Diagnosing or screening for prostate cancer among men, means looking for cancer before it causes symptoms. The reason for screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.

Although at the moment there are no standard tests to screen for prostate cancer; yet two tests are commonly used to screen for prostate cancer, and they include:

1. Prostate Specific Antigen (PSA) Test

A prostate specific antigen (PSA) test is used to measure the level of PSA in the blood. The PSA is a type of protein released by prostate tissue that is a man's blood, i.e. a blood sample is drawn from a vein in the arm and analyzed for PSA. It's normal for a small amount of PSA to be in your bloodstream. However, if a higher than normal level is found, it may indicate prostate infection, inflammation, enlargement or cancer.

PSA levels also can be affected by:

• Certain medical procedures
• Certain medications
• An enlarged prostate
• A prostate infection

2. Digital Rectal Examination (DRE)

Digital rectal examination (DRE) inserts a gloved, lubricated finger into a man’s rectum, which is adjacent to the rectum to feel the prostate for any abnormalities in the shape or size of the gland; and therefore prescribing further tests.

Though the PSA test and DRE test helps to detect prostate cancer in its earliest stage, yet the reliability of such test is still under much debate.

When a digital rectal exam (DRE) or a PSA test reveals abnormal results, the next step is further testing to determine whether prostate cancer is present. Here, a medical scientist is expected to recommend some diagnostic tests for further examination if an individual is experiencing any form of symptoms. The most common diagnostic tests for the prostate include:

3. Imaging Tests

This is the use of x-rays, sound waves / radioactive substances and magnetic fields to create images of the internal part of the man’s body. This is done to look for cancer in the prostate; help the doctor see the prostate during prostate biopsy or other types of prostate cancer treatment; or probably check if the prostate cancer hasn’t spread to other parts of the man’s body.

The common types of imaging tests devices used include:

• Transrectal Ultrasound (TRUS): Whenever a patient complains of severe symptoms relating to prostate cancer, the doctor can use the transrectal ultrasound to further evaluate the prostate. Here, a small ultrasound probe is inserted into the rectum; thus making sound waves that create a picture of the prostate gland, showing the extent of prostate enlargement or abnormalities.
• Magnetic Resonance Imaging (MRI): Magnetic resonance imaging (MRI) is sometimes used to create a more detailed set of images than an ultrasound can provide It creates a detailed images of soft tissues in the body using radio waves and strong magnets. It gives medical practitioners a very clear picture of the prostate and nearby areas. A contrast material called gadolinium may be injected into a vein before the scan to better see details.
• Bone Scan: Whenever prostate cancer spreads to distant parts of the body, it often goes to the bones first. A bone scan can help show if cancer has reached the bones.

Here, an individual is injected with a small amount of low-level radioactive material, which settles in damaged areas of bone throughout the body. A special camera detects the radioactivity and creates a picture of your skeleton.

A bone scan might suggest cancer in the bone, but to make an accurate diagnosis, other tests such as plain x-rays, CT or MRI scans, or even a bone biopsy might be needed.

• Computed Tomography (CT) Scan: A CT scan uses x-rays to make detailed, cross-sectional images of the body. This test isn’t often needed for newly diagnosed prostate cancer if the cancer is likely to be confined to the prostate based on other findings (DRE result, PSA level, and Gleason score). Still, it can sometimes help tell if prostate cancer has spread into nearby lymph nodes. If the prostate cancer has resurfaced after treatment, the CT scan can often tell if it is growing into other organs or structures in the pelvis.
• Positron Emission Tomography (PET) or PET-CT Scan:A PET scan is usually combined with a CT scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into the patient’s body. This substance is taken up by cells that use the most energy, due to the fact that cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

4. Biopsy

A biopsy is a procedure that can be used to diagnose prostate cancer. This is when a small piece of tissue is removed from the prostate and looked at under a microscope to see if there are cancer cells. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. This is because the specimens for biopsy are usually taken from several areas of the prostate (this is done to ensure that a better sample is taken for proper examination).

A biopsy is the main tool for diagnosing prostate cancer, but a doctor can use other tools to help make sure the biopsy is made in the right place, and these could include:

• TRUS - Guided Biopsy (Transrectal Ultrasound – Guided Biopsy): Using this type of biopsy, an ultrasound probe is placed in the rectum to allow visualization of the prostate. Then at least 12 needles are placed into the prostate to take samples that are examined for abnormal cells. In case a patient had had a magnetic resonance imaging (MRI) before the biopsy, the MRI images may help target areas that looked suspicious. This procedure can sometimes be painful or make the patient uncomfortable, so patients are given anesthetics to numb the area and minimize any discomfort while asleep. Yet, this procedure could lead to complications including infections or bleeding.
• Transperineal Biopsy: In this procedure, samples are gotten by placing a needle into the prostate through the perineum, i.e. the skin between the scrotum and anus. It’s done under a general anesthetics, and has a huge advantage of a reduce complication than transrectal biopsy.

When a biopsy confirms the presence of cancer, the next step is to determine the level of aggressiveness (grade) of the cancer cells. A laboratory pathologist examines a sample of cancer to determine how much cancer cells differ from the healthy cells. A higher grade indicates a more aggressive cancer that is more likely to spread quickly.

The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Gleason scoring combines two numbers and can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer), though the lower part of the range isn't used as often.

Most Gleason scores used to assess prostate biopsy samples range from 6 to 10. A score of 6 indicates a low-grade prostate cancer. A score of 7 indicates a medium-grade prostate cancer. Scores from 8 to 10 indicate high-grade cancers.

[Next Week: How To Treat Prostate Cancer]