Different tests to diagnose prostate cancer

Prostate cancer resulting in a malignant tumor has become a major cause of death among men, globally. The incident rates reported across the world vary in statistics due to lesser data available from PSA screening. Prostate cancer is showing a rapid increase among men who are obese and have other lifestyle diseases. There is also risk from aging, ethnicity as well as a genetic history of prostate cancer in the family.

The most common type of prostate cancer is Adenocarcinoma. Others include sarcoma, neuroendocrine tumors, and other rarer carcinomas. It is important to identify prostate cancer through early detection/screening as well as through its symptoms. This can have a great impact on the survival rate of prostate cancer patients. Screening decisions can be based on several factors. There may be several factors that affect the development of prostate cancer. These can be individual risks or the effect of the environment we live in.

If prostate cancer is not detected promptly, it may result in several complications. Notably, metastasis – where cancer grows slowly or rapidly outside the prostate gland and spreads to the nearby organs, bones, or tissues through the bloodstream or urinary tract.

In some cases, it may result in the removal of the prostate gland or bladder, if cancer spreads to the urinary tract. The treatment may then require a combination of medication, surgery, and the support of catheters to discharge urine. For men between the ages of 30-40 years who are experiencing any symptoms or early warning signs, must see a doctor or medical practitioner immediately. Bloody discharge, unbearable pain in the pelvic area may warrant an immediate screening without delay.

Early symptoms and warning signs 

In the benign stage, the prostate gland may be enlarged and this condition is called Benign Prostatic Hyperplasia (BPH). This is not a serious threat and may not invade nearby lymph nodes, tissues, or organs. Sometimes cancer cells can move out of the primary (original) tumor and attack surrounding tissues to form a new tumor which might be the same as the primary tumor composition.

By identifying signs & symptoms of prostate cancer and through early detection/screening there can be an effective increase in the survival rate of prostate cancer patients. There are different types of screening tests available for prostate cancer. Early-onset may be asymptomatic but advanced cases can throw up symptoms like:

  1. Problems while urinating, weak stream (also known as dribbling), or even  frequent urination in the night

  2. Passing blood in the urine or semen

  3. Having an erectile dysfunction

  4. Severe pain in the back, spreading to the hips, chest or ribs, and even bones (in serious cases it can cause a fracture to the bones)

  5. Complete weakness or numbness in legs/feet ranging to even swelling in severe cases (edema)

  6. Loss of bladder/bowel movement

  7. Abnormal weight loss or fatigue

Learn more about the early signs and symptoms of prostate cancer you must look out for

Screening for prostate cancer 

Most doctors advise men aged over 50 years to undertake prostate cancer screening. This is because prostate cancer is more common in older men when compared to younger men. A discussion with your health professional will help you understand the risks associated with prostate cancer. Also, it can help with the various available screening methods. Those who have a family history of cancer or those from certain ethnicities might be at a higher risk. There is still a lot of discussion around whether the benefits of getting tested can outweigh the associated risks. Perfectly healthy men might prefer to undergo screening for prostate cancer.

There are different types of screening tests for prostate cancer like:

Digital Rectal Exam (DRE)

This is considered a more invasive method of testing. During the DRE, a doctor will physically insert a gloved finger (using lubrication) directly into the rectum to examine the prostate. In case of any abnormalities arising from the shape, size, or the way the gland feels, further tests will be recommended. The procedure will only cause temporary discomfort but no significant damage to the prostate. After this, you will be able to resume your regular activities.

Prostate-Specific Antigen Test (PSA Test)

The PSA is a protein that is produced in optimal quantities by normal cells and in excess by malignant cells of the prostate gland. A blood test that measures the PSA levels are required to be undertaken. If the PSA levels are found to be elevated, then your doctor might also suggest a DRE initially. However, PSA scores are not enough to determine prostate cancer.

The reason for the increase in these levels could also be associated with an inflammation in the prostate (also known as Benign Prostatic Hyperplasia). Usually, men with PSA scores higher than 4.0 ng/ml are considered to have prostate cancer but recent studies have shown otherwise. Certain drugs such as Finasteride and Dutasteride are known to lower PSA levels. This may lead to false detection of prostate cancer in patients suffering from treatment drugs. This is why the Gleason Test and Grade Scores are used in the staging of cancer cells.

There are many types of PSA tests such as 4K Score Tests, Prostate Health Index (PHI), or Percent-free PSA. These may be a little more advanced whereby if the results are abnormal, then your doctor may refer you to take different types of tests.

Recent developments in science have led us to minimally invasive medical devices that help in measuring the PSA levels with high levels accuracy like Prostametrix ™ by Medicametrix™.

Read more about Prostametrix™ – a medical device that’s transforming prostate health management.

Genomic testing

Through genomic testing of the prostate cancer cells, your doctor can determine what type of gene mutations exist. Genome testing can help with the prognosis of a particular disease and everyone doesn’t need to undertake these tests. In certain situations, they can be useful in making treatment decisions. Genomic testing can also look at hereditary health problems that can pass on from generations and it can also observe cancer genes and their behavior. Medical professionals can conduct further genomic tests through biopsy and can determine whether these cells will grow into malignant cells or not.

Computerized tomography (CT) scan

Men with lower risk can also be monitored with active surveillance. This means getting frequent PSA level tests, biopsies, or DREs. There is not much data available on minimally invasive treatments except for keeping constant vigil. This includes future MRIs or biopsies if something is detected early. A computerized tomography (CAT) scan is a series of x-rays that are taken from different body angles, producing cross-sectional images. These could be of bones, blood vessels, etc. These tend to provide much more clarity compared to x-rays.

