Detecting prostate cancer

There is a screening test for prostate cancer called the prostate-specific antigen (PSA) test. PSA is made by prostate cells and all men have PSA levels that can be detected in the blood. Men with prostate cancer often have more PSA in their blood. Elevated PSA levels can occur with noncancerous conditions, so it is important to repeat the test to confirm the results. If high PSA levels are found repeatedly, doctors may suggest taking a biopsy of the prostate.

Another test a doctor can do is a digital rectal exam (DRE), which involves feeling the prostate with a gloved finger. If there is a high PSA level, or a lump is felt, small tissue samples will be taken from six to eight locations in the prostate with the use of a biopsy needle. The doctor guides the biopsy needle with the aid of a transrectal ultrasound (TRUS), a device which creates an image of the prostate. The doctor will also want a biopsy sample of the lymph nodes to check if the cancer has spread.

Staging prostate cancer

If cancer is found, a specialist (usually a pathologist) will stage the cancer and apply a Gleason score to the tumour, which defines how aggressively the tumour is growing and will reflect the treatment options available. The lower the score, the better the chances of survival.

Prostate cancer staging is based on the tumour's characteristics, such as its size and whether it has spread. Staging helps determine the prognosis (chances of recovery) and treatment options.

  • In Stage T1, the cancer tumour is microscopic and actually can't be detected by a DRE. A biopsy is needed to find traces of the tumour.
  • In Stage T2, the tumour has grown but is still only in the prostate itself. The doctor can detect it at this stage by DRE and it can be removed by removing the whole prostate.
  • By Stage T3, the cancer has spread outside the prostate gland (but not to other organs), such as to the seminal vesicles (which produce semen).
  • By Stage T4, there is a lower chance of recovery because the cancer has spread outside the prostate gland to the lymph nodes, the bladder (where urine is stored), or distant parts of the body such as the bones.