Prof. Dr. Rahmi Çubuk

Prostate Diseases

Prostate Diseases

Early Diagnosis of Prostate Cancer

Early Diagnosis of Prostate Cancer

What is Cancer Screening ?

Cancer screening involves testing or examinations conducted to detect potential cancer before symptoms appear. In some types of cancer, screening can help detect the disease at an early stage when it is easier to treat. Prostate cancer can also be detected early through screening methods.

At What Age Should Prostate Cancer Screening Begin ?

Prostate cancer screening generally starts at the age of 50 for men. However, if there is a family history of prostate cancer (father, brother, etc.), screening should begin at age 45.

How is Prostate Cancer Diagnosed Early ?

Prostate cancer can be diagnosed early by measuring the levels of PSA (Prostate-Specific Antigen) in the blood or by conducting a digital rectal examination (DRE). The PSA test is a simple blood test, while the DRE involves the doctor using a gloved finger to examine the prostate gland. If these screenings raise suspicion, further tests may be required to determine whether cancer is present. If cancer is suspected based on screening tests or symptoms, advanced diagnostic tests will be necessary. The definitive diagnosis of prostate cancer can only be confirmed through a prostate biopsy.

What Questions Will Your Doctor Ask During a Prostate Examination ?

If your doctor suspects you might have prostate cancer, they will ask about urinary issues or sexual problems and how long these symptoms have been present. They will also inquire about your family history (father, brother, etc.) to assess risk factors.

The doctor will perform a digital rectal examination (DRE), where they insert a gloved finger into the rectum to feel for any lumps or irregularities in the prostate. The doctor may also examine other parts of your body and may recommend additional tests.

What Imaging Techniques (CT/MRI) are Used After Cancer Detection ?

If prostate cancer is diagnosed, your doctor will want to determine whether the cancer has spread outside the prostate tissue. The most commonly used imaging techniques to assess the spread of prostate cancer include:

  • Computed Tomography (CT): CT scans use X-rays to create detailed cross-sectional images of your body. When combined with other findings (e.g., PSA levels, PRM results, and Gleason score), CT scans are not usually necessary if the cancer is confined to the prostate. However, CT scans can help detect whether the cancer has spread to nearby lymph nodes or other organs.
  • Magnetic Resonance Imaging (MRI): MRI provides detailed images of soft tissues without radiation. It uses radio waves to create detailed pictures of the body. MRI is particularly useful for evaluating the prostate and determining whether the cancer has spread to the seminal vesicles or other surrounding structures, which is critical for determining treatment options. Sometimes, a contrast agent called gadolinium may be injected into a vein to enhance the imaging.
  • Bone Scan: If prostate cancer has spread to distant areas, it typically first affects the bones. A bone scan can help determine if cancer has reached the bones. A small amount of radioactive material is injected into the body, which then collects in damaged bone areas. A special camera detects the radioactivity and creates an image of the skeleton. While a bone scan can show potential cancer in the bones, further tests such as X-rays, CT scans, MRIs, or even a bone biopsy may be needed for a definitive diagnosis.

What is PSA and How is It Evaluated ?

PSA is a substance produced by prostate cells. A PSA blood test is primarily used for prostate cancer screening in men without symptoms. Elevated PSA levels can indicate the possibility of prostate cancer or prostatitis (prostate inflammation). However, a normal PSA level does not rule out prostate cancer.

In most men without prostate cancer, the PSA level in the blood is below 4 ng/ml per milliliter. When prostate cancer develops, the PSA level is typically above 4. However, PSA levels below 4 do not guarantee the absence of cancer, as about 15% of men with PSA levels below 4 may still have prostate cancer detected during a biopsy.

  • PSA levels between 4 and 10 ng/ml: The probability of prostate cancer is around 25%.
  • PSA levels above 10 ng/ml: The probability of prostate cancer exceeds 50%.

When deciding whether to perform a prostate biopsy, PSA levels alone are not the determining factor. Age, race, and family history are also important factors in the decision-making process.