significantly after age 60. Many men will have some form of the disease after age 80. It is rare for younger men to have prostate cancer.
• Ethnicity: African-American men have a higher risk for prostate cancer than men of other races or ethnicity. Latino men are also at higher risk for prostate cancer. Asian and Native American men have a lower chance of getting prostate cancer than other ethnic groups.
• Family history: Men who have a first-degree blood relative, such as father, brother or son, are at a higher risk for developing prostate cancer. According to the American Cancer Society, men who have more than one first-degree relative with prostate cancer should start discussing their options with their physician at age 40.
• Weight or Body Mass Index: Men who are obese or consume a high-fat diet may be at risk for prostate cancer.

We offer the full range of treatment options for prostate cancer including the latest, state-of-the-art techniques. Not all men diagnosed with prostate cancer need treatment. Active surveillance or watchful waiting may be an option for cancers that are lower grade and slower growing, particularly if you are older.

Every man is different and we will recommend an approach specific to your age at diagnosis, personal circumstances, overall medical condition and quality-of-life concerns.