Prostate cancer screening
Through prostate cancer screening, prostate cancer can be detected at an early stage.
Unfiltered PSA screening alone is controversial among experts; different screening concepts are currently the subject of research. A comprehensive screening examination is recommended depending on risk factors such as age, family history, and ethnic background.
Discuss your individual situation as well as possible advantages and risks of screening with your doctor. Together you can decide whether such a screening makes sense for you or not.
Prostate examinations include:
- Digital Rectal Examination (DRE)
During a digital rectal examination (DRE), your doctor inserts a gloved, lubricated finger into your rectum in order to palpate your prostate, which is located directly in front of the end of your rectum. If your doctor detects abnormalities in the consistency, shape, or size of your prostate gland, they will recommend further tests. - Prostate-Specific Antigen (PSA) Test
In this test, a blood sample is taken and analyzed for what is known as prostate-specific antigen (PSA), a substance produced in the prostate gland. It is normal for a small amount of PSA to be detectable in your blood. However, if an elevated PSA concentration is found, this may indicate a possible prostate inflammation, infection, enlargement, or prostate cancer.
With the help of a combination of PSA test and DRE, prostate cancer can be detected at its earliest stage. However, studies provide conflicting results as to whether these examinations actually reduce the risk of dying from prostate cancer. For this reason, the already mentioned debate on the usefulness of such prostate cancer screening exists.
Diagnosis
If abnormalities are detected during a DRE or PSA test, your doctor will recommend further examinations to determine whether prostate cancer is present. These include:
- MRI of the Prostate
In recent years, MRI has proven to be an essential tool in the evaluation of suspected prostate cancer and has become well established in clinical practice. MRI can be used to visualize tumors within the prostate. It serves as an aid in the diagnostic process and also plays a crucial role in guiding targeted tissue sampling during an MRI fusion biopsy (see “Evaluation of Prostate Cancer”). - Prostate Biopsy
If initial tests raise suspicion of prostate cancer, your doctor will recommend a prostate biopsy. In this procedure, small tissue samples are taken from your prostate using a thin needle. These samples are then examined in a laboratory for the presence of cancer cells.
Determination of the aggressiveness of the cancer cells
If the biopsy confirms the presence of prostate cancer, the next step is to determine the aggressiveness of the cancer cells.
A pathologist will examine your cancer tissue sample in a laboratory to assess how much the cancer cells differ from healthy cells. A higher degree of deviation indicates a more aggressive cancer that may spread quickly.
The most commonly used scale to determine how differentiated the prostate cancer cells are is the so-called Gleason score. This score consists of two numbers and ranges from 2 (= non-aggressive cancer) to 10 (= very aggressive cancer).
Determining the Stage of Prostate Cancer
Once a diagnosis of prostate cancer has been made, your doctor will attempt to determine the progression (stage) of the cancer. If there is a suspicion that the cancer has already spread beyond the prostate, the following further examinations may be considered:
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Bone scan
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Ultrasound
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Computed tomography (CT)
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Magnetic resonance imaging (MRI)
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Positron emission tomography (PET)
Not every test is appropriate for every patient. Your doctor will help you decide which examinations are best suited to your individual case.
Once the test results are available, your doctor can assign your cancer to a disease stage. This makes it easier to determine the appropriate treatment options. The stages of prostate cancer are usually divided as follows:
- Stage I
The cancer is at a very early stage and limited to a small part of the prostate. Under the microscope, the cancer cells are not considered aggressive. - Stage II
At this stage, the tumor may still be considered small, but it may already appear aggressive under the microscope. In other cases, stage II prostate cancer may already be more advanced and affect both sides of the prostate gland. - Stage III
The cancer has spread beyond the prostate to the seminal vesicles and surrounding tissues. - Stage IV
At this stage, more distant organs, such as the bladder, are affected, or metastases are present in lymph nodes, bones, lungs, or other organs.