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How is prostate cancer diagnosed?

The best way to detect early stage prostate cancer - These are regular finger examinations of the prostate and a blood test for PSA. Since most malignant tumors of the prostate gland arise in the part of the gland that is closest to the rectum, many tumors can be detected during a routine rectal examination. Many doctors recommend that most men, starting at the age of 50, undergo a rectal examination annually, as well as take a blood test for PSA (prostate-specific antigen). African Americans and men who have a family history of prostate cancer are recommended screening tests from the age of 40.

PSA - This is a protein whose blood level usually increases in the presence of prostate cancer, which makes it a valuable tool in detecting prostate cancer at an early stage. Together, these two screening tests provide the greatest chance of detecting prostate cancer while it is localized and is best treated. Prostate cancer can also be detected by chance during treatment for bladder disorders. Due to the possibility of a false positive test result for PSA, it is important to discuss this analysis with your doctor before passing it. Increased PSA does not mean you have cancer. Rather, it raises issues that need to be addressed and explained. There are many reasons for elevated PSA levels, and cancer is just one of them.

If, as a result of a routine screening examination, there is a suspicion of cancer and / or an increased PSA level, the doctor may perform a biopsy of the prostate gland under the supervision of an ultrasound probe that is inserted into the rectum (transrectal ultrasound) An X-ray of the urinary tract, as well as blood and urine tests, are usually done to help make a diagnosis. A biopsy will confirm whether cancer is present or not. Guided by an ultrasound image, the doctor inserts a needle into the prostate gland and removes small pieces of tissue from the suspicious area. Sometimes a biopsy is performed using a cystoscope, a narrow device that is inserted through the urethra. The pathologist then examines the tissue sample under a microscope to determine if cancer cells are present. To determine if the cancer has spread beyond the prostate, doctors can do a CT scan of the bones, a chest X-ray, or other imaging procedure.

What treatments are available?

Since prostate cancer often grows slowly and may not be fatal in many men, some men, after discussing options with their doctors, choose "expectant observation." Expectant observation involves monitoring prostate cancer for signs that it is becoming more aggressive, but no treatment is being used. More often this approach is recommended for men who are older or suffer from other life-threatening diseases. In such cases, the cancerous tumor can grow so slowly that it will not lead to death.

If a decision is made to treat cancer, other factors, such as the age and general health of the patient, affect the type of treatment. The decision on how to treat this cancer is complex, and many men, before making a decision on treatment, find out the opinion of another doctor.

Depending on when the cancer was diagnosed, treatment includes one type of treatment or a combination of radiation therapy, surgery, hormone therapy, and rarely chemotherapy. Localized prostate cancer can usually be cured with surgery, radiation therapy, or cryosurgery — freezing malignant cells with liquid nitrogen. The choice is made depending on each individual case and depends on many factors.

Standard Surgery - Radical Prostatectomy - consists in the removal of the prostate gland and nearby lymph nodes. In many cases, surgeons can remove the prostate gland without cutting the nerves that control penile erection or bladder function, making complications such as impotence or incontinence much less common than in the past. Depending on the age of the man and the volume of surgery needed to remove the entire cancerous tumor, techniques for maintaining the sensitivity of nerve endings allow approximately 40% - 65% of men who had erections before surgery to save them after surgery without the need for any additional treatment of erectile dysfunction.

After surgery, most men experience some incontinence, but usually they regain full control of urination. Impotence can be treated in a variety of ways, including medications such as Levitra, Cialis, or Viagra. If the incontinence is strong or prolonged, you can use special disposable underwear, catheter-type catheters, biological feedback, penile clips, do exercises, in rare cases that cannot be resolved on their own, you can completely eliminate incontinence by surgically installing sphincters around the urethra channel or urethral sling.

Radiation therapy can be very effective as a primary treatment for localized prostate cancer. It can also be used after surgery if the cancer has not spread. If the cancer has spread to neighboring tissues, radiation therapy is the preferred treatment, and it is also used in the later stages to alleviate the pain associated with the spread of cancer to the bones. Incontinence and impotence also occur after radiation therapy, and some studies have shown results similar to those with surgery. New forms of radiation therapy, such as LTMI (radiation therapy with modulation of radiation intensity) are even more effective and have fewer side effects.

Permanent implantation of radioactive grains (brachytherapy) allows you to deliver a high dose of radiation therapy to the prostate gland with limited damage to surrounding tissues. During this procedure, small radioactive grains are introduced into the prostate gland under ultrasound control. Implants remain in place constantly and become inactive after many months.

Even late stages that cannot be cured can be controlled for many years with hormone therapy, sometimes in combination with other treatments. Hormone therapy slows the growth of a cancerous tumor, interfering with the supply of testosterone, although treatment effectiveness may decrease over time. Testosterone can be removed from the bloodstream by surgically removing the testes (orchiectomy) or by supplying female hormones, such as estrogen, or other drugs that block testosterone production. Men usually prefer treatment with drugs that block testosterone production because they are effective, less invasive, and cause fewer side effects than surgery or drugs with female hormones. If the testes are removed, the scrotum can be left and testicular implants can be inserted.

