| Prostate cancer | Diagnosing prostate cancer | Treatment for prostate cancer |
| Coping with side effects of treatment for prostate cancer |
This information has been reviewed by:
Associate Professor Jeremy Millar, The Alfred
Doctors and other health professionals you may see
How prostate cancer is diagnosed
Digital rectal examination (DRE)
Computerised tomography (CT) scan
Magnetic resonance imaging (MRI)
Early prostate cancer usually causes no symptoms.
Many men over 50 have urinary symptoms such as:
However, in most men these symptoms are generally caused by benign prostatic hyperplasia (BPH) and not by cancer. BPH cannot turn into prostate cancer.
Later stage prostate cancer may cause symptoms including:
Often men have these symptoms without it being cancer. However, you should have any symptoms checked by a doctor.
Your doctor will examine you and suggest tests to see if you have cancer. This can be worrying and tiring, especially if you need to have several tests.
If the tests show you have or may have cancer, your doctor will refer you to a specialist. The specialist will examine you and may ask you to have more tests. If you have cancer, one or more specialists will advise you about treatment options. It may be helpful for you to seek a second opinion.
You should expect to be cared for by a team of health professionals from the relevant major fields (see following list). Ideally, all your tests and treatment should be available at your hospital. This may not be possible in some non-metropolitan areas.
Health professionals who care for people with prostate cancer include:
If your doctor thinks you might have prostate cancer, tests can be done to find out for certain. These tests will also check the size of the cancer and find out if it has spread.
It is important that you understand what it will mean if a test shows you have cancer. You need to think beforehand about whether you would want to have treatment. This will depend on your age, health, what you want and the stage of the cancer. Your doctor can help you decide what is best for you.
You may have some or all of the following tests.
A blood test may be done to check the level of prostate-specific antigen (PSA). PSA is usually found in the blood in larger amounts when prostate cancer is present. A high level of PSA does not mean you have prostate cancer. However, you will need a biopsy to know for certain. It is very common for benign prostatic hyperplasia to cause a high level of PSA. Speak to your doctor if you would like to talk about your PSA reading. PSA is usually measured in nanograms per millilitre (ng/ml). PSA can also be measured in micrograms per litre (µg/L).
A digital rectal examination is a check of the prostate through the back passage (rectum). The doctor places a gloved finger into your rectum and feels the prostate through the rectum wall. If your doctor feels anything unusual, such as an enlarged prostate or an odd shape, they may arrange a biopsy.
In a biopsy, small samples of tissue are removed to be looked at under a microscope.
For a biopsy of the prostate, a small needle is put into the prostate. It is guided by an ultrasound probe in the rectum (this is called transrectal ultrasound or TRUS). The probe is the size and shape of a middle finger. It shows the shape and condition of the prostate on a screen like a television.
Six to 12 samples of prostate tissue are taken from different parts of the prostate. The biopsy is usually done with local anaesthetic to make the area numb. You will have a mild sedative.
After the biopsy, men sometimes have minor bleeding in the urine, semen and from the rectum. Infection can happen-you may have antibiotics to try to stop this.
The biopsy helps you and your doctor decide about treatment. The doctor will see how many of the tissue samples, if any, show cancer. If there is cancer, it will be graded, depending on how the tissue appears under the microscope. This is known as the Gleason score. The lower the score is on a scale of 2 to 10, the less aggressive (fast-growing) the cancer is likely to be.
You may have a bone scan to see if the prostate cancer has spread to your bones.
You will have an injection of a radioactive tracer (like a dye) into a vein, probably in your arm. You will need to wait for the tracer to make its way through your body. This usually takes about four hours. You can eat and drink normally during this period.
When it is time for your scan, you may be asked to undress and put on a gown, then lie on a table under a scanning machine. The machine will detect rays from the tracer and turn these into pictures that can be seen on a computer screen. The tracer will show any ‘hot spots' in your bones that may be cancer.
The test will take about two hours. It is painless and has no side effects.
A CT scan is a type of x-ray. It gives a cross-sectional picture of the organs and other structures (including any tumours) in your body.
CT scans are usually done at a hospital or a radiology clinic. It takes about 30 to 40 minutes to complete this painless test.
You will be asked not to eat or drink anything before the scan, except for a liquid dye. The dye makes your organs appear white on the scans that are taken, so anything unusual will show more clearly.
You will lie on a table while the CT scanner, which is large and round like a doughnut, moves around you. You may be given contrast (like a dye) into a vein, probably in your arm.
Most people are able to go home as soon as their scan is over.
This test is like a CT scan, but it uses magnetism instead of x-rays to build up pictures of the organs in your pelvic area, including your prostate and other organs nearby.
Like a CT scan, MRI is painless, and the magnetism is harmless.
You will be asked to lie down inside a large metal tube, which is open at both ends. The tube makes some people feel claustrophobic (afraid of being in a small space). You can usually take someone into the room with you to keep you company.
A probe may be placed in your rectum to get a better view of the prostate. The test may take up to an hour. The machinery can be quite noisy.
If you have a metal device like a pacemaker or joint replacement you should not have an MRI.
This test will help your doctor decide whether the cancer has spread beyond your prostate. This will help you both decide which treatment is best for you.
The tests described on the previous pages show whether you have cancer. They will also show where the cancer is and whether the cancer cells have spread to other parts of your body. This helps your doctors ‘stage' the disease.
‘Stage' describes the extent of the cancer in your body. It helps show which treatment is needed. It also is a guide to prognosis.
A common ‘staging system' used for prostate cancer is the ‘TNM system', where T = tumour, N = nodes and M = metastases.
Ask your doctor to explain the stage of your cancer in a way you can understand. This will help you choose the best treatment for your situation.
