Diagnosis, Staging, and Prognosis

Diagnosing prostate cancer often begins with a couple of initial tests, especially if you're experiencing symptoms or undergoing routine screening.

• Initial Tests:
  • Digital Rectal Exam (DRE): A healthcare professional inserts a gloved, lubricated finger into your rectum to feel your prostate gland for any unusual changes in its size, shape, or texture. This exam can be part of a screening, or done if symptoms suggest a prostate condition.
  • Prostate-Specific Antigen (PSA) Blood Test: This blood test measures the amount of PSA, a substance made by prostate cells, in your blood. A high PSA level can be a sign of prostate cancer, but it can also be due to other conditions like prostate infection or enlargement. If your PSA is high, the test is usually repeated, and if it remains high, further tests may be recommended.
  • 
    
• Next Steps - Imaging Tests: If the initial tests raise concerns, imaging tests can provide detailed pictures of your prostate to look for signs of cancer.
  • Prostate Ultrasound (Transrectal Ultrasound): If a DRE detects something concerning, an ultrasound might be recommended. A thin probe inserted into the rectum uses sound waves to create images of your prostate gland.
  • Prostate MRI (Magnetic Resonance Imaging): An MRI uses a magnetic field and radio waves to create detailed pictures of your prostate. It's often used to pinpoint suspicious areas that could be cancer and can help guide a biopsy. Different types of prostate MRIs include contrast-enhanced MRI (using a dye for clearer pictures) and MRI with endorectal coil (using a device in the rectum for better images), and multiparametric MRI (which helps distinguish healthy tissue from cancer).
  • 
    
• Prostate Biopsy - The Definitive Answer: The only way to definitively know if you have prostate cancer is by taking a sample of prostate cells for testing.
  • During a biopsy, a needle removes tissue from your prostate, either through the skin or the rectum.
  • Transrectal Prostate Biopsy: This is the most common type. An ultrasound probe in the rectum guides a needle through the rectal wall into the prostate to collect tissue samples from different areas.
  • Perineal Prostate Biopsy: Less common, this involves inserting a needle through the perineum (the skin between the scrotum and anus) to get tissue samples, often guided by ultrasound.
  • The tissue samples are then sent to a lab to determine if they contain cancer.
  • While generally safe, a prostate biopsy carries risks like bleeding, blood in urine or semen, difficulty urinating, or infection.

After all your tests, your healthcare team will assign a stage to your cancer. This stage helps them understand the cancer's size and how quickly it's growing.

Factors considered for staging include:

• How much of the prostate contains cancer.
• Whether the cancer has grown outside the prostate (e.g., to the rectum or bladder).
• If the cancer has spread to lymph nodes.
• If the cancer has spread to other parts of the body, like bones.
• Your PSA level.
• Your grade group.

Prostate cancer stages range from 1 to 4.

• Lower stage numbers (1 and 2): Mean the cancer is small and contained within the prostate, with a higher chance of being cured.
  • Stage 1: Small cancer on one side of the prostate, low PSA, grade group 1.
  • Stage 2A: Small cancer on one side with intermediate PSA, or affects both sides with low PSA; grade group 1.
  • Stage 2B: Cancer only in the prostate, possibly on both sides, intermediate PSA, grade group 2.
  • Stage 2C: Cancer only in the prostate, possibly on both sides, intermediate PSA, grade group 3 or 4.
• Higher stage numbers (3 and 4): Mean the cancer is larger or has spread, potentially making a cure less likely.
  • Stage 3A: Cancer only in the prostate, possibly on both sides, high PSA; includes grade groups 1 to 4.
  • Stage 3B: Cancer has grown beyond the prostate to nearby organs like seminal vesicles, bladder, or rectum; PSA can be low, intermediate, or high; includes grade groups 1 to 4.
  • Stage 3C: Any size prostate cancer with a grade group of 5; may have grown beyond the prostate but hasn't spread to distant sites.
  • Stage 4A: Cancer has spread to the lymph nodes.
  • Stage 4B: Cancer has spread to other parts of the body, such as the bones.