Diagnosis & Staging
Cancer is a disease that starts in our cells. Our bodies consist of millions of cells that group together to form organs and tissues – lungs, liver, muscles and bones. Genes inside of each cell tell it when to grow, work, reproduce and die. Under normal circumstances these orders are very clear; the cells obey them, and we remain healthy.
But when a cell’s instructions get confused, it grows abnormally. These abnormal cells will form groups over time and result in lumps or tumours. Sometimes, these abnormal cells will invade the tissues around them and spread to other parts of the body – this is cancer. Cancerous tumours can be dangerous and it is very important to find them and treat them before they spread.
Cancers are generally named after the body part where they start – most prostate cancer starts in the glandular tissue of the prostate. It is called ADENOCARCINOMA
Prostate cancer is often slow-growing and can be managed very successfully but it is important to diagnose it early.
In it's early stages prostate cancer has no symptoms. It can grow for years without any warning signs. When symptoms do finally appear, many of them are the same as those caused by urinary blockage or irritation from benign, non-cancerous diseases, such as benign prostatic hyperplasia or prostatitis.
It however must be emphasized that NONE of these symptoms are found only in cancer, and most commonly are caused by benign, non-cancerous disorders, and most men with prostate cancer have no symptoms whatsoever.
- Slow urine stream
- Hesitancy in initiating urination
- Frequent urination during the day or night
- Strong urges to void
- Problems with sexual function
- Aching pains in the penis, scrotum, testicles, anus, lower abdomen, or lower back
Advanced cancer may result in fatigue, loss of energy, persistent swelling of one or both legs and pain in the back, rib or hip.
How can I find out if I have prostate cancer?
During an annual check up, doctors usually do a DRE (digital rectal exam). If the doctor feels anything unusual, or you have experienced changes in your urination habits, a PSA test may be ordered. This is a blood test that measures how much prostate specific antigen (PSA) the prostate is producing. It is the most sensitive test we have for prostate cancer but it can be difficult to interpret. If levels are higher than normal, it means that there could be a prostate problem – not necessarily cancer. There could be an infection in the prostate or enlargement that is not cancerous.
If the doctor suspects prostate cancer, he or she may recommend further tests. A transrectal ultrasound uses sound waves to make a picture of the prostate and allows the doctor to take a biopsy. The needle biopsy will be used to remove a small amount of tissue and sent to pathology to see if it contains cancer cells. If cancer is detected by using either of these tests, x-rays and further ultrasounds may also be used to check the stage of your cancer, and this will help to determine treatment options.
Once all of the tests are done and a diagnosis of prostate cancer is confirmed, you will meet with your doctor to decide on treatment.
Why is it important to know the grade and stage of prostate cancer?
The grade and staging of prostate cancer helps the doctor and patient determine which treatment will work best for the individual. Complete staging may only be possible after surgery or additional tests and it may be necessary to remove some lymph nodes near the cancer to get an accurate picture.
The presence of cancer beyond the prostate has a major impact on treatment. For patients at risk for spread, further staging tests should be undertaken before a treatment decision is made. These tests may include a bone scan, CT scan or chest x-ray.
I have prostate cancer – now what?
Once you have a firm diagnosis of prostate cancer, your doctor, usually your urologist, will sit down with you and to discuss the following eight issues:
- grade of the tumour
- stage of the tumour
- significance of PSA
- impact of various treatment options on your quality of life, specifically with respect to sexual functioning and urinary control
- the risk of your particular cancer causing major problems during your lifetime if not treated
- the likelihood of cure with each of the treatment options
- the likelihood of disease control with each of the treatment options if the cancer is not curable
- risks of the major side effects from each of the treatment options