Definition & Overview

Prostate cancer is one of the most common types of cancer that affect men aged 50 and above. A part of the male reproductive system, the prostate is a walnut-shaped gland that produces seminal fluids that nourishes and transports sperm as well as neutralizes the acidity of the vaginal tract. Located beneath the bladder, the prostate also contains smooth muscles, which main function is to expel the semen during ejaculation.

Prostate cancer develops due to inherited and acquired DNA mutations. Patients with a history of cancer in their family and who are at least 50 years old are at a higher risk of developing the condition. Other risk factors are a diet that consists of meat cooked at high temperatures, exposure to metal cadmium, and sedentary lifestyle.

There are different types and stages of prostate cancer. While some cases require no treatment, other types can grow more aggressively. Just like other types of cancer, early detection improves prognosis or the chances of curing the disease. For this reason, prostate cancer screening is highly recommended particularly to those who are considered at high risk of developing the condition.

Who Should Undergo & Expected Results

Cancer screening tests — including the prostate-specific antigen (PSA) is recommended for:

  • Men who are at least 50 years old – The American Urological Association recommends undergoing PSA starting at the age of 50. Depending on the risk factors of the patient, the screening test should be performed at a regular interval. However, it’s no longer necessary for men who are 75 years and older.

  • Race – studies have confirmed that black men have a higher risk of suffering and dying from prostate cancer.

  • Family history – patients who have a family history of prostate cancer have a higher risk of developing the condition.

  • Obesity and diet – patients whose diet includes meat that is cooked in high temperatures and who are obese are encouraged to undergo PSA.

Various organizations have different guidelines as to who should and shouldn’t undergo the test. However, the majority recommends the test for men in between the ages of 40 and 75 and those who have a family history of the condition. It’s also crucial for patients who are experiencing the following symptoms:

  • Having a hard time urinating or urinating frequently particularly at night
  • Having the feeling that the bladder is not empty following urination
  • Having the sudden urge to urinate more frequently
  • Having to strain to urinate

How Does the Procedure Work?

Prostate cancer screening is performed with prostate-specific antigen (PSA) blood test, which measures the level of PSA, a protein produced by cells of the prostate gland. Healthy men have PSA levels under 4 nanograms per milliliter of blood. If the PSA level goes above four, the chances of having a prostate cancer is 1 in 4. However, if the PSA is more than 10, the chances increase to more than 50%.

If the PSA level is more than four but the patient is not showing symptoms of prostate cancer, the diagnosing physician will perform additional tests, which include the following:

  • Transrectal ultrasound – Typically performed following an abnormal PSA blood test, this uses a small probe that is inserted into the rectum to assess the condition of the prostate. Using sound waves, the probe picks up the echoes produced during the procedure, which is used by the computer to create a black and white image of the prostate. The procedure can also be used to measure the size of the prostate gland and in conducting treatments including cryosurgery and brachytherapy.

  • Biopsy – If previous test results suggest the presence of prostate cancer, a biopsy will be performed. In this procedure, a sample of blood tissue will be taken through a core needle biopsy and assessed under a microscope. A thin, hollow needle will be inserted through the wall of the rectum into the prostate to remove samples. Due to the nature of the procedure, it is typically performed under local anaesthesia. The biopsy samples will then be assessed to rule out the presence or absence of cancer. If prostate cancer has been confirmed, the pathologist will determine the stage of cancer, which will determine the most appropriate treatment option.

  • Digital rectal exam – If prostate cancer has been confirmed, additional imaging tests will be performed to determine if cancer has already spread to different parts of the body. Imaging tests may use sound waves, x-rays, magnetic fields, and radioactive substances. A bone scan will also be performed.

Possible Complications and Risks

Experts have confirmed that prostate cancer screening has detected several cases of prostate cancers that would have never caused damage to the patient’s body. This type of diagnosis has led to some degree of overtreatment such as radical prostatectomy and radiation therapy, which are blamed for various side effects including urinary incontinence and erectile dysfunction. Meanwhile, prostatic biopsies are also associated with sepsis, positive urine cultures, hematuria, and pain as well as psychological effects particularly to those who have undergone biopsies but were later cleared of prostate cancer.

References:

  • Harris R, Lohr KN: Screening for prostate cancer: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 137 (11): 917-29, 2002. [PUBMED Abstract]
  • Litwin MS, Pasta DJ, Yu J, et al.: Urinary function and bother after radical prostatectomy or radiation for prostate cancer: a longitudinal, multivariate quality of life analysis from the Cancer of the Prostate Strategic Urologic Research Endeavor. J Urol 164 (6): 1973-7, 2000. [PUBMED Abstract]
  • Steineck G, Helgesen F, Adolfsson J, et al.: Quality of life after radical prostatectomy or watchful waiting. N Engl J Med 347 (11): 790-6, 2002. [PUBMED Abstract]
  • Fowler FJ Jr, Barry MJ, Walker-Corkery B, et al.: The impact of a suspicious prostate biopsy on patients' psychological, socio-behavioral, and medical care outcomes. J Gen Intern Med 21 (7): 715-21, 2006. [PUBMED Abstract]
  • Rietbergen JB, Kruger AE, Kranse R, et al.: Complications of transrectal ultrasound-guided systematic sextant biopsies of the prostate: evaluation of complication rates and risk factors within a population-based screening program. Urology 49 (6): 875-80, 1997. [PUBMED Abstract]
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