Prostate Cancer Diagnosis and Surgery

Approximately 1 in 6 men older than 50 years of age will develop prostate cancer. The ability to provide an early diagnosis of prostate cancer has drastically improved since the implementation of prostate cancer screening in the United States.

However, it is not clear whether there is actually a benefit to the early diagnosis of prostate cancer in all men. In fact, the United States Preventative Services Task Force (USPTF) guidelines discourage prostate cancer screening in men age 75 years and older because the data has yet to suggest any strong benefit.

Despite the controversy over prostate cancer screening, early detection of prostate cancer can provide tremendous benefits in terms of expanding the available treatment options at the time the diagnosis is made. The diagnosis of prostate cancer is suggested during cancer screening by elevated prostate specific antigen (PSA) levels in the blood. Additionally, prostate screening includes a digital rectal exam (DRE) to detect asymmetric enlargement or nodularity of the prostate. A high PSA and abnormal prostate on DRE can also occur with prostatitis and benign prostatic hyperplasia so further investigation is necessary to clarify the diagnosis. This is most commonly done using a transrectal guided ultrasound biopsy.

The exact cancer treatment options available to a man with prostate cancer depend upon specific information that is gathered through imaging tests and the evaluation of prostate tissue gathered on biopsy. The biopsied prostate tissue is examined under the microscope and the prostate cancer is given a grade, also called a Gleason score. The information from imaging modalities, whether ultrasound or CT scan, is used too. Imaging allows for the staging of the prostate cancer using the TNM system.

Once the prostate cancer has been staged and graded, the physicians know how early they have managed to detect the cancer. This information is invaluable in determining which treatment option will be the most effective at eradicating the cancer.

Treatment options for prostate cancer include the following:

1. Radical prostatectomy- This is the most commonly used surgical option. The prostate is dissected out. Many doctors believe that surgical excision of the prostate provides the best chance for a cure. Unfortunately, it is associated with a higher risk of side effects than the other treatment options listed below.

2. Cryotherapy- Destruction of cancerous prostate cells using extremely cold temperatures. Not commonly used, though research is showing that it may have a useful role in localized prostate cancer.

3. External beam radiation therapy (also called intensity-modulated radiation therapy)- Commonly used for localized or locally advanced prostate cancer.

4. Permanent prostate brachytherapy- Radioactive pellets are implanted in the prostate, killing prostate cancer over time.

5. Watchful waiting- Monitoring prostate cancer with regular PSA measurements and DRE or ultrasound is the best treatment option for some men. However, choosing this as the best option involves careful evaluation and discussion with the treating physician.

The early diagnosis of prostate cancer occurs much more commonly with the widespread use of PSA and DRE screening techniques. The importance of early detection lies in the ability to then treat effectively by selecting from a wider variety of treatment options.