Eleanor N. Dana Cancer Center

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Prostate Cancer Diagnosis

At the Eleanor N. Dana Cancer Center, we use several procedures to help diagnose prostate cancer. The table below summarizes the risk categories for prostate cancer.

Risk Categories

Digital Rectal Exam (DRE)
A health-care provider gently inserts a gloved forefinger into the rectum to feel the prostate gland for enlargement or other abnormalities, such as a lump.

If a patient's cancer cannot be felt, it considered low risk (stage T1c). If a nodule is palpated on DRE, but it is confined to the borders of the prostate, the cancer is considered intermediate risk (stage 2a or b). If the cancer is large enough to be palpated and is growing outside of the prostate, this is indicative of high-risk disease (stage T3 or T4).

Prostate-Specific Antigen (PSA) Test
A prostate-specific antigen test measures the amount of PSA circulating in the blood, expressed in nanograms per milliliter (ng/mL). This level is used to assess prostate cancer risk. A value of 0 to 10 is indicative of low-risk prostate cancer. A value between 10 and 20 represents intermediate risk and a value greater than 20 indicates high-risk disease.

MRI
UT Health physicians use a new, noninvasive way to detect prostate cancer. The MRI helps doctors cut down on unnecessary biopsies, and if a biopsy is needed, it can be more targeted and specific because of the MRI.

Biopsy
The Eleanor N. Dana Cancer Center performs biopsies to evaluate the abnormal results of a DRE or an elevated PSA blood test. Patients receive a local anesthetic, often lidocaine, (which dentists use) that is injected into the area close to the prostate to make the procedure more comfortable.

A doctor inserts a small transrectal ultrasound (TRUS) probe with an imaging device into the rectum to view the prostate on a video screen. Using this image as a guide, the physician injects a thin needle through the wall of the rectum into the prostate and removes several tiny samples of tissue.

When patients receive their prostate biopsy report, one important finding they should note is the relative volume of their cancer. Most modern biopsy schemes entail 12 cores that are taken during the prostate biopsy. A low-volume cancer is one in which no more than 2 cores are positive for cancer. Intermediate and high-volume diseases are a bit more difficult to discern, but typically, cancer that is present in greater than 6 cores is considered high volume.

Prostate Cancer StagesPSA density is a simple ratio calculated from a patient's PSA value and prostate volume. Expressed as an equation, it is:

PSA Density = PSA/Prostate Volume

For example, a man with a PSA of 4.0 and a prostate volume of 40gm will have a PSA density of 0.10. PSA density has been shown to be a predictor of risk status, with a lower density (low PSA, larger prostate) being associated with a lower-risk cancer. A density of 0.15 is usually regarded as the maximum for low-risk disease.

Gleason Score
Donald Gleason was a pathologist who determined that the architectural structure of prostate cancer glands as viewed under the microscope indicated the aggressiveness of the disease. He came up with a scoring system numbered from 1 to 10. The system has been modified since then, and urologists now use only scores from 6 to 10.

The higher the Gleason number, the more aggressive the cancer, so Gleason 6 (3+3) prostate cancer is less aggressive than Gleason 7 (3+4, 4+3) which, in turn, is less aggressive than Gleason 8, 9 or 10 (4+4, 4+5, 5+5). Just like golf, patients want the lowest number when it comes to a Gleason score.

To learn more about prostate cancer diagnosis or to schedule an appointment, call 419.383.6644.

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Last Updated: 4/20/16