The prostate is a small walnut sized gland found below the urinary bladder in men. During sexual climax, it releases fluid into the urethra that forms a part of the semen and energises the sperm as well as reduces the acidity of the vaginal canal.
Prostate cancer is a malignant cancer that can spread to the lymph nodes, bones and other parts of the body. It is the most common cause of death in elderly men over 75 years of age.
Treatment for prostate cancer mainly depends on the type and stage of cancer and therefore appropriate tests are essential.
Tests involved with prostate cancer treatment:
Digital Rectal Examination (DRE)
Your doctor inserts a gloved finger into the rectum to feel the condition of the prostate that lies close to the rectal wall. If your doctor feels something suspicious such as a lump or bump, further tests will be carried out. Other tests are needed to enable a more accurate diagnosis.
A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate.
As men get older the prostate gland grows and so the PSA is likely to rise. A high PSA may indicate some type of prostate disease. The level can be raised due to inflammation of the prostate (Prostatitis) and enlargement of the prostate gland (Benign Prostatic Hyperplasia or BPH).
PSA is a useful tool for diagnosing and monitoring prostate diseases, but further tests are required to confirm which condition is present.
Trans Rectal Ultrasound Guided biopsies is discussed elsewhere, Click here to find out more.
Staging and Grading
The tests performed are used to determine the stage of the prostate cancer. Biopsy specimens are analysed to find out how aggressive the cancer is.
The staging system describes how far the cancer has spread within and/or beyond the prostate capsule.
There are no symptoms and the tumour is confined within the prostate. It is usually found during the investigation of a different complaint.
Again the tumour is confined to the prostate and although symptoms may not be apparent, it can be felt during a DRE.
The tumour has spread just outside the prostate gland and may effect nearby tissue.
A common symptom is difficulty in urinating.
Also known as Metastatic cancer, the tumour has spread to other parts of the body. Bones and Lymph nodes are commonly afflicted and symptoms may include fatigue, weight loss, bone pain and difficulty urinating.
The Gleason Score indicates how aggressive the cancer is. The Gleason Score (or Sum) is something that the pathologist tells about the cancer in terms of its aggressiveness on the basis of careful inspection under the microscope. The Gleason Score is actually made up of 2 numbers known as Gleason Grades. When a pathologist looks at the prostate cancer under the microscope, a number grade from 1 to 5 is assigned to the areas most representative of the cancer present (the primary Gleason Grade). A second number grade from 1 to 5 is given to the second most representative area within the cancer (The secondary Gleason Grade). These two numbers are added together to give the Gleason Score, the maximum Gleason Score is 10 and the minimum Gleason score is 2. The higher the score, the more aggressive the tumour is likely to be and this will impact on the likely success of treatment.
Your doctor may want to see if the cancer has metastasised and has affected you bones. A small amount of radioactive material is injected into your arm, which is then absorbed by your bones as they heal. Your arm will then be scanned an hour later to view the activity of the bone and ascertain whether the cancer has spread.