Early Detection for Prostate Cancer
Currently, there are two primary screening tools for prostate cancer: the PSA test and the Digital Rectal Exam. Doctors typically use both tests during an examination.
A PSA test is a simple blood test that measures the level of PSA in a man's body. PSA, or Prostate Specific Antigen, is a protein produced in the prostate. An elevated PSA may (but not necessarily) indicate cancer. Doctors generally recommend men seek initial screening at 50, or younger if they have risk factors such as family history of prostate cancer.
During a Digital Rectal Exam, a physician inserts a gloved finger in the lower rectum to feel for bumps or abnormalities on the prostate through the wall of the rectum.
Neither of these tests diagnoses cancer; they only indicate that there is something that requires further evaluation. If either test produces abnormal results, your physician may follow up with an ultrasound or biopsy for more information. If you do have cancer, he or she may perform an additional scan or MRI to see if the cancer has spread beyond the prostate. This step is called staging.
Doctors also grade tumors according to how different the tumor tissue is to normal prostate tissue, which indicates how fast the tumor is growing and is one factor in determining a man's treatment. Prostate cancer is usually graded on the Gleason Scale, which looks at patterns of cells in cancer tissue and grades them on a scale of two to ten. The most common pattern is rated a one; the most abnormal a five. If there is a second common pattern, it's also graded on the same scale. Doctors add the two scores to arrive at a Gleason score. If there is no second pattern, the first score counts twice.
In February 2009, doctors and researchers at the Genitourinary Cancers Symposium described two potential new prostate screening tools. The first is a urine test, called the T2ERG urine test, which detects gene fusion associated with prostate cancer and is reportedly more accurate in detecting prostate cancer than other screening methods.
The second tool is a risk calculator, which considers four prostate cancer risk factors for a more accurate prediction of future risk. The calculation includes PSA score, previous biopsy results, family history and size of the prostate. At any given PSA level, a family history increases risk, while a previous negative biopsy result and increased prostate size volume lowers risk. At a certain threshold, patients should be screened more often.
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