All about prostate cancer diagnosis

Early diagnosis and treatment of prostate cancer can significantly improve outcomes for patients. Here to tell us what’s involved is leading consultant urologist Mr Mohamed Asad Saleemi.

What is prostate cancer?

Prostate cancer is a type of cancer that occurs in the prostate gland, which is a small gland located below the bladder in men. The prostate produces seminal fluid that nourishes and transports sperm. Prostate cancer is one of the most common types of cancer in men, and it often grows slowly. Some forms of prostate cancer remain confined to the prostate gland, where they may not cause serious harm. However, other types are more aggressive and can spread quickly.

What are the symptoms of prostate cancer?

In its early stages, prostate cancer may not cause any symptoms. However, as the disease progresses, patients may experience urinary problems, such as difficulty urinating, a weak or interrupted urine flow and the need to urinate more frequently, especially at night. Other symptoms can include:

• blood in the urine or semen;
• erectile dysfunction;
• discomfort in the pelvic area, and;
• bone pain.

How is prostate cancer diagnosed?

The diagnosis of prostate cancer typically involves several steps and tests:

Prostate-specific antigen (PSA) test

A PSA test measures the level of prostate-specific antigen in the blood. Elevated levels of PSA can indicate the presence of prostate cancer, but they can also be caused by other conditions, such as an enlarged prostate or prostatitis. Therefore, a high PSA level alone is not conclusive for prostate cancer.

Digital rectal examination (DRE)

During a DRE, a doctor inserts a gloved, lubricated finger into the rectum to examine the prostate gland. This test allows the doctor to feel for any abnormalities, such as lumps or hard areas, that might indicate the presence of cancer.

MRI scan

Magnetic resonance imaging (MRI) can provide detailed images of the prostate and surrounding tissues. An MRI is often used to identify areas of the prostate that may be cancerous and to guide further diagnostic procedures, such as biopsies.

Prostate biopsy

A biopsy involves taking small samples of prostate tissue to be examined under a microscope. This is usually done using a transrectal ultrasound (TRUS) to guide the biopsy needle. The samples are analysed to determine if cancer cells are present and, if so, to assess their aggressiveness (Gleason score).

What happens after a prostate cancer diagnosis?

Once prostate cancer is diagnosed, further tests may be needed to determine the stage and extent of the disease. Staging involves assessing whether the cancer is confined to the prostate or has spread to other parts of the body. Common staging tests include bone scans, CT scans and MRI scans.

What are the treatment options for prostate cancer?

Treatment options for prostate cancer depend on several factors, including the stage of the cancer, the patient’s overall health, and personal preferences. Options may include:

Active surveillance

For low-risk, slow-growing prostate cancer, active surveillance involves regular monitoring with PSA tests, DREs, and possibly biopsies to track the progression of the disease. Treatment is initiated only if the cancer shows signs of progression.

Surgery

A common surgical option is a radical prostatectomy, which involves removing the entire prostate gland and some surrounding tissue. This can be done using traditional open surgery or minimally invasive techniques, such as laparoscopic or robotic-assisted surgery.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. This can be delivered externally (external beam radiation) or internally through radioactive seeds placed in the prostate (brachytherapy).

Hormone therapy

Hormone therapy, or androgen deprivation therapy (ADT), reduces the levels of male hormones (androgens) that can stimulate the growth of prostate cancer cells. This can be achieved through medications or surgical removal of the testicles.

Chemotherapy

Chemotherapy uses drugs to kill rapidly growing cancer cells. It is often used for advanced prostate cancer that has spread beyond the prostate.

Immunotherapy

Immunotherapy helps the immune system recognise and attack cancer cells. This is a newer form of treatment that may be used in certain cases of advanced prostate cancer.

Regular screening and prompt medical attention for any symptoms are crucial. Patients should discuss the potential benefits and risks of each diagnostic test and treatment option with their healthcare provider to make informed decisions about their care.

Concerned about prostate cancer, and require an early diagnosis? Arrange a consultation with Mr Saleemi via his Top Doctors profile.