Chemotherapy and vaccine therapy are effective in some cases. in advanced stages of prostate cancer.

The goal of treating prostate cancer is to recover, and it is likely if the man was diagnosed with prostate cancer at an early stage. Anyone who has recovered from prostate cancer should be examined regularly and carefully monitored for PSA levels.

As with other cancers, new treatments for advanced prostate cancer are being developed. Researchers apply radiation therapy and hormone therapy in innovative ways, and study the effectiveness of chemotherapy in patients who do not respond to other treatments.

Determination of PSA level in the blood

PSA (prostate-specific antigen) is a substance produced by the prostate gland. The predominant amount of PSA is in semen, a small amount in the blood. Most healthy men have a PSA level in the blood below 4 ng / ml (nanograms per milliliter). If the PSA level in the blood rises, so does the chance that you may have prostate cancer. If the PSA level in the blood is between 4 and 10 ng / ml, the probability of prostate cancer is one in four. If the PSA level in the blood is above 10 ng / ml, then the likelihood of a prostate tumor increases by 50%. However, in some men with prostate cancer, PSA levels in the blood are below 4 ng / ml.

Factors causing an increase in PSA levels in the blood (except for cancer).

  • BPH (benign prostatic hyperplasia) is an enlargement of the prostate that is not associated with cancer and which many older men have.
  • Age - PSA levels increase with age, even if no changes occur in the prostate itself.
  • Prostatitis - infections and inflammation of the prostate gland.
  • Ejaculation can increase PSA levels for a while, but then it returns to normal.

Determining PSA levels is important not only in the early diagnosis of prostate cancer. It is also used in other cases.

  • If a man is diagnosed with prostate cancer, determining PSA levels along with other studies can help determine which additional studies are needed and which treatment method to use.
  • Too high a PSA level may indicate that the tumor has already spread beyond the prostate. This helps determine the treatment method, as some treatment methods cannot be used if the cancer cells have already spread to the lymph nodes or other organs.
  • PSA levels help determine the effectiveness of treatment, as well as whether there is a relapse of cancer after treatment.
  • If, instead of immediate treatment, you chose an observation strategy, determining the level of PSA, you can monitor the development of cancer and, if necessary, start treatment.

PSA levels do not indicate changes such as the re-development of prostate cancer after treatment (relapse), or its spread beyond the prostate (metastases). According to PSA indicators, it is impossible to predict what symptoms will develop and predict life expectancy. Many patients with very high PSA levels feel well and have nothing to complain about. But other patients with low PSA levels have pronounced symptoms. If there are other adverse diseases, you also need to monitor the change in the PSA level, determining its level from only one blood test is ineffective.

Prostate palpation through the rectum

During this examination, the doctor puts a special glove on his hand and applies grease to his finger, then he inserts a greased finger into your rectum and probes the prostate gland. If at the same time he finds irregularities or seals, it could be cancer. The prostate gland is located directly in front of the rectum, and most types of cancer that form in the prostate begin in the part that is adjacent to the rectum and can be palpated. Although this procedure is unpleasant, it is painless and takes place quickly.

Compared to determining the PSA level, prostate palpation is a less effective method, but sometimes in this way cancer can be detected in men whose PSA level in the blood is normal. Palpation of the prostate gland should also be carried out if the presence of prostate cancer is already proven. Using this research method, cancer spread within the gland can be determined. This method can also determine whether the cancer has resumed after treatment.

Transrectal ultrasound

During transrectal ultrasound, sound waves are used, which with the help of a computer create an image of the prostate. To conduct this study, a small probe is inserted into the rectum. This probe produces sound waves, which, entering the prostate gland, reflect the “echo”, which is then perceived by the probe. The computer turns this echo into a black and white image.

This examination lasts only a few minutes. During insertion of the probe into the rectum, you will feel a slight pressure, but usually it is painless. Transrectal ultrasound is also used during a biopsy in order to correctly insert the biopsy needle and take a sample directly from the part of the prostate that has been affected by cancer.

Prostate Biopsy

If some symptoms or test results suspect prostate cancer, then you need to have a prostate biopsy to confirm this diagnosis completely.

A biopsy is the only method that can be used to accurately diagnose prostate cancer. During a biopsy, prostate cells are taken and then sent to a laboratory to determine the presence of cancer cells in a tissue sample. For biopsies, a cannula is generally used. This happens as follows: during a transrectal ultrasound, the doctor, following a computer image, inserts a needle through the wall of the rectum into the prostate gland. After removing the needle, a small piece of tissue (approximately 1 cm long, 2 mm wide) remains in it. Some doctors give an injection through the skin in the area between the anus and the scrotum.

Although one can conclude from this description that this procedure is painful, it creates only a little discomfort, as everything happens very quickly. During the examination, the doctor can use the tool for local anesthesia. A biopsy lasts approximately 15 minutes. Before performing this procedure, you can ask your doctor to apply local anesthesia. Sometimes tissue samples are taken from different parts of the prostate gland. Ask your doctor how many samples he will take from you.

