Diagnosis

After more than 30 years of studies and trials and hundreds of millions of dollars, it has been proven that early detection is the only contributing factor for better cancer control and improved survival. Early detection and early intervention of progressive prostate cancer may help to decrease the 40,000 prostate cancer-related deaths each year.

Shape

The Process

PSA screening

All men 50 years or older should have a PSA test (blood test), an annual rectal exam and, if necessary, a transrectal ultrasound (TRUS). Men between the ages of 40 and 49 should have a PSA screening if an immediate family member has prostate cancer or if they are African American.

early intervention

Early detection and early intervention of progressive prostate cancer may help to decrease the 40,000 prostate cancer-related deaths each year. The updated American Cancer Society’s recommendations for prostate cancer detection in asymptomatic men are that annual PSA and DRE (digital rectal examination) should be offered to men aged 50 or older who have at least a 10-year life expectancy, and to younger men at higher risk, such as African-American men or men with a strong familiar predisposition to prostate cancer (two or more affected first-degree relatives, e.g., father, brother). Patients Should Be Given Information Regarding The Potential Risks And Benefits Of Intervention.

recommendations

It is our recommendation that a patient should proceed to a transrectal ultrasound if the PSA level is more than 2.5 ng/ml or the digital rectal examination is abnormal, regardless of the PSA level. For high risk men, an ultrasound examination is recommended if their PSA level is over 2.0 mg/ml.

Shape

We Are Here To Help You With Any Questions You May Have

Over the past several years, increases in the reported incidence of prostate cancer have been disproportionate to the changes in the population demographics.The main reason for this rapid rise may be the easy access to PSA (blood test)and subsequent ultrasound guided biopsies (random biopsy).

Mass screening efforts present a dilemma for the patients and the clinicians. Although saving many lives, screenings also pick up so called “latent” or“insignificant” tumors that may not need any treatment.

It is reported that 15 to 20 percent of patients who have a radical prostatectomy may have been exposed to unnecessary surgery and related post-surgical complications. Screenings are justifiable and treatments are usually effective when either slow-growing progressive cancers (which will become symptomatic and can kill) or rapidly progressing (very malignant cancers that are likely to kill) are detected. Unfortunately, it is difficult to predict how a prostate cancer will progress. The individual patient and his physician must weigh the possibly deleterious effects of screening against the possible benefits.

For these two reasons, an accurate diagnosis is of utmost importance. The key to an accurate diagnosis with the highest chance of survival is early detection.

Early prostate cancer usually produces no symptoms and is discovered during a routine physical examination either by a positive digital rectum exam or an elevated PSA level which may lead to a biopsy. Once symptoms appear, they often resemble those of benign prostatic hyperplasia (BPH). This can be dangerous, because non-cancerous enlargement of the prostate is common in men over 40, and difficulty with urination may be attributed to aging rather than disease.

Men experiencing the symptoms of BPH should see their physician immediately for a thorough examination.

Signs and symptoms for prostate cancer include the following:

  • Blood in the urine or semen
  • Frequent urination, especially at night
  • Inability to urinate
  • Nagging pain or stiffness in the back, hips, upper thighs or pelvis
  • Pain during ejaculation
  • Pain or burning during urination
  • Weak or interrupted urinary flow

Considered a minimally invasive procedure, a biopsy is the removal of a sample of tissue for the purpose of diagnosis. A biopsy is necessary because areas of inflammation or infection will often appear very similar to areas of cancer, and it is essential to absolutely rule out any possibility of cancer.

If a biopsy is performed, it will be a directed biopsy with tissue samples taken specifically from the noted abnormal areas. There is no predetermined number of tissue samples taken as each biopsy is a result of the individual findings on the ultrasound examination. However, Dr. Bahn’s experience coupled with the state-of-the-art technology used by the Institute, ensures that the tissue samples taken will be extremely accurate and be as few as possible.

