Screening and Diagnosing Prostate Cancer

Because prostate cancer often does not cause symptoms, regular screening is important in ensuring that the disease is detected at its earliest, most treatable stage. For men with particularly high risk, this may mean an annual prostate exam starting at age 50.
Some of the screening tools used at City of Hope to detect and diagnose prostate cancer include:
  • Prostate specific antigen (PSA) test: A simple blood test to determine if your PSA level is higher than normal. A high PSA reading can be caused by either a benign or cancerous growth of the prostate, or simply by a prostate infection.
  • Digital rectal exam (DRE): During this procedure, the physician examines the prostate gland by inserting a gloved, lubricated finger into the rectum to check for any evidence of abnormalities in its texture, shape or size. The DRE, along with the PSA test, helps to detect prostate cancer in men who have no symptoms of the disease.
  • Biopsy: A core needle biopsy is the most common method of diagnosing prostate cancer. Usually, six to 18 biopsy samples are taken from different areas of the prostate. Placing the ultrasound probe into the rectum can be temporarily uncomfortable, but is usually easily tolerated by most men. At City of Hope, our urologists have popularized the use of a local anesthetic prior to obtaining the prostate biopsies. This alleviates the pain and discomfort of the individual needle biopsies, making the entire procedure much more tolerable.
  • Transrectal ultrasound of the prostate (TRUSP): TRUSP uses sound waves to create an image of the prostate on a video screen. There is a small probe, which is inserted into the rectum. The prostate is visualized and biopsies can then be taken through the probe while simultaneously imaging the prostate. The procedure takes approximately 10 to 20 minutes.
  • Bone scan: This X-ray procedure can show whether the cancer has spread from the prostate to the bones. This is not routinely ordered unless there are signs of aggressive disease, such as an elevated PSA or localized bone pain.
Stages of Prostate Cancer
To properly plan for treatment, prostate cancer patients are staged in accordance to how advanced the disorder is. This is primarily done by taking a number of factors into consideration, including:

  • PSA level in the blood
  • Whether the cancer is detectable by an imaging scan or by touch during a DRE
  • Gleason score (which estimates how aggressive the prostate cancer is)
  • Whether the cancer has spread to lymph nodes or other organs
Based on these factors, patients are staged according to their risk level, with higher risk patients requiring more intensive treatments.
  • Stage 1: The cancer is found in the prostate only through a biopsy, and cannot be felt by a DRE or seen in imaging tests.
  • Stage 2: The cancer is still contained within the prostate, but is at a more advanced stage than stage 1 based on multiple criteria (such as PSA levels and Gleason scores.)
  • Stage 3: The cancer has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles.
  • Stage 4: The cancer has spread beyond the seminal vesicles to other organs, bones or lymph nodes.

If you have been diagnosed with prostate cancer or are looking for a  second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.