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Testing and Staging

Prostate Cancer Symptoms
A man with prostate cancer may or may not have symptoms. The common symptoms of prostate cancer often do not mean the presence of the disease. However, a man who experiences one or more of the following symptoms, particularly if he is at higher risk for prostate cancer, should see his doctor.

A need to frequently urinate, especially at night
Difficulty starting urination or holding back urine
Inability to urinate
Weak or interrupted urine flow
Painful or burning urination
Difficulty obtaining an erection
Painful ejaculation
Blood in urine or semen
Frequent pain or stiffness in the lower back,
hips or upper thighs

A variety of conditions may cause these symptoms. For example, as a man ages, his prostate may grow. An enlarged prostate, called benign prostatic hyperplasia (BPH), can block the flow of urine or interfere with sexual function. BPH is not prostate cancer, but can cause many of the same symptoms.

Only a doctor using appropriate tests can determine if a man has prostate cancer, BPH, or another condition with similar symptoms.

There is one major minimally-invasive treatment for prostate cancer today.

Brachytherapy
Click here to find out more about Brachytherapy

The PSA Test and Others: Screening For Prostate Cancer
There are four major diagnostic tools for detecting prostate cancer, including the well-known PSA test. These tests fall into two categories: those that screen for the disease and those that help the doctor determine the stage of the disease when it is found. Screening tests for prostate cancer include:

Prostate-specific Antigen Test (PSA Test). The PSA test analyses a blood sample drawn. It checks the sample for PSA, a substance only the prostate gland produces. A small amount of the PSA produced diffuses into the bloodstream and this is what is measured. If higher-than-normal levels of PSA occur, it may indicate prostate disease (infection, enlargement of the prostate gland or cancer).

Digital Rectal Exam (DRE). The prostate is located next to the rectum. A doctor performs a digital rectal exam by inserting a gloved, lubricated finger into the rectum to examine the prostate. If the doctor finds any abnormalities in the texture, shape or size of the gland, more tests may be needed.

Transrectal Ultrasound. If the doctor has concerns, he or she may use transrectal ultrasound to further evaluate the prostate. This involves inserting a small probe into the rectum. The probe emits sound waves to produce an image of the prostate gland and its surroundings

Prostate Biopsy. Under ultrasound guidance the doctor removes 6-12 small samples of tissue for further pathological evaluation. These tissue cores allow for definitive diagnosis of prostate cancer and for correct cancer grading (also called Combined Gleason Score or CGS). The biopsy and its resulting CGS are important tools for definitive diagnosis and help in choosing the appropriate treatment approach.

Staging of Prostate Cancer
If the prostate biopsy is positive for cancer, the doctor may use additional tests to determine how wide spread it is:

Is confined to the prostate
Has grown beyond the prostate
Has spread, and if so, where it has spread

This is called "staging" the disease. Determining the cancer stage is crucial to deciding the best treatment. (Visit the Treatment Options section for more information on various prostate cancer treatments.)

Prostate Cancer Staging System
The prostate cancer staging system standardises the description of the extent to which the cancer has spread. There are several different staging systems for prostate cancer. The most widely used system is the TNM system.

The TNM system describes the extent of the primary Tumor (T stage); whether or not the cancer has spread to nearby lymph Nodes (N stage), and the absence or presence of distant Metastasis (M stage). "Metastasis" refers to the spread of cancer cells from the prostate gland to another part of the body.

Four categories describe the prostate tumor's (T) stage, ranging from T1 to T4.

T1: The cancer is microscopic, unilateral and non palpable. The doctor can't feel the tumour or see it with imaging such as transrectal ultrasound. Treatment for BPH may have disclosed the disease, or it was confirmed through the use of a needle biopsy done because of an elevated PSA.

T2: The doctor can feel the cancer with a DRE. It appears the disease is confined to the prostate gland on one or both sides of the gland.

T3: The cancer has advanced to tissue immediately outside the gland

T4: The cancer has spread to surrounding organs in the pelvis

Tests That Help Stage & Grade Prostate Cancer
After detecting the possible presence of prostate cancer, a doctor can choose from several different tests to determine its stage.

DRE can tell the doctor if the cancer is T1, T2, or beyond T2.

Biopsy when prostate cancer is detected, a biopsy will take small samples of tissue from the prostate. A pathologist will evaluate the tissue and assign a Combined "Gleason grade" Score (CGS). The grade will range from 2 to 10. The higher the number, the more aggressive is the cancer. The Gleason grade is a major factor in deciding the best treatment for the cancer.

Computed Tomography (CT) Scan A computer controlled x-ray procedure that produces detailed cross-sectional images of the body using hundreds of x-ray like images. This test will help tell if prostate cancer has spread into other organs. CT scans have limitations; they are much better in determining skeletal structures than soft tissue structures.

Magnetic Resonance Imaging (MRI) MRI uses strong magnetic fields instead of x-rays to produce an image of the body. MRI scans can be very helpful in looking at prostate cancer. By producing a very clear picture of the prostate gland, the MRI can show whether the cancer has spread outside the gland into the seminal vesicles or bladder.

Endorectal MRI Even more accurate than the whole body MRI, an Endorectal MRI helps to determine if the prostate cancer is confined to the gland. The test can also help detect the site of prostate cancer in men suspected of having prostate cancer that is eluding diagnosis with other routine tests.

Radionuclide Bone Scan Helps show whether cancer has spread from the prostate to bones. It is very common for prostate cancer to spread to skeletal structures (mostly long bones).

ProstaScint Scan Detects the spread of prostate cancer to lymph nodes and other soft (non-bone) organs. It can distinguish prostate cancer from other cancers and benign disorders.

Lymph Node Sampling Conducted to find if cancer has spread from the prostate to nearby lymph nodes. Normally performed when there is a high suspicion of such spread.



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