Recommendations for early detection of prostate cancer

By Davinder Marjara

Mississauga, September 18 (CINEWS): The American Cancer Society (ACS) recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information. The discussion
about screening should take place at:Prostate-biopsy-procedure

• Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
• Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
• Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

After this discussion, those men who want to be screened should be tested with the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.
If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the patient’s general health preferences and values.
Assuming no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test:
Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years.
Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.
Because prostate cancer often grows slowly, men without symptoms of prostate cancer who do not have a 10-year life expectancy should not be offered testing since they are not likely to benefit. Overall health status, and not age alone, is important when making decisions about screening.
Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient’s health, values, and preferences.

If prostate cancer screening tests results aren’t normal

If the results of early detection tests – the prostate-specific antigen (PSA) blood test and/or digital rectal exam (DRE) – suggest that you might have prostate cancer, your doctor will do other tests, such as a transrectal ultrasound and a prostate biopsy to find out.

Transrectal ultrasound (TRUS)

For this test, a small probe about the width of a finger is lubricated and placed in your rectum. The probe gives off sound waves that enter the prostate and create echoes. The probe picks up the echoes, and a computer turns them into a black and white image of the prostate.
The procedure often takes less than 10 minutes and is done in a doctor’s office or outpatient clinic. You will feel some pressure when the TRUS probe is placed in your rectum, but it is usually not painful. The area may be numbed before the procedure.
TRUS is not used as a screening test for prostate cancer because it can’t always tell the difference between normal tissue and cancer. Instead, it is most often used to look for prostate cancer when a man has symptoms or has an abnormal PSA level or digital rectal exam (DRE). During a prostate biopsy, TRUS is used to guide the biopsy needles into the right area of the prostate.
TRUS is useful in other situations as well. It can be used to measure the size of the prostate gland, which can help determine the PSA density and may also affect which treatment options a man has.

Prostate biopsy

A biopsy is a procedure in which a sample of body tissue is removed and then looked at under a microscope. A core needle biopsy is the main method used to diagnose prostate cancer. It is usually done by an urologist, a surgeon who treats cancers of the genital and urinary tract, which includes the prostate gland.
Using transrectal ultrasound to “see” the prostate gland, the doctor quickly inserts a thin, hollow needle through the wall of the rectum into the prostate. When the needle is pulled out, it removes a small cylinder (core) of prostate tissue. This is repeated from 8 to18 times, but most urologists will take about 12 samples.
Though the procedure sounds painful, each biopsy usually causes only a brief uncomfortable sensation because it is done with a special spring-loaded biopsy instrument. The device inserts and removes the needle in a fraction of a second. Most doctors who do the biopsy will numb the area first with local anaesthesia. You might want to ask your doctor if he or she plans to do this.
The biopsy itself takes about 10 minutes and is usually done in the doctor’s office. You will probably be given antibiotics to take before the biopsy and possibly for a day or 2 after to reduce the risk of infection.
For a few days after the procedure, you may feel some soreness in the area and will probably notice blood in your urine. You may also have some light bleeding from your rectum, especially if you have hemorrhoids. Many men also see some blood in their semen or have rust colored semen. This can last for several weeks after the biopsy, depending on how frequently you ejaculate.
Your biopsy samples will be sent to a lab, where a pathologist (a doctor who specializes in diagnosing disease in tissue samples) will look at them under a microscope to see if they contain cancer cells. If cancer is present, the pathologist will also assign a grade to it. This is often expressed as a Gleason score (or Gleason sum). Although in theory this can range from 2 to 10, Gleason scores below 6 are rare. The higher your Gleason score, the more likely it is that your cancer will grow and spread quickly.
Getting the biopsy results usually takes at least 1 to 3 days, but it can sometimes take longer.
Even when taking many samples, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer (because your PSA level is very high, for example) a repeat biopsy may be needed to help be sure.
Prostate biopsy results are sometimes called suspicious. The pathologist may use terms such as prostatic intraepithelial neoplasia (PIN), atypical small acinar proliferation (ASAP, or just atypia), or proliferative inflammatory atrophy (PIA). Suspicious results mean that the cells don’t look quite normal, but they don’t look like cancer, either. If your biopsy results come back suspicious, your doctor may want to repeat the biopsy.

What are the signs and symptoms of prostate cancer?

Early prostate cancer usually causes no symptoms. But more advanced prostate cancers can sometimes cause symptoms, such as:
• Problems urinating, including a slow or weak urinary stream or the need to urinate more often, especially at night.
• Blood in the urine
• Trouble getting an erection (erectile dysfunction)
• Pain in the hips, back (spine), chest (ribs), or other areas from cancer spread to bones
• Weakness or numbness in the legs or feet, or even loss of bladder or bowel control from cancer pressing on the spinal cord.
Other conditions can also cause many of these same symptoms. For example, trouble urinating is much more often caused by benign prostatic hyperplasia (BPH) than cancer. Still, it’s important to tell your doctor if you have any of these problems so that the cause can be found and treated, if needed.

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