How can I tell if I have prostate cancer before I have any symptoms?
If you can find the cancer in its early, non-symptomatic stages, before it has spread beyond the prostate gland, the chances of successful treatment are much higher.
There are two common screening tests that can be done in the doctor’s office, which are effective at finding cancer in the early stages.
- PSA – A blood test to measure the amount of prostate-specific antigen (PSA) in your blood.
- DRE €“ Where a digital rectal exam (DRE). Your doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectum wall for hard or lumpy areas.
A normal PSA test along with a DRE can reassure you that you probably don’t have prostate cancer. But if you are over 75, it’s probably not necessary to have a PSA test. PSA testing is generally recommended for men between 40-75, and men with risk factors.
Do I have Prostate Cancer?
DRE and PSA tests can detect prostate problems, but can’t tell the doctor if you have cancer or a benign growth. If the PSA and DRE results detect any abnormalities, you will need other tests like a prostate biopsy in order to diagnose your condition.
A prostate biopsy helps the doctor explore the tissues of a tumor to see if it is benign or malignant. This will answer the fundamental question: Do I have cancer? A hollow needle is inserted into the prostate to collect samples of tissue to look for cancer cells.
How Serious is it?
Even if cancer cells are found, remember that all cancer cells are not the same. They can differ widely in their severity or aggressiveness. The pathologist will grade the cancer cells they find. They are measuring how much the cancerous prostate differs from normal prostate tissue. The pathologist assigns a grade to the most common tumor pattern, and a second grade to the next most common tumor pattern. The two grades are added together to get a Gleason Score. For example, if the most common tumor pattern was grade 3, and the next most common tumor pattern was grade 4, the Gleason Score would be 3+4 = 7. The Gleason Score ranges from 2 to 10, with 10 having the worst prognosis. For Gleason Score 7, a Gleason 4+3 is considered a more aggressive cancer than a Gleason 3+4.
The higher the grade, the more likely it is that the tumor will grow quickly and spread. Your doctor uses the tumor grade along with things like your age and overall health to decide how best to treat you.
During this phase, your doctor will determine the stage or extent of the cancer. They need to see if the tumor is confined to the prostate, or has spread out to other parts of your body. The stage of the cancer is based on the results of the staging and the diagnostic tests such as the PSA test and the original biopsy.
Here are the stages of prostate cancer.
- Stage I: The cancer can’t be felt during a DRE, and it can’t be seen on an ultrasound. The cancer is located only in the prostate.
- Stage II: The tumor is more advanced or a higher grade than Stage I, but the tumor doesn’t extend beyond the prostate. It may be felt during a digital rectal exam, or it may be seen on a ultrasound.
- Stage III: The tumor extends beyond the prostate (extra capsular extension). The tumor may have invaded the seminal vesicles, but cancer cells haven’t spread to the lymph nodes.
- Stage IV: The tumor may have invaded the bladder, rectum, or nearby structures. It may have spread to the lymph nodes, bones, or to other parts of the body.
Limitations of screening
The American Cancer Society warns that there are limits to prostate cancer screening tests €” neither the PSA test nor the DRE is 100% accurate. These tests can have abnormal results even when cancer is not present (false positive results). And normal results can occur even when cancer is present (false negative results).
What’s more, some prostate cancers grow so slowly that they would likely never cause problems. Men with slow-growing cancer are more likely to die of old age than of cancer. Because all prostate issues cause an elevated PSA level, sometimes men are diagnosed with a prostate cancer that is actually so slow-growing it would never have led to their death or even caused any symptoms. Even though they could live a normal life without being treated, they may still get aggressive cancer treatment. This happens because the doctor can’t determine how aggressive (fast growing and fast spreading) their cancer is, or because the men are afraid not to be treated.
Since aggressive treatments like surgery and radiation can have side effects that can seriously affect your quality of life, it is important to know if you have a slow-growing cancer or an aggressive cancer. If your cancer is the slow-growing kind, you have another choice. You can safely opt for « active surveillance » rather than radiation or surgery.
In that scenario, your doctor will monitor you carefully and frequently for indications that your cancer is becoming aggressive. You can live for years with a much better quality of life while you wait.
For more information about early detection visit:
- National Cancer Institute
- American Cancer Society
*Information from American Cancer Society (ACS) website.