Doctors use a CAT scan to detect cancer and may also use it to learn about the nature of cancer. Another useful information that it can provide is as to what stage the cancer is currently in and this can help your doctor choose the best treatment option. It also helps find the right location for the biopsy and in planning therapies such as radiation while also monitoring the effectiveness of the treatment. A CAT scan can also be used to check any new cancerous growth, once the treatment period is over.

Magnetic resonance imaging (MRI)

This test can be used to find a tumor in the body and also helps understand if a tumor is cancerous. Doctors are using MRI to learn about the size and location of the tumor, plan treatment such as surgery or radiation, and also monitor how well the treatment is working for a patient. The advantage is that MRI can offer stable visualization of potentially significant prostate cancer and thus is better used for facilitating biopsy among patients.

There is also increased use of guiding targeted diagnostic prostate biopsies. MRI can also be useful in evaluating males wherein the diagnosis of prostate cancer has already been undertaken. Some benefits include optimizing the localization of the tumor in the staging purpose, identifying risks, selecting natural candidates having lower risk disease as a matter of active surveillance, and monitoring those patients. At times it can also be used to identify any failure in radiation therapy.

Positron emission tomography (PET) scan

For men who have been detected with high-risk localized prostate cancer where the cancer is confined to the prostate gland, additional testing is advised. To determine if there is any evidence of metastatic cancer – a conventional CT scan or a nuclear imaging test such as a bone scan is used. Since both technologies have challenges such as finding individual prostate cancer cells, small tumors can go undetected. The scans which detect bone damage are used for screening other bone-related disorders. This can lead to unnecessary testing.

A PET scan is a type of nuclear imaging test where a patient is inserted with an IV of a radioactive tracer. This in turn can be detected through a scan. Tracer has a molecule that binds to the PSMA protein and is usually found in large quantities in prostate cancer cells. That molecule is linked to a radioactive compound or radioisotope. This is a development in a combination of PET-CT scans (combining both methods) and PSMA PET-CT which is found to be more accurate than a PET-CT scan. Some studies suggest that the radiation exposure to the PCMA PET-CT compared to the conventional PET scan. The future of this technology is still being shaped as there are many PSMA targeted tracers and are still awaiting approvals

Transrectal Ultrasound (TRUS)

Originally developed as a method for guiding transperineal biopsies, TRUS provided more stability before PSA emerged as a testing tool. This was a more accurate observation as compared to DREs as it can locate the extent of cancer in glands that appear to be normal. Lower levels of PSA still resulting in cancer detection and increased screening in younger males has changed the methodology of detection. Biopsies are generally performed on patients who have higher chances of cancer. The accuracy of TRUS was observed to be valuable in this case. Once PSA screening came into being, its ability to detect small volume, impalpable cancers came to the fore. In cases where cancers cannot be detected by a method of systematic sampling, TRUS is still relied upon for guiding trans-rectal biopsy.

Biopsy

A prostate biopsy is conducted using a needle to collect tissue samples from the prostate gland. Before getting a biopsy it is recommended that the results from initial tests such as the PSA blood test or a DRE are thoroughly examined. The collected samples from the prostate biopsy are examined under a microscope for abnormal cell growth. If cancer cells are present, then the evaluation of how quickly the cancer is likely to progress is determined. This will also ensure the best treatment option is made available.

Your doctor will advise you to take up a prostate biopsy in case a PSA test has indicated abnormally higher levels for your age. It could also be that your doctor has found some abnormalities during a DRE. Other reasons could be that a previous biopsy might have resulted in a normal observation but elevated PSA levels could be a cause of worry. Sometimes a previous biopsy might have shown abnormal cell growth and may not still be cancerous. Repeated biopsies will be conducted to rule out cancer growth. There are some risks associated with biopsies such as bleeding, difficulty in urinating, and the development of certain infections. It is best advised to consult a doctor before taking this screening test.

Here is what we can do to reduce the risk of prostate cancer

How to choose the best screening method

As observed here there are different types of screening tests for prostate cancer. The effectiveness of various tests depends on the nature of cancer, it’s staging and its treatment options. There are minimally invasive screening tests and treatment options available. This might involve faster recovery, less time in the hospitals, and living your life through active surveillance.

PSA has revolutionized early detection, better selection of candidates for curative therapy, and accurate surveillance of cancer relapse. However, medical practitioners have actively sought through identifying better means of diagnosis and staging patients with malignant cancers.

Advances in imaging which is a more minimally invasive method have helped detect the location extent and the aggressiveness of the malignant tumor.

It is advisable to talk to your doctor about the benefits of screening. Finding prostate cancer at an earlier stage can increase the chances of beating it. However, there are also some risks associated with false positives from screening methods. Some men might be treated for prostate cancer due to high levels of PSA. This is a harmful condition resulting from overdiagnosis. Some older men who go through prostate biopsy many times can develop complications or other infections. It is best to talk to your medical practitioner to understand the best method for screening and the treatment thereafter.

Conclusion

Some men may have a higher risk or exposure to Prostate Cancer owing to their age, ethnicity, or access to healthcare. If you consider yourself in the high-risk category, contact your health care provider and find out how you can lower your risks. There is no way to prevent Prostate Cancer but only options of lowering its risks. Weave in an overall health plan that is congruent with your lifestyle and easy to keep up with. There may be other options such as medications to lower the risk and prevent Prostate Cancer. However, the side-effects and effectiveness of various tests will need to be considered. Getting regular screening done such as DREs (Digital Rectal Examination) and testing PSA levels can lead to early detection and recourse. It is also advisable to reduce stress from daily life and make time for the outdoors. In general, keeping yourself happy, peaceful and stress-free can reduce not just the risk of Prostate Cancer but also other diseases.