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Friday, Sep 22nd

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Prostate Cancer Diagnosis

The initial detection of signs that you may have prostate cancer is now most commonly the result of some regular form of check–up carried out by your primary care physician which may include:
  • A Digital Rectal Examination (DRE).
  • A Prostate Specific Antigen (PSA) test.
  • Transrectal Ultrasound (TRUS).
The most common symptom which may make a man go to either his primary care physician or a urologist, and which might subsequently lead to a diagnosis of prostate cancer, is some form of problem with normal urination.
The diagnosis of prostate cancer requires identification by a pathologist of prostate cancer tissue in a specimen removed from the prostate (using a technique known as a prostate biopsy). No other clinical test can provide an absolute diagnosis of prostate cancer.

A Digital Rectal Examination (DRE)
DRE stands for digital rectal examination. In a digital rectal examination the physician inserts his finger into the rectum in order to be able to feel the size, shape, and texture of the prostate and other nearby organs. In classical medicine, before the availability of the modern wonders of science, the digital rectal examination was the only way a physician could tell if there was a possible disorder of the prostate, short of cutting you open and looking.

Over the years, highly experienced physicians became relatively good at using digital rectal examinations to tell whether patients had clinically important prostate disorders. However, DRE is a “Subjective” technique. In other words, the ability to use a DRE well is all about the skill of the physician and his or her ability to interpret what he or she feels.

A Prostate Specific Antigen (PSA) Test
PSA stands for Prostate Specific Antigen. The PSA test or prostate specific antigen test has revolutionized the detection of prostate cancer and monitoring of the effects of treatments. On its own, it is very probably responsible for the accurate diagnosis of prostate cancer in millions of men worldwide.

The PSA blood test tells doctors when patients have a higher than normal level of PSA. A high level of PSA usually means that the patient has a prostate problem, but it does not necessarily mean he has cancer. Men who have a prostate infection or prostate growth that is not cancerous may also have high levels of PSA.

Accuracy
For every 100 men over age 50 that have the PSA test:
10 of these men will have a higher than normal level of PSA. These 10 men will then need to go through other tests and examinations.
The test will identify some men who don’t have cancer, creating unnecessary anxiety. It will also miss some who do have cancer, giving them a false sense of security about their health.

Will using the PSA test save lives?
In some men, using the PSA test to find prostate cancer and then to treat it may help them to live longer. But for other men, the test may find very slow–growing cancers that would never have caused problems during their lifetime. If they had not had the test, these men would likely have led healthy lives, unconcerned about prostate cancer. Since they had the test, they will now have to deal with knowing they have prostate cancer and possibly decide about treatments that may leave them impotent and incontinent.

Transrectal ultrasound (TRUS)
TRUS stands for Transrectal Ultrasound
TRUS is most commonly used to do two things:
  • The first is to guide the doctor when he or she is carrying out a technique known as a biopsy of the prostate, when small samples of tissue are taken from the prostate in order to make a proper diagnosis.
  • The second is in order to try and establish the volume of the prostate, which is important if the doctor wants to know the PSA density.
Specialists may also use TRUS for other reasons in some prostate cancer patients or patients suspected of prostate cancer. However, it has now been generally agreed that TRUS has no particular value in identifying patients with prostate cancer when used on its own or in combination with such techniques as DRE or PSA.

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