Urologic Screening, Diagnosis and Treatment

How is prostate cancer found?

Prostate cancer can often be found early by a PSA test (testing the amount of prostate-specific antigen in the blood) and a digital rectal exam (DRE). The chances for surviving prostate cancer are better if it is found early. Talk to your doctor about getting tested.

PSA Testing

The PSA blood test measures a protein (prostate-specific antigen) made by prostate cells. The higher the PSA score, the greater the chance of having prostate cancer. It is important to note that a high PSA score does not mean that you have prostate cancer.

Digital Rectal Exam (DRE) Testing

To conduct the DRE, the doctor inserts a gloved, lubricated finger into the rectum to feel for any irregular or abnormally firm area that might be cancer. DRE is less effective than the PSA blood test in finding prostate cancer, but it can sometimes find cancers in men with normal PSA levels. For this reason, both the PSA and the DRE should be used for finding prostate cancer early.

How is prostate cancer diagnosed?

Diagnostic testing may include:

• Biopsy – A biopsy is a procedure in which a sample of tissue is removed and then examined under a microscope to determine if it is cancerous (malignant) or non-cancerous (benign).
• Grading – Most pathologists grade prostate cancers according to the Gleason system, which assigns a grade using numbers from 1 to 5. A Grade 1 is assigned if the cancerous tissue closely looks like normal prostate tissue. Grades 2 through 4 have intermediate features. A Grade 5 tumor lacks features similar to normal prostate tissue and its cells seem to be spread throughout the prostate. The grades of the two most common features are added for the Gleason score.

How is prostate cancer treated?

Prostate cancer can be treated in many ways including surgery, radiation therapy, hormonal therapy, chemotherapy and watchful waiting. Our board-certified physicians work together to develop the optimal treatment plan for each patient.

• Surgery: Surgery, or radical prostatectomy, is the procedure in which a surgeon removes the entire prostate gland including some surrounding tissue. Surgery is most often used if the cancer is not thought to have spread outside of the prostate gland. The urologists are skilled surgeons offering the latest techniques for radical nerve-sparing prostatectomy, both retropubic (incision made in the lower abdomen) and perineal (incision made in the skin between the scrotum and the anus).
• Radiation Therapy: Radiation therapy uses high-energy rays or particles to kill cancer cells. Radiation is sometimes used to treat low-grade cancer that is still confined within the prostate gland or that has only spread to nearby tissue. Cure rates for these patients appear to be similar to those for men getting radical prostatectomy. If the disease is more advanced, radiation may be used to reduce the size of the tumor and to provide relief from present and future symptoms.
• Hormonal Therapy: Hormone therapy lowers levels of androgen male hormones in the body. The main androgen is called testosterone. Androgens, produced mainly in the testicles, can allow prostate cancer cells to grow. Lowering androgen levels can make prostate cancers shrink or grow more slowly.
• Chemotherapy: Chemotherapy is sometimes used if prostate cancer has spread outside of the prostate gland and hormone therapy isn’t working. Systemic chemotherapy uses anticancer drugs injected into a vein or given by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment potentially useful for cancers that have metastasized (spread to other organs).