Symptoms and Diagnosis of Prostate Cancer
The only way for a physician to truly diagnose prostate cancer is through a biopsy. This involves collecting a small sample of prostate tissue and examining it under a microscope for cancerous cells. Recent research has found, however, that many patients with high PSA levels don’t actually need biopsies.
As a Siteman patient, your care team will only test you when absolutely necessary. WashU Medicine urologists use a range of techniques and tools to identify at-risk patients who require biopsies. Our experts perform all testing as precisely as possible.
The earlier doctors diagnose prostate cancer, the easier they can treat it. However, because prostate cancer usually causes no symptoms in its early stages, someone could have prostate cancer and not know it. That is why screening with the PSA blood test is very important. The PSA remains the best way to diagnose prostate cancer as early as possible.
Prostate Cancer Symptoms
If you’re experiencing any of these symptoms, it does not mean that you have prostate cancer. Other health problems can cause any of these symptoms. Still, it’s important to speak with your provider about any symptoms that last longer than two weeks. It could very well be nothing, but it’s best to know for sure what’s going on in your body so that you can get whatever care you may need.
Symptoms of prostate cancer can include the following; though this is not an exhaustive list:
- Weak or interrupted (“stop-and-go”) flow of urine
- Sudden urge to urinate
- Frequent urination (especially at night)
- Trouble starting the flow of urine
- Trouble emptying the bladder completely
- Pain or burning while urinating
- Blood in the urine or semen
- A pain in the back, hips, or pelvis that doesn’t go away
These symptoms are similar to another non-cancerous condition called benign prostatic hypertrophy (BPH), an enlargement of the prostate that can occur as males age. The prostate may get bigger and block the urethra or bladder, causing trouble urinating or sexual problems. Even though it’s not cancer, patients may still need surgery.
Tests to Diagnose Prostate Cancer
At Siteman, WashU Medicine prostate cancer specialists perform a range of urine, blood, and imaging tests to determine whether high PSA scores indicate a real risk of aggressive prostate cancer.
When our experts do recommend a biopsy, they often use advanced imaging methods to make sure they target the correct area of the prostate.
Urine and blood-based biomarkers
These tests evaluate a patient’s blood and urine for signs of potential prostate cancer. Depending on the results, doctors may decide that a patient’s high PSA score does not indicate cancer.
There are many urine- and blood-based biomarker tests. WashU Medicine prostate cancer specialists at Siteman lead in identifying and assessing the accuracy of biomarkers for the correct diagnosis of prostate cancer and for differentiating aggressive disease from slow-growing disease.
MRI
Magnetic resonance imaging (MRI) scans help the urologist identify which part of the prostate to biopsy and check for signs of cancer in the surrounding tissue.
Clinicians and researchers at Siteman are researching ways to combine biomarkers and MRI scans to predict which patients with high PSA scores have cancer and which of those patients have a more serious form of the condition.
Transrectal ultrasound
During this test, the urologist inserts a finger-sized probe into the rectum to check the prostate. The probe bounces high-energy sound waves (ultrasound) off internal structures to create a picture.
WashU Medicine prostate cancer experts at Siteman have begun to explore the use of newer ultrasound technology that allows for higher-resolution imaging of the prostate, which is available at only a few locations in the world.
Biopsies
There are a few different types of biopsies your physician may order after reviewing your medical history.
MRI fusion-guided biopsy
MRI ultrasound fusion-guided biopsies combine a patient’s MRI scan and ultrasound imaging to pinpoint the suspicious area of the prostate. The imaging detail can help physicians recognize when they can treat cancers with non-surgical methods.
Who should get the UroNav MRI-Guided Biopsy?
- Patients with elevated PSA but haven’t had a biopsy.
- Patients with history of high PSA but whose conventional biopsy hasn’t revealed cancer.
- Patients whose conventional biopsy has led to a diagnosis of small prostate cancer.
What benefits can patients expect from this procedure?
- A better biopsy, since conventional biopsies can mischaracterize and underestimate the size of a malignant prostate tumor.
- More precise information on the location of the tumor for removal.
Transrectal biopsy
During this procedure, the urologist inserts a thin needle into the rectum through a small ultrasound probe and collects cells from the prostate for examination.
Transperineal biopsy
Although transrectal biopsy is available at many locations, Siteman urologists conduct a high number of transperineal biopsies that go through the skin rather than the rectum. This dramatically reduces the risk of infection and improves the quality of the biopsy.
After a Diagnosis
Once doctors diagnose prostate cancer, they give it a grade on a scale of 2 to 10. The scale indicates how aggressive the cancer is, with 10 being the highest.
Doctors determine the grade, called a Gleason score, based on the tissue samples they collect from the prostate during the biopsy.
Depending on the patient’s PSA level and Gleason score, doctors may need to conduct additional tests to determine if the cancer has spread to other parts of the body.
Conventional staging imaging includes a PET scan, bone scan, or a CT scan.
- PET scan: the most commonly used, a PET scan will reveal areas of abnormal cell activity in the body, allowing physicians to detect cancer that has spread to lymph nodes, bones, or other organs.
- Bone scan: demonstrates abnormal bone activity, which could indicate prostate cancer that has spread into the bone (in metastatic prostate cancer).
- CT scan: takes detailed pictures of organs to determine if the cancer has spread outside the prostate.
Prognosis for Patients with Prostate Cancer
For the most part, the prognosis of prostate cancer is very good. Most patients who get a prostate cancer diagnosis after a PSA screening benefit from finding the disease early. Doctors can either observe the majority of prostate cancers detected this way with active surveillance or eliminate the cancer with a prostatectomy.
For patients with more aggressive disease, prognosis depends on many factors:
- The stage of the cancer
- Gleason score
- PSA level
- The patient’s age
- The treatment approach – surveillance, surgery, radiation, etc.
Treatment options may also depend on the patient’s general health, expected side effects of treatment, past treatment for prostate cancer, and the wishes of the patient.