Detecting and Measuring
Detecting prostate cancer
To determine if a man is at risk for prostate cancer, doctors use a simple blood test called a Prostate Specific Antigen (PSA) test. This can be performed right in a physician’s office. For most men, annual PSA testing combined with a digital rectal exam (DRE) should begin at age 50. However, African-American men and men with a family history of prostate cancer should begin getting tested at age 40.
PSA is an enzyme that is produced only by prostate cells, either normal or cancerous, and secreted into the seminal fluid to keep it liquefied. A small amount of PSA is leaked into the bloodstream by prostate cells, which allows it to be measured. When a prostate cell is cancerous, it leaks more PSA into the bloodstream. On average, one cancerous prostate cell will produce 10 times more PSA than a healthy cell. When cancerous cells multiply, this causes a man’s PSA level to rise.
The triggers that define prostate cancer
PSA is measured through nanograms per milliliter of blood (ng/ml). Abnormal PSA levels are defined as:
- Higher than 4.0 ng/ml for men over age 60
- Higher than 2.4 ng/ml for men 60 and under
Learn more from Dr. Critz or download RCOG’s educational brochure.
The higher the PSA normally means that more cancer is present. But there are some prostate cancers that do not produce a high level of PSA and can fool doctors. The best way to determine the amount of cancer in a patient is with a biopsy. (See Table 2 from the Q&A section.)
A prostate biopsy is performed by a urologist, who uses tiny needles to remove the suspected cancerous cells from the prostate. This is where the expertise of the urologist can make a difference. The urologist must get a tissue sample from many different areas of the prostate to fully evaluate the cancer (See Figure 1 from the Q&A section.)
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‘Grading’ prostate cancer
After the biopsy is performed, a pathologist examines the tissue taken from the prostate. If cancer is detected, the pathologist assigns a score between two and 10, called a Gleason score. The more aggressive the cancer, the higher the number will be. (Table 5 refers to Question 17 in the Q&A section regarding cancer cell growth and Gleason score 6.)
The power of a second opinion
Not all pathologists are experienced in examining prostate biopsies. That’s why RCOG has one of its expert consulting pathologists give each one of our patients a second opinion. Why? Because we get more information from the Second Opinion Pathology Reports. For instance, most pathology reports do not include information about perineural invasion, the percentage pf grades 4 or 5 in each needle core, or the percentage of cancer in each needle. Additionally, in 25% of cases, RCOG’s pathologist changes and updates the Gleason score.
Locating the cancer
Finding the cancer within the prostate is determined by what’s called cancer stage. All doctors use the same method, which is the digital rectal exam (DRE).
Staging the cancer is actually the least reliable of all the measurements used to determine the extent of prostate cancer. Men diagnosed with stage T1 or T2 cancer will often actually have stage T3 cancer. This is because cancerous cells can leak outside the prostate, as these cells are often located near the wall of the prostate. Known as microscopic capsule penetration, the cancerous cells can destroy the capsule, leak out and spread to other nearby areas, such as the rectum or bladder. Microscopic capsule penetration cannot be detected by a DRE. Other tests, such as MRI scans or color Doppler ultrasound scans, are also unreliable for detection of cancer leakage. We are telling you this not to frighten you, but because one of the most important things you should learn is that before any type of prostate cancer treatment, it’s impossible to know just how extensive the cancer is in any individual. (See Table 5 from the Q&A section.)
Defining cure
You should always have a clear understanding of how a “cure” is defined and how it applies to you after your treatment. After a patient undergoes treatment, he should no longer have any prostate cells in his body to make PSA. Therefore, his PSA should fall to an undetectable level—PSA 0.2 ng/ml. RCOG only considers a man to be cured of prostate cancer when he has a PSA 0.2 ng/ml or lower, and remains at that level for 10 years and longer. We use 10 years as a benchmark because, in the vast number of cases, if prostate cancer is going to grow back, it will do so within 10 years. This is how RCOG calculates its overall cure rate, which is based on more than 12,000 men, and has the highest proven cure rate of any prostate cancer treatment available today, using the strictest definitions of cure – 83% for early, intermediate and advanced cancers. (88% for early and intermediate prostate cancers.)
Demand this same standard for cure
If you have been newly diagnosed with prostate cancer, your goal should be to cure this disease, not just treat it. So as you talk to different doctors, it’s important that you ask how many patients they have cured. Find out how many of their patients have a PSA 0.2 ng/ml after 10 years. RCOG knows it has set a tough standard, and you shouldn’t be afraid to ask for anything less. The course of treatment is your decision and you have a right to know a doctor’s track record.
Learn how RCOG cures prostate cancer.
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Get answers to all of your questions regarding prostate cancer, and speak to a physician to help evaluate your personal situation.
Read the stories of survivors of Prostate Cancer.
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