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How is prostate cancer diagnosed or evaluated?
Prostate cancer is diagnosed through biopsy. Prostate cancer may be detected in the following ways:
- Prostate specific antigen (PSA). Measurement of prostate specific antigen (PSA)--a simple blood test--is useful in early prostate cancer detection.
- Digital rectal exam. During a digital rectal examination, a health professional inserts a lubricated, gloved finger of one hand into the rectum to palpate (feel) the prostate gland for any nodules or abnormalities.
- Transrectal ultrasonography with fine-needle aspiration. Transrectal ultrasound uses high-frequency sound waves from a probe placed in the rectum to make an image of the prostate gland on a video screen. Using transrectal ultrasound for guidance, a physician inserts a thin needle into the suspicious area and withdraws a small sample of tissue. The sample is then analyzed under a microscope to confirm the prostate cancer diagnosis.
- Other radiographic tests. A bone scan is useful to evaluate bone metastasis, which eventually develops in nearly 80% of prostate cancer patients. A CT scan and transrectal ultrasonography may be useful in selected patients to assess the extent of prostate cancer and high-resolution MRI can be used to detect small lymph node metastases.
- Staging and grading are used to describe how abnormal or aggressive the cancer cells appear. The stage and grade help to predict long-term results, response to treatment and survival.
- Stage A: confined to the prostate, no nodule palpable
- Stage B: palpable nodule confined to the gland
- Stage C: local extension
- Stage D: regional lymph nodes or distant metastases
The Gleason scale is the most common scale used for grading prostate cancer. The Gleason scale assigns prostate cancer cells a score from 1 to 10, by combining the two most common patterns of cells to give a total score. The scores are broken down into three main levels:
- Prognosis is generally good if score is less than 5.
- A score of 6 to 10 carries an intermediate prognosis.
- A score of more than 10 correlates with poor prognosis.
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