Prostate Cancer Health Article

Signs and symptoms

Frequently, prostate cancer has no symptoms, and the disease is diagnosed when the patient goes for a routine screening examination. However, occasionally, when the tumor is larger or the cancer has spread to the nearby tissues, the following symptoms may occur:

• weak or interrupted flow of the urine
• frequent urination (especially at night)
• difficulty starting urination
• inability to urinate
• pain or burning sensation when urinating
• blood in the urine
• persistent pain in lower back, hips, or thighs (bone pain)
• difficulty having or keeping an erection (impotence)

Diagnosis

Although prostate cancer may be very slow-growing, it can be quite aggressive, especially in younger men. When the disease is slow-growing, it may go undetected. Because it may take many years for the cancer to develop, many men with the disease are likely to die of other causes rather than from the cancer.

Prostate cancer is frequently curable when detected early. However, because the early stages of prostate cancer may not have any symptoms, it often remains undetected until the patient goes for a routine physical examination. Diagnosis of the disease is made using some or all of the following tests.

Digital rectal examination (DRE)

In order to perform this test, the doctor puts a gloved, lubricated finger (digit) into the rectum to feel for any lumps in the prostate. The rectum lies just behind the prostate gland, and a majority of prostate tumors begin in the posterior region of the prostate. If the doctor does detect an abnormality, he or she may order more tests in order to confirm these findings.

Blood tests

Blood tests are used to measure the amounts of certain protein markers, such as prostate-specific antigen

(PSA), found circulating in the blood. The cells lining the prostate generally make this protein and a small amount can be detected in the bloodstream. However, prostate cancers typically produce a lot of this protein, and it can be easily detected in the blood. Hence, when PSA is found in the blood in higher than normal amounts (for the patient's age group), cancer may be present. Occasionally, other blood tests also are used to help with the diagnosis.

Transrectal ultrasound

A small probe is placed in the rectum and sound waves are released from the probe. These sound waves bounce off the prostate tissue and an image is created. Since normal prostate tissue and prostate tumors reflect the sound waves differently, the test can be used to detect tumors. Though the insertion of the probe into the rectum may be slightly uncomfortable, the procedure is generally painless and takes only about 20 minutes.

Prostate biopsy

If cancer is suspected from the results of any of the above tests, the doctor will remove a small piece of prostate tissue with a hollow needle. This sample is then checked under the microscope for the presence of cancerous cells. Prostate biopsy is the most definitive diagnostic tool for prostate cancer.

If cancer is detected during the microscopic examination of the prostate tissue, the pathologist will "grade" the tumor. This means that the tumor will be scored on a scale of 2-10 to indicate how aggressive the tumor is. Tumors with a lower score are less likely to grow and spread than are tumors with higher scores. This method of grading tumors is called the Gleason system. This is different from "staging" of the cancer. When a doctor stages a cancer, the doctor gives it a number that indicates whether it has spread and the extent of spread of the disease. In Stage I, the cancer is localized in the prostate in one area, while in the last stage, Stage IV, the cancer cells have spread to other parts of the body.

X rays and imaging techniques

X-ray studies may be ordered to determine whether the cancer has spread to other areas. Imaging techniques (such as computed tomography scans and magnetic resonance imaging), where a computer is used to generate a detailed picture of the prostate and areas nearby, may be done to get a clearer view of the internal organs. A bone scan may be used to check whether the cancer has spread to the bone.

The American Cancer Society and other organizations recommend that PSA blood testing and DRE be offered to men with at least a 10-year life expectancy beginning at age 50. Men at higher risk for prostate cancer, such as those with a family history of the disease or African American men, may wish to consider screening at an earlier age such as 45. A low-fat diet may slow the progression of prostate cancer. Hence, the American Cancer Society recommends a diet rich in fruits, vegetables and dietary fiber, and low in red meat and saturated fats, in order to reduce the risk of prostate cancer.