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3. How is prostate cancer diagnosed?

One of the most important things to realize about prostate cancer is that, with rare exception, the malignancy does not produce symptoms until it has metastasized (spread outside the prostate gland) to other organs. The exception is when it is associated with benign prostatic hypertrophy in which case it may contribute to difficult urination. In this case the diagnosis may be made when the pathologist examines the tissue removed when the urologist performs a turp (transurethral resection of the prostate) to relieve the obstruction.

Thus, in the majority of cases if prostate cancer is to be detected in its curable state it must be done during routine physical and hematological examinations of asymptomatic patients. These examinations include a rectal digital examination of the prostate wherein irregularities of the posterior surface of the prostate are detected by the examiners finger and, most importantly, by periodic determinations of the males PSA (the prostatic specific antigen blood test). Interestingly, a study performed many years ago at the Mayo clinic revealed that one of the most meaningful things, from a cost effectiveness standpoint, that came out of the yearly physical examinations they performed on business executives was the detection of curable prostate cancer.

At this point I must address a very significant misconception that is held by many in the medical profession, and even some Academic Urologists, I am sorry to say. These physicians rely on large body statistical evidence that at first glance would seem to suggest that, taken as a whole, men with prostate cancer would be better off if they were never diagnosed with the disease. The rational being that the complications of treatment and possible over treatment out weight any possible benefit the population as a whole might gain from efforts to cure the cancer. Along the same lines those who support this course, or rather, non course of action, also maintain that the diagnosis and treatment of prostate cancer for the nation as a whole is too expensive to be cost-effective. Interestingly, you never hear anything about the cost-effectiveness of treating lung cancer, colon cancer or, God forbid breast cancer.

I believe this line of reasoning is erroneous for at least two reasons! First, and possibly most importantly, death from prostate cancer is a prolonged extremely painful ordeal. It is one thing to keel over and die from a massive heart attack or stroke; It is quite another to die a prolonged death from incurable prostate cancer that has metastasized to the bone. If you don’t believe anything else I tell you in this eBook, believe that! If you are unfortunate enough to develop the malignancy, and are not likely to die from something else, you need to be diagnosed early so that the cancer can be cured, that’s the long and the short of it!

Second, you can make a case, from a statistical standpoint, for almost any supposition. In this case, don’t let the statistics confuse you; rather follow your instincts and common sense. In this respect, I know of no urologist under the age of 75 and in reasonably good health that does not get his yearly PSA test. Why do you think this is? By the way I think most primary care physicians and internists make sure that they are tested for prostate cancer on a yearly too.

WE will discuss who should get a PSA momentarily; however, if you have an elevated PSA what’s next? The diagnosis of prostate cancer is not based on the PSA test along. For a diagnosis of prostate cancer to be make the urologist must perform a prostate needle biopsy, usually under ultra sound, so that tissue specimens from suspicious and non-suspicious areas of the gland may be examined histologically for the presence or absence of malignant tissue. Cancerous tissue is graded on a Gleason score of 1 to 10. Low grade, score, tumors are less malignant and less likely to have metastasized, while high grade tumors carry a significantly more ominous prognosis because they are faster growing and are more likely to have metastasized before the diagnosis was made.