To reduce the risk of infection, your doctor may prescribe antibiotics that you must take before and after the biopsy. A few days after the biopsy, you may feel some pain in the area of ​​the biopsy, observe a slight admixture of blood in the urine or a slight discharge of blood from the rectum. In some men, an admixture of blood in semen may be observed within one or even two months after the biopsy.

Sometimes cancer can affect only a small part of the prostate gland, therefore, in some cases, cancer cells may not be detected in a tissue sample taken by biopsy, although in fact there is cancer. This is called a “mistakenly negative answer.” If the sample of your biopsy does not contain cancer cells, but the doctor is sure that you still have cancer, a second biopsy is necessary.

A tissue sample is sent to the laboratory. In the sample, the doctor is looking for cancer cells. If cancer cells are found in it, it is necessary to determine the degree of cancer. The classification system for cancer cells allows you to more accurately determine the rate of development and spread of the tumor.

By the results of a biopsy, the presence of a tumor can be confirmed and its degree determined. The biopsy results may also contain other information necessary for evaluating the tumor. It could be:

  • the number of tissue samples taken by biopsy that contain cancer cells (for example, seven out of twelve samples contain cancer cells),
  • the number of cancer cells in each sample (in percent),
  • whether the cancer is located in one part of the prostate gland (in the right or left) or in both (bilateral).

Sometimes cells are not like cancer cells, but at the same time, these cells do not look like normal cells. In such cases, a second biopsy is necessary.

Radiological bone scan

Outside the prostate, cancer most often spreads to the bones. A radiological bone scan reveals where the cancer cells are located in the bones. To do this, a radioactive substance will be injected into your vein. It contains a small dose of radiation and does not cause any side effects. The radioactive substance accumulates in diseased bone cells and during body scans indicate the places where the so-called "hot spots" are located in the bones. It may turn out that these cells are not cancer cells, since the radioactive substance also accumulates both in cells affected by arthritis and in cells altered due to another disease. More research is needed to find out what happened to the bone cells.

Computed tomography (CT)

Computed tomography uses x-rays. A series of images is shot at different angles. Компьютер эти снимки обобщает, и в результате получается детальное изображение. После снятия первой серии изображений врач может попросить Вас выпить контрастное вещество.This will help “stain” the guts to distinguish them from the tumor. This harmless coloring contrast medium can also be injected into a vein. Using computed tomography, you can determine whether the cancer has spread to the pelvic lymph nodes. Lymph nodes are equal in size to peas and are a collection of white blood cells, they form networks and fight infections.

An examination of computed tomography takes longer than a conventional X-ray examination. You should lie motionless on a special table, which is located in a cylindrical apparatus. Since the apparatus is very crowded, you may feel some inconvenience.

Magnetic Resonance Imaging (MRI)

This has been studied similar to computed tomography, only here they use radio waves and a strong magnetic field. Using magnetic resonance imaging, you can get a very clear and accurate image that helps the doctor determine if the cancer has spread to the seminal vesicles and bladder.

The study of magnetic resonance imaging lasts longer than the study of computed tomography - it lasts about one hour. During the study, you are in a cramped “pipe” that constricts you and may cause a feeling of discomfort. To get a better image, most doctors insert a probe into the rectum. He should stay there for about 30-45 minutes, and this can cause discomfort. As in the study of computed tomography, a dye contrast medium can be injected into a vein, but this is rarely done.

Radiological scan of the prostate

Also, as with radiological bone scans, a radiological substance is introduced during the radiological scan of the prostate that contains a small dose of radiation and which helps determine the area of ​​the cancer beyond the prostate. Only prostate cells attract the radioactive material used in this study, even if these cells are located elsewhere in your body. The advantage of this study is that you can get a picture of the spread of cancer in the lymph nodes and other organs. With it, you can find out if prostate cancer or another disease caused problems.

Lymph node biopsy

A lymph node biopsy can be used to determine whether cancer cells have spread to nearby lymph nodes. If this happens, then surgical treatment cannot be carried out, and the doctor must choose other methods of treatment. There are different types of biopsies.

  • Biopsy during surgery. The surgeon can remove the lymph nodes through a longitudinal incision in the lower abdomen. This biopsy is usually done during surgery to remove the prostate gland. While you are lying on the operating table and are under anesthesia, the lymph nodes are checked in the laboratory. Based on the results of the analyzes, the surgeon decides to continue the operation. If cancer cells are found in the lymph nodes, surgery is usually interrupted. This is due to the fact that removing the prostate gland will not cure you of cancer, but it can cause serious complications and side effects.
  • Biopsy during laparoscopy. The doctor uses thin, flexible tubes, which are inserted through small incisions into your stomach, and examines the lymph nodes that are located directly at the prostate gland. These lymph nodes can be removed using special tools that are inserted through these ducts. Since in this case a large incision is not made, the recovery period lasts only a few days, and only a minor scar remains after the operation. This method is rarely used and only to men who are prescribed radiation therapy rather than surgery.
  • Needle aspiration biopsy. When conducting a needle aspiration biopsy to take a tissue sample, the doctor disinfects the surface of the skin through which, following the image of computed tomography, a thin needle is inserted directly into the lymph nodes. This procedure is performed on an outpatient basis, and within a few hours after its completion, you can go home. This method is rarely used.