Prostate Cancer Detection and Diagnosis

Early detection is still one of our strongest tools in minimizing the effects of prostate cancer. When found in its earliest, most treatable stage, we can minimize its impact on nerve damage and other side effects from many of the common treatments. Beginning at age 50, the American Cancer Society recommends discussion take place for men at average risk and at age 40 for men at highest risk due to a significant family history of the disease. The decision to be screened should be made once the information about the uncertainties, risks and benefits of screenings have been discussed. If screening is right for you, two types of early detection screenings are:

Digital Rectal Exam (DRE): a physician inserts a gloved finger in the anus and feels the prostate for abnormalities

Prostate Specific Antigen (PSA) Test: a blood test that measures PSA levels

Diagnostic equipment and surgical procedures may help detect and diagnose prostate cancer:

Transrectal Ultrasound: a probe is inserted into your rectum to measure prostate volume and scan for tumor masses

Transrectal Ultrasound Guided Biopsy: a probe is inserted into your rectum where 8 to 12 small samples of prostate tissue may be taken for biopsy, which is a microscopic evaluation of potential cancer cells. A prostate biopsy is needed to confirm or rule out a diagnosis of prostate cancer.

Grading the Prostate Cancer

If cancerous cells are found, they are rated from one to five using the Gleason system. The Gleason system assigns the cells a grade based on how the patterns, sizes and shapes of the cells are different from healthy prostate cells.

  • If most of the cancerous tissue looks like normal prostate tissue, a lower grade of one is assigned.
  • If the cancerous cells lack the features of a normal prostate cell and demonstrate the highest prostate cancer cell type, a grade of five is assigned.
  • Grades two, three and four have features between those described above.

It is possible for prostate cancers to have different Gleason grades, so samples from multiple areas of your prostate are taken and graded using the Gleason system. Those two numbers are added together to determine the overall Gleason Score, between two and ten. The lower the number, the more the cancerous cells look like normal prostate cells. The higher the number, the less these cells look like normal cells.

The Gleason Score is used to indicate your prostate cancer's aggressiveness, which helps determine your appropriate treatment.