Q. What is a PSA Test?

A. PSA stands for Prostate-specific antigen test (PSA test). This test analyzes a blood sample. It checks the sample for PSA, a substance produced by the prostate gland. If higher-than-normal levels of PSA are detected, above a level of 4.0ng/ml, it may indicate prostate infection or enlargement of the prostate gland, or cancer.

Q. What other screening is done for Prostate Cancer?

A. Screening tests fall into two categories: those that screen for prostate cancer and those that help determine the stage of the disease. These tests include:

1. Digital rectal exam (DRE). This is performed by the doctor who inserts a gloved, lubricated finger into the rectum to examine the prostate, to look for abnormalities in texture, shape or size of the gland.
2. Transrectal ultrasound. The transrectal ultrasound is used to further evaluate the prostate. A small probe is inserted into the rectum. The probe emits sound waves to produce an image of the prostate gland.
3. Prostate biopsy. With an ultrasound, the doctor removes 6-12 cores (tiny prostate bits) for pathological evaluation. These tissue samples provide a definitive diagnosis of prostate cancer and correct cancer grading, which is also known as the Combined Gleason Score or CGS. The biopsy and CGS are important diagnose and choose the appropriate treatment approach.

Q. How are the stages of prostate cancer determined?

A. In "staging" the disease, the doctor needs to determine the following about the cancer:

• If it is confined to the prostate
• If it has spread beyond the prostate
• Where it has spread to

Q. What are the different stages of prostate cancer?

A. There are several different staging systems for prostate cancer. The most widely used system is the TNM system, which describes the extent of the primary Tumor (T stage); whether or not the cancer has spread to nearby lymph Nodes (N stage), and the absence or presence of distant Metastasis (M stage). "Metastasis" refers to the spread of cancer cells from the prostate gland to another part of the body.

There are four categories that describe the prostate tumor's (T) stage, ranging from T1 to T4, or Stage A to D, described as follows:

• T1/Stage A: The cancer is microscopic, unilateral and non palpable. The doctor can't feel the tumor or see it with the assistance of imaging. Treatment for benign prostate hyperplasia (BPH) may have uncovered the disease, or it was confirmed through a needle biopsy done because of an elevated PSA.
• T2/Stage B: The doctor can feel the cancer with a DRE. The disease is confined to the prostate gland on one or both sides of the gland.
• T3/Stage C: The cancer has advanced to tissue immediately outside the gland
• T4/Stage D: The cancer has spread to other parts of the body

Q. What are Gleason Grade Scores?

A. A Gleason grade ranges from 1 to 5 and is based on the degree of differentiation among the cells. A Gleason grade of 1 indicates that the cancer cell clusters resemble the small, regular, evenly spaced prostate tissue.

Grade 1 – small, uniform cells, tightly packed
Grade 2 – varied cell sizes and shapes, loosely packed
Grade 3 – Increased cell size and shape irregularity, less distinction between cells
Grade 4 – Large, irregular fused cells
Grade 5 – Irregular, fused cells that have invaded surrounding connective tissue cells

Q. How is the cancer stage determined?

DRE – by touch, the doctor can tell if the cancer is T1, T2, or beyond T2.

Biopsy - small samples of tissue are taken from the prostate for a pathologist to evaluate the tissue and assign a Combined Gleason Grade Score (CGS), which ranges from 2 to 10. The higher the number means the more aggressive the cancer.

Prostatic Acid Phosphatase (PAP) blood test - determines if the cancer is confined to the prostate or not.

Computed tomography (CT) scan - produces detailed cross-sectional images of the body using hundreds of x-ray like images to determine if the prostate cancer has spread into other organs. CT scans are ideal for determining skeletal structures but have a limited mass size resolution.
Magnetic resonance imaging (MRI) - uses strong magnetic fields instead of x-rays to produce an image of the body based on cellular oscillation omitted energy. MRI scans produce a very clear picture of the prostate gland and can show whether the cancer has spread beyond the gland.

Endorectal MRI - helps to determine if the prostate cancer is confined to the gland and can also help detect the site of prostate cancer in men that may have prostate cancer that cannot be diagnosed with other routine tests.

Q. What are the symptoms of prostate cancer?

A. Prostate cancer may or may not exhibit symptoms and the common symptoms do not always mean it exists. However, one or more of the following symptoms, particularly if one is at higher risk for prostate cancer, should prompt a visit to the doctor:

1. A need to frequently urinate, especially at night
2. Blood in urine or semen
3. Difficulty obtaining an erection
4. Difficulty starting urination or holding back urine
5. Frequent pain or stiffness in the lower back, hips or upper thighs
6. Inability to urinate
7. Painful ejaculation
8. Painful or burning urination
9. Weak or interrupted urine flow