Introduction:
Prostate cancer is a disease of the prostate gland, a part of the reproductive system in the male population. Prostate cancer grows slowly, usually stays in the gland, and does not require treatment. However, when cancer grows faster and spreads, treatment is required, involving surgery and radiation. Prostate cancer is a serious condition, and its early diagnosis is an important criterion in managing this condition.
What Is the Prostate?
The prostate gland and seminal vesicles are part of the male reproductive system. The prostate gland is very small, almost the size of a walnut. The seminal vesicles are present on the back of the prostate. The prostate is present below the bladder and in front of the rectum, and it surrounds a small tube called the urethra that helps in carrying the urine from the bladder to excrete it through the penis.
The primary function of the prostate and seminal vesicles is to make fluid for semen. During ejaculation, the sperm moves out to the urethra, and at the same time, the fluid made from the prostate and seminal vesicles also moves into the urethra. Then this mixture of semen goes through the urethra and gets out of the penis during ejaculation.
What Is Prostate Cancer?
Cancer is caused by the abnormal growth of cells, which affects the normal function of body cells and makes the functioning of the body harder. Prostate cancer develops when abnormal or cancerous cells form and grow in the prostate gland; these growths can be malignant (cancerous) or benign (non-cancerous) in nature. The cancerous growth from the prostate gland can metastasize or spread to other body organs and tissues, such as the bladder or rectum. This can be life-threatening if cancer spreads to other parts of the body.
The benign growths are not life-threatening, and they stay localized at one location and do not spread to other parts of the body. These benign growths can be easily removed, and they may or may not grow back in some cases.
What Are the Stages of Prostate Cancer?
Prostate cancer usually stays localized in one location, and if the tumor or cancer progresses to other body parts, it is called advanced prostate cancer. Therefore, prostate cancer is often grouped into four stages -
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Early Stage (Stage I and II) - The tumor is localized in the prostate.
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Locally Advanced (Stage III) - In this stage, the tumor has advanced to the outside of the prostate but only to nearby tissues and is often called locally advanced prostate cancer.
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Advanced (Stage IV) - Cancer metastases to the other parts of the body, such as bones, liver, lymph nodes, and lungs, and this stage is termed advanced prostate cancer.
What Are the Various Ways of Diagnosing Prostate Cancer?
There are various tests used for diagnosing prostate cancer, and not every test is required to make the diagnosis, which can vary from person to person. Some of the following factors may help in choosing the diagnostic tests: -
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Type of cancer.
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Signs and symptoms.
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Age and overall health.
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Results of earlier medical tests.
Early Tests -
In the initial stage, if prostate cancer is detected, a physical examination and some of the following tests may be done which include -
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Prostate-Specific Antigen (PSA) Test - PSA is a protein released by the prostate gland that is present in higher levels in the blood. Therefore, levels of PSA can be raised in situations like cancer, benign prostatic hypertrophy (BPH), or inflammation of the prostate.
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Digital Rectal Exam (DRE) - This method is used to find abnormal parts of the prostate by feeling the area using a finger. This method is not that precise and requires experience to perform this and is not considered the best method for the detection of prostate cancer.
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Biomarker Tests - This method is used to detect the biomarkers that are present in the blood, urine, or body tissues of a person with cancer. It is also called a tumor marker and is made by the tumor or by the body in response to cancer.
Advanced Imaging Tests for Prostate Cancer
Imaging tests for the prostate are not always required. However, for patients with advanced prostate cancer, one of the following imaging tests is done to provide more information about the disease and make a treatment plan.
MRI (Magnetic Resonance Imaging)
MRI scans use magnetic fields instead of X-ray radiation to create images of soft tissues. This gives a very clear picture of the prostate and nearby areas. A contrast material called Gadolinium can be injected into the body to see the image with more detail.
Uses of MRI
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In the case of prostate biopsy, the MRI can help in locating and targeting the areas that have a high chance of having cancer cells. Moreover, it helps guide the needles into the prostate during the prostate biopsy.
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In case prostate cancer is found, the MRI can help in determining the stage of cancer. The MRI scans can show if cancer has spread to other locations outside the prostate. To improve the accuracy of MRI, an endorectal coil may be placed in the rectum.
Transrectal Ultrasound (TRUS)
In this test, a small probe about the width of a finger is lubricated and inserted in the rectum. The sound waves are produced by this probe and create echoes; these echoes are picked by the probe, and the black and white images of the soft tissue are received on the computer screen. This procedure usually takes 15 to 30 minutes and is commonly done in the doctor’s office.
Uses of TRUS
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It is often used when a person has abnormal DRE (digital rectal exam) or PSA (prostate-specific antigen) test results.
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It can be used during prostate biopsy to guide the needles in the correct direction for the collection of samples.
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It can also be used as a guide in different treatments, such as brachytherapy (internal radiation therapy) or cryotherapy.
Computed Tomography (CT or CAT) Scan - CT scan uses X-rays to take detailed pictures of the inside of the body. Multiple pictures are taken from different angles during this procedure and are combined into a detailed three-dimensional image that shows any abnormality or tumor present in the body. It helps in measuring the tumor size, and sometimes, a special dye called a contrast medium is given before the scan to get a detailed image.
Positron Emission Tomography (PET) or PET-CT Scan - A PET scan can be combined with a CT scan, which helps in creating pictures of organs and tissues inside the body. In this scan, a small amount of radioactive material is injected into the body, and a scanner detects this substance to produce the images inside of the body. Unfortunately, this type of PET scan is not very helpful in finding prostate cancer cells in the body. Various new materials or tracers are being used nowadays, which include fluciclovine F18, sodium fluoride F18, and choline C11, to be better at detecting prostate cancer cells.
Whole-body Bone Scan - A bone scan uses a radioactive tracer such as Technetium-99 to detect the spread of cancer in the body. Prostate cancer usually spreads to the bone first, and a bone scan may help in detecting the cancer cells. For this test, a tracer is injected into the patient’s vein, and it gets collected in the area of bone where metabolic activity has occurred. The healthy bones appear lighter to the camera, and areas of injury appear darker and stand out in the image. This test might suggest cancer in the bone; however, additional tests have to be carried out as they may show bone injury, such as fractures or abnormal structural changes in the bone.
Genetic Testing - Some doctors nowadays may also recommend genetic testing in patients with prostate cancer to look for any inherited gene changes. It is used in patients with a family history of BRCA gene mutation or Lynch syndrome, as well as in patients with a high risk of prostate cancer and where cancer has spread to other parts of the body.
After these diagnostic tests, the doctor will review the results to determine if it is cancer. Moreover, the results can also help the doctor describe the type and stage of cancer, and a treatment plan will be formulated to control cancer.
Conclusion:
With the early diagnosis and treatment of prostate cancer, it can be easily managed. Patients with localized or benign prostate cancer can lead a healthy life without any complications or treatment. These various diagnostic methods can help in checking the spread and size of cancer cells. Based on the results of these tests, the healthcare professional will create a treatment plan to control cancer.
