Understanding Prostate Cancer -- Prevention
How Do I Know If I Have Prostate Cancer?
The best way to detect prostate cancer in its early stages is with regular digital prostate exams and prostate specific antigen (PSA) blood tests. Because most malignant prostate tumors originate in the part of the gland nearest the rectum, many cancers can be detected during routine rectal examinations. Many doctors recommend an annual rectal exam, supplemented by a PSA blood test, starting at age 50 for most men. The screenings are recommended beginning at age 40 to 45 for African Americans and those with a family history of prostate cancer.
PSA is a specific type of protein whose blood level tends to increase in the presence of prostate cancer, making it a valuable tool in detecting early prostate cancer. However, the PSA levels can also elevate in prostate inflammation, urinary retention, prostate infection, benign prostatic hypertrophy (BPH), and prostate manipulation. Despite this, digital rectal exams and PSA tests are the two screening measures that offer the best chance of detecting prostate cancer while it is localized and most treatable. Prostate cancer may also be discovered incidentally during treatment for urinary problems. Because of the possibility of a false-positive PSA reading, it is important to discuss this test with your doctor before having one. As mentioned earlier, an elevated PSA does not mean that you have cancer. Rather, it raises questions that need to be addressed and explained.
If routine screening arouses suspicion and/or PSA levels are elevated, a doctor should perform biopsies of the prostate guided by an ultrasound instrument inserted in your rectum (transrectal ultrasound). X-rays of the urinary tract, along with blood and urine studies, are performed routinely to aid diagnosis. Performing a biopsy will confirm whether or not cancer is present: Guided by ultrasound images, the doctor inserts a needle into the prostate and extracts small slivers of tissue from the suspicious area. Sometimes biopsies are instead obtained through a cystoscope, a narrow telescope passed through the urethra. A pathologist then studies the sample under a microscope to determine whether cancer cells are present. In order to determine if the cancer has spread outside the prostate gland, doctors may arrange CT scans, bone scans, chest X-rays, or other imaging tests.
For men who have persistently elevated PSA levels, but negative biopsies there is a new urine test known as a PCA-3. This test is performed after a digital rectal examination and measures a PSA product called DD3. It prevents the need for repeat biopsies in some men. A test in development at Johns Hopkins University, called EPCA-2, is proving to be a more sensitive test for detecting prostate cancer, even in men with normal PSA levels and BPH. This test detects a protein linked to prostate cancer. This test can predict spread of the cancer beyond the capsule of the prostate as well.
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