Diagnostic accuracy is highly dependent on the skill and experience of the physician as well as the quality of equipment. Underestimation of the disease is the single-most common cause of selecting the wrong treatment option and as a result, leads to treatment failures. In previous studies, we reviewed 140 men with a known cancer diagnosis based on biopsies performed at other institutions that stated the cancer was confined within the prostate. All of the subjects had staging biopsies repeated by our staff. The result showed close to 30 percent of these men had cancer that was already outside of the prostate. In these cases, it was necessary to reconsider the treatment options and overall cancer management. Because of this, our mission continues to be the most accurate diagnosis possible.

Results of the biopsy are normally obtained within five to seven days. Dr. Bahn will personally call patients with results as soon as he receives them.

What is a Transrectal Ultrasound (TRUS)?

A transrectal ultrasound (TRUS) is a non-invasive procedure in which a probe is inserted into the rectum in order to take a “picture” of the prostate. Careful ultrasound evaluations, including black and white and color Doppler imaging, are important in identifying the size and the location of a tumor.

Many physicians use only black and white imaging. Dr. Bahn, however, uses both black and white and color Doppler ultrasounds including power Doppler and tissue harmonic technology. The Institute’s state-of-the-art ultrasound allows Dr. Bahn to precisely determine the prostate’s size. This measurement is then used to calculate the predicted PSA level based on the size of the prostate. This is then used to determine if that individual PSA is abnormal for that particular patient.

In addition to more precise measurements of the prostate, the color Doppler imaging technology can more accurately detect subtle abnormalities in the prostate by looking at the blood flow patterns. Prostate disease often results in an increase in blood flow to the affected area, which the color imagining was made for reading.

If no abnormal areas are detected and particularly if the elevated PSA level can be explained by the size of the prostate, a biopsy may not be required. If such is the case, we may not rush to biopsy in order to make a diagnosis. Watchful waiting, with periodic PSA testing, may be adequate. However, if the serum PSA level is higher than the predicted level or if areas of abnormality are found, the patient may be at a risk of having a significant tumor. In these cases, a biopsy would be recommended.

What Is A PSA Test?

The PSA test is a simple blood test that can detect prostate cancer five to ten years before it becomes clinically evident.

The Institute recommends for men to keep track of their PSA level, as any one reading is not as significant as the “trend over time.” We believe there isn’t a “normal” PSA level, as the number may change due to a number of factors. One of the biggest influencing factors is age because the prostate grows as men mature, which, in turn, creates a higher PSA level.

For an accurate PSA reading, men should avoid:

  • Sexual activity 48 hours prior to taking a test.
  • Excessive bike riding or lengthy car rides.
  • Finally, never take a PSA test for two weeks after a digital rectal exam, or six to eight weeks after a TRUS or a biopsy. Any procedures dealing with the prostate—whether non-invasive or minimally invasive—will increase PSA levels.

Patients should have a TRUS done if the PSA level is more than 2.5 ng/ml or the digital rectal examination is abnormal, regardless of the PSA level. For high risk men, a TRUS examination is recommended if their PSA level is over 2.0 ng/ml.

Men with a family history of prostate cancer are considered to be at high risk. Research suggests that high dietary fat is also a prominent risk factor. There may be a hereditary factor, but no gene has been identified.

Other possible risk factors include the following:

  • Age (96 percent of cases occur in men over 55)
  • Exposure to heavy metals (e.g., cadmium)
  • Infectious agents
  • Low exposure to ultraviolet light
  • Race (African American men have the highest rate)
  • Smoking
  • Farmers (probably due to pesticide use)
  • Airline pilots
  • Vietnam veteran

Early prostate cancer usually produces no symptoms and is discovered during a routine physical examination either by a positive digital rectum exam or an elevated PSA level which may lead to a biopsy. Once symptoms appear, they often resemble those of benign prostatic hyperplasia (BPH). This can be dangerous, because non-cancerous enlargement of the prostate is common in men over 40, and difficulty with urination may be attributed to aging rather than disease.

Men experiencing the symptoms of BPH should see their physician immediately for a thorough examination.

Signs and symptoms for prostate cancer include the following:

  • Blood in the urine or semen
  • Frequent urination, especially at night
  • Inability to urinate
  • Nagging pain or stiffness in the back, hips, upper thighs or pelvis
  • Pain during ejaculation
  • Pain or burning during urination
  • Weak or interrupted urinary flow