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Understanding Prostate Cancer -- Diagnosis & Treatment

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How Do I Know If I Have Prostate Cancer?

Two tests are used to look for prostate cancer: a digital rectal exam and a PSA blood test.

The PSA blood test looks for something called prostate-specific antigen in the blood. Who should have a PSA test and when is controversial:

  • The U.S. Preventive Services Task Force does not recommend regular PSA tests. The task force say the tests may find cancers that are so slow growing that treatment, which can have serious side effects, would offer no benefit.
  • The American Cancer Society (ACS) recommends a discussion between the doctor and patient about the pros and cons of PSA tests. Men shouldn't get the test unless their doctor has given them this information, says the ACS. The ACS recommends that the discussion start at age 50 for most men at average risk for prostate cancer, or age 40 to 45 for those at high risk of prostate cancer.
  • The American Urologic Association (AUA) also recommends men talk with their doctor about the pros and cons of the PSA test. The AUA says men who want to be tested should start at age 40.

PSA levels in blood are higher if there is prostate cancer, making it a valuable tool in finding early prostate cancer. But PSA levels can also be high from infection or inflammation in the prostate or from an enlarged prostate.

It is important to discuss this test with your doctor before having one. A high PSA level does not mean that you have cancer; a normal PSA level does not mean you don't have cancer.

If PSA levels are high or have gone up since the last PSA test, your doctor will do a biopsy of the prostate gland using a small ultrasound probe inserted in the rectum (transrectal ultrasound). Tissue samples will be tested for cancer.

If cancer is found, the doctor will do abdominal and pelvic X-rays to see if the cancer has spread outside the prostate. A CT scan and a bone scan may also be done.

For men who have high PSA levels but biopsies don’t find cancer, there is a urine test known as a PCA-3 that looks for cancer. This test can prevent the need for repeat biopsies in some men.

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