Researchers and doctors are learning more each day about screening for prostate cancer. Because there is disagreement in the field about how often to screen with PSA, or whether to do so at all, the American Cancer Society recommends men 50 and older discuss this with their doctors if they have an average risk of prostate cancer. Those who have one or more relatives with prostate cancer need to talk to their doctors about screening earlier.
Screening might include a prostate-specific antigen (PSA) blood test done every two years. If PSA levels rise, the chances of having prostate cancer also increase. An increasing PSA level does not mean a man has prostate cancer, but it is an indication further testing is needed. Doctors also may perform a digital rectal exam (DRE) as part of the screening or order additional diagnostic tests.
A self-exam is the best way to detect this cancer early. UMMC Cancer Institute doctors recommend that, beginning in their teens, men examine their testicles monthly. Knowing the normal shape, size, and weight of the testicles will help detect any changes, should any occur. If there is a change in size or shape, or if there are small hard lumps under the skin, schedule an appointment with a doctor. Other conditions can cause swelling or lumps, but only a physician can rule out cancer.
UMMC urologists can perform these tests in-office. If the tests indicate a prostate problem, you may be referred to a genitourinary cancer specialist for more testing. Many prostate cancers grow slowly, so doctors may not recommend screening for older men.
Doctors use many tools to diagnose genitourinary cancers, including a physical exam, a digital rectal exam, blood tests, other lab tests, imaging, and biopsies. A combination of lab and imaging tests may be recommended to confirm or rule out cancer. Doctors will consider symptoms, results of a physical exam, and other medical conditions or family history before recommending any tests.
This test is used to assess how well the kidneys are functioning. When creatinine levels are elevated in older men, it often represents obstruction of urinary outflow by an enlarged prostate.
Doctors inject a small amount of radioactive material that travels through the bloodstream and collects in damaged areas of the bones. A scanner can show where it collects and can help detect if prostate cancer has spread to the bones. If “hot spots” show up, other tests may be needed to rule out arthritis or other bone diseases.
A CT scan, sometimes called a CAT scan, provides more detail about what is going on inside the body. During the scan, an X-ray beam moves in a circle around the body and sends digital information to a computer that interprets the data and displays it in two-dimensional form on a monitor.
A doctor will insert a gloved, lubricated finger into the rectum to feel the prostate, which is adjacent to the rectum. Any bumps or hard areas on the prostate may indicate cancer.
This blood test can be used to screen for prostate cancer before any known symptoms. The blood is tested for a protein molecule the prostate secretes and which usually occurs in small numbers. Higher numbers may indicate prostate cancer. Inflammation also can cause increased PSA levels, so it cannot be used alone to diagnose prostate cancer.
As they age, many men will have an enlarged prostate, called benign prostatic hyperplasia or BPH. While it can raise PSA levels, it does not increase the risk for developing prostate cancer.
Doctors will review PSA levels to help determine recommendations for further testing or for treatment. Once treatment begins, PSA tests can be used to monitor how well treatment is working.
MRIs are often ordered to see if cancer has spread. An MRI uses magnets and radio waves to make a detailed image of the body.
In this procedure, a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner makes detailed digital pictures of the area of the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find clusters of cancer cells in the body.
This single scan combines the ability of a CT scan to show tissue that looks abnormal and a PET scan to show tissue that acts abnormally. The UMMC Cancer Institute radiology department’s PET/CT scanner offers the highest level of detailed image quality currently available. The ability to look at CT and PET images together helps doctors more precisely identify the location of abnormal, possibly malignant (cancerous) tissue in the body.
A low-level radioactive material is injected into the body, and then a camera is used to see where it collects. The injected material seeks out prostate cells and sticks to them. Doctors use the test to look for prostate cells in the lymph nodes and other soft organs. Most often, doctors recommend this test for men whose PSA levels rise after treatment.
Ultrasound procedures allow doctors to see soft tissues such as muscles, blood vessels, and organs. It uses sound waves that move through the skin, bounce off the organs, and project an image of them. In this procedure, a probe, about the size of a finger, is inserted into the rectum to examine the internal organs. The echo forms a picture of the body tissues, which can be used to locate the area for a biopsy.