If you have difficulties with urination, see your doctor. This condition
doesn't always relate to prostate cancer, but it can be a symptom of
If you're a man older than 50, you may want to see your doctor to
discuss beginning prostate cancer screening.
Screening and diagnosis
Prostate cancer frequently doesn't produce symptoms. The first
indication of a problem may come during a routine screening test.
Screening tests include:
During a DRE, your doctor inserts a gloved, lubricated finger into
your rectum to examine your prostate, which is adjacent to the
rectum. If your doctor finds any abnormalities in the texture, shape
or size of your gland, you may need more tests.
Prostate-specific antigen (PSA) test.
A blood sample is drawn from a vein and analyzed for PSA, a
substance that's naturally produced by your prostate gland to help
liquefy semen. It's normal for a small amount of PSA to enter your
bloodstream. However, if higher than normal levels are found, it may
be an indication of prostate infection, inflammation, enlargement or
A sample of your urine is analyzed for abnormalities that may
indicate a problem. This test doesn't detect prostate cancer, but it
can help detect or rule out other conditions that may cause similar
signs and symptoms.
If other tests raise concerns, your doctor may use transrectal
ultrasound to further evaluate your prostate. A small probe, about
the size and shape of a cigar, is inserted into your rectum. The
probe uses sound waves to get a picture of your prostate gland.
If initial test results suggest prostate cancer, your doctor may
recommend a prostate biopsy. During a biopsy, small tissue samples are
taken and analyzed to determine if cancer cells are present.
To do a biopsy, your doctor inserts an ultrasound probe into your
rectum. Guided by images from the probe, your doctor identifies any
suspicious areas. Then a fine, hollow needle is aimed at these areas of
your prostate. A spring propels the needle into your prostate gland and
retrieves a very thin section of tissue.
If an abnormal area is seen on the transrectal ultrasound, your doctor
likely will biopsy that area. If no abnormality is seen, eight sections
of tissue usually are taken from different areas of your prostate gland.
Very large prostate glands may require more than eight biopsies to
adequately assess the gland for cancer. A pathologist who specializes in
diagnosing cancer and other tissue abnormalities evaluates the samples.
From those, the pathologist can tell if it's cancer and estimate how
aggressive your cancer is.
Once a cancer diagnosis has been made, you may need further tests to
help determine if or how far the cancer has spread. Many men don't
require additional studies and can directly proceed with treatment based
on the characteristics of their tumors and the results of their
pre-biopsy PSA tests.
A bone scan takes a picture of your skeleton in order to determine
whether cancer has spread to the bone. Prostate cancer can spread to
any bones in your body, not just those closest to your prostate,
such as your pelvis or lower spine.
Ultrasound not only can help indicate if cancer is present, but also
may reveal whether the disease has spread to nearby tissues.
X-ray films may show if the cancer has spread to your lungs, ribs or
tomography (CT) scan.
A CT scan produces cross-sectional images of your body. CT scans can
identify enlarged lymph nodes or abnormalities in other organs, but
can't determine whether these problems are due to cancer. Therefore,
CT scans are most useful when combined with other tests.
resonance imaging (MRI).
This type of imaging produces detailed, cross-sectional images of
your body using magnets and radio waves. An MRI can help detect
evidence of the possible spread of cancer to lymph nodes and bones.
A lymph node biopsy is the best way to determine whether cancer has
spread to nearby lymph nodes. During the procedure, some of the
nodes near your prostate are removed and examined under a microscope
to determine if cancerous cells are present.
When a biopsy confirms the presence of cancer, the next step, called
grading, is to determine how aggressive the cancer is. The tissue
samples are studied, and cancer cells are compared with healthy prostate
cells. The more different the cancer cells are from the healthy cells,
the more aggressive the cancer and the more likely it is to spread
Cancer cells may vary in shape and size. Some cells may be aggressive,
while others aren't. The pathologist identifies the two most aggressive
types of cancer cells when assigning a grade.
The most common cancer grading scale runs from 1 to 5, with 1 being the
least aggressive form of cancer. Known as Gleason scores, named for the
doctor who invented them, these numbers may be helpful in determining
which treatment option is best for you. The Gleason score adds the
grades of the two most aggressive types of cancer cells; therefore,
scoring may range from 2 (non-aggressive cancer) to 10 (very aggressive
After the level of aggressiveness of your
prostate cancer is known, the
next step, called staging, determines if or how far the cancer has
spread. Your cancer is assigned four stages based on how far it has
Signifies very early cancer that's confined to a microscopic area
and which your doctor can't feel.
Your cancer can be felt, but it remains confined to your prostate
Your cancer has spread beyond the prostate to the seminal vesicles
or other nearby tissues.
Your cancer has spread to lymph nodes, bones, lungs or other organs.
Complications from prostate cancer are related to both the disease and
its treatment. One of the biggest fears of many men who have prostate
cancer is that treatment may leave them incontinent or impotent.
Fortunately, therapies exist to help cope with or treat these
The typical complications of prostate cancer and its treatments include:
Prostate cancer can spread to nearby organs and bones and can be
Although early-stage prostate cancer typically isn't painful, once
it has spread to bones, it may produce pain, which can be intense.
Treatment can range from the use of over-the-counter pain relievers
to prescription narcotics. Radiation also is commonly used to treat
painful lesions. Often radiation and prescription pain relievers are
Not all people
with cancer that has spread to bones have pain. Pain can be
controlled, and there's no reason a person has to suffer with
intense pain. If your doctor is unable to control your pain
effectively, you may need to consult a pain specialist. While it's
not always possible to make all of your pain go away, your doctor
will work with you to try to control pain to a point where you're
Both prostate cancer and its treatment can cause incontinence. Some
men experience incontinence after surgery to remove the prostate.
Treatment recommendations depend on the type of incontinence you
have, how severe it is and the chance that it will improve given
time. Treatments include behavior modifications (such as going to
the bathroom at set times rather than according to urges), exercises
to strengthen pelvic muscles (commonly called Kegel exercises),
medications and catheters. If leakage problems have continued for a
prolonged period without improvement, your doctor may suggest more
progressive procedures. These procedures may include implanting an
artificial urinary sphincter, placement of a sling of synthetic
material to compress the urethra, or the injection of bulking agents
into the lining of the urethra at the base of the bladder to reduce
dysfunction (ED) or impotence.
Like incontinence, ED can be a result of prostate cancer or its
treatment, including surgery, radiation or hormone treatments.
Medications and vacuum devices that assist in achieving erection are
available to treat ED. Medications include sildenafil (Viagra),
tadalafil (Cialis) and vardenafil (Levitra). If other treatments
fail, penile implants can be inserted surgically to help create an
Many men may develop feelings of depression after a diagnosis of
prostate cancer or after trying to cope with the side effects of
treatment. These feelings may last for only a short time, they may
come and go, or they may linger for weeks or months. Depression that
lingers and interferes with your ability to manage your life should
be treated. Treatment may involve counseling or antidepressant
medication. A combination of the two therapies often is successful.