The diagnosis of prostate cancer and identification of correct treatments
Written in association with:Prostate cancer usually develops over many years, and tends to have no external symptoms until the prostate becomes big enough to disrupt urination and sexual function. During this time, the cancer may spread to organs in other parts of the body, which is why it is ideal to get diagnosed as early as possible to develop a treatment plan that adequately addresses the spread and severity. In this article, consultant urological surgeon Mr Peter William Cooke shares all about how prostate cancer is diagnosed and treated.
How is prostate cancer diagnosed?
It is recommended that men go to regular screenings for prostate cancer, as it can be used to detect the cancer before symptoms manifest. This will likely include a prostate-specific antigen (PSA) blood test. PSA is made by cells in the prostate gland – both normal and abnormal cells – and whilst there is no known correlation between PSA levels and prostate cancer, it is known that those with prostate cancer will also have higher PSA levels, i.e. a PSA score of more than 10 nanograms per millimetre means the chance of a patient having prostate cancer is over 50 per cent.
Another screening test is a digital rectal exam (DRE), in which a doctor physically assesses the surface of the prostate by inserting a gloved, lubricated finger into the rectum – the doctor will be looking for any hardness, bumps, or abnormal size of the prostate.
When screening tests results aren’t normal, and after the patient’s medical and family history has been reviewed, a doctor may recommend that the patient undergo a prostate biopsy or imaging scans like MRI or ultrasound scans:
- During a biopsy, a sample of the prostate is extracted with a thin, hollow needle that is punched into the prostate either through the wall of the rectum (transrectally) or through the skin between the scrotum and anus (transperineally). The sample is then analysed in a lab for cancer cells by a pathologist.
- A transrectal ultrasound uses a small probe inserted into the rectum and emits sound waves that bounce off the internal organs and structures in the form of echoes. With these echoes, a computer is able to generate them into an image of the prostate.
- An MRI uses radio waves and strong magnets to image the soft tissues of the body (such as the prostate). A certain technique, the multiparametric MRI (mpMRI), is used to better define possible areas of cancer in the prostate, and doctors can use this information to predict how the cancer might spread. A normal MRI is used in conjunction with another kind of MRI (such as a diffusion weighted imaging, dynamic contrast enhanced MRI, or MR spectroscopy) to compare and locate abnormal areas.
How is prostate cancer treated?
When prostate cancer is discovered and diagnosed, it will be assigned a grade. The grade of the cancer is based on how abnormal the cancer looks under the microscope, and how likely it is to spread and grow. Higher-grade cancers look more abnormal, and they’re more likely to grow and spread quickly. There are 2 main ways to describe the grade of prostate cancer.
- Grade group 1 means that the cells look like normal prostate cells and may not grow.
- Grade group 2 means that the cells look similar to normal prostate cells and they are likely to grow slowly.
- Grade group 3 means that the cells are less like normal prostate cells and will grow at a moderate rate.
- Grade group 4 means that the cells look abnormal and are likely to grow moderately or possibly quickly.
- Grade group 5 means that the cells are very abnormal and are likely to grow quickly
Doctors will consider the grade group, the level of PSA, and the condition of the tumour to categorise the cancer into one of the risk group as part of the Cambridge Prognostic Group (CPG). This helps to inform both patients and doctors about how the cancer can best be treated or managed.
Options include active surveillance for low-risk cancers, surgical removal of the prostate (prostatectomy), radiation therapy, hormone therapy, and chemotherapy for more advanced stages. In recent years, newer treatments like immunotherapy and targeted therapies have also emerged, offering hope for better outcomes with fewer side effects. Understanding these aspects of prostate cancer can help guide discussions between doctors and patients and inform decisions about treatment.
If you are experiencing issues with urination or your prostate, you can consult with Mr Cooke on his Top Doctors profile.
