There are no standard or routine screening tests for prostate cancer. Studies are being done to find ways to make prostate-specific antigen (PSA) testing more accurate for early cancer detection. A PSA test or digital rectal exam (DRE) may be able to detect prostate cancer at an early stage:
- DRE: It is an exam of the rectum (end part of the bowel). The doctor inserts a lubricated, gloved finger into the lower part of the rectum to feel the prostate for lumps or anything else that seems unusual.
- PSA test: It is a test that measures the level of PSA in the blood. PSA is a substance made mostly by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. The PSA level may also be high in men who have an infection or inflammation of the prostate or benign prostatic hyperplasia (an enlarged, but non-cancerous, prostate). A free PSA is a more precise marker for those who are at a high-risk case.
- Prostate cancer gene 3 (PCA3) RNA test: If a man has a high PSA level, a biopsy of the prostate does not show cancer, and the PSA level remains high after the biopsy, a PCA3 RNA test may be done. This test measures the amount of PCA3 RNA in the urine after a DRE. If the PCA3 RNA level is higher than normal, another biopsy may help diagnose prostate cancer.
- Prostate health index (PHI): This measures three different forms of the PSA protein to detect any prostate abnormalities including cancer.
- Magnetic resonance imaging (MRI) scan: An MRI scan uses a powerful magnet and radio waves to build up detailed pictures of the inside of the body. The doctor may suggest this scan to help work out if a biopsy is needed. An MRI can be used to show whether cancer has spread from the prostate to nearby areas. It can also help guide the biopsy needle. A specialized type of MRI called multi-parametric magnetic resonance imaging (mpMRI) is used for people suspected of having prostate cancer. This combines the results of three MRI images to provide a more detailed image.
What are the causes of prostate cancer?
The exact cause of prostate cancer is still unknown. Current risk factors for prostate cancer include:
- Age: The risk of prostate cancer increases with age.
- Race: African American men are more than twice as likely to be diagnosed with prostate cancer and to die from the disease.
- Family history: Men with a family history of prostate, breast, ovarian, colon, or pancreatic cancers may be at an increased risk of prostate cancer.
- Genetic mutations: Inherited mutations of BRCA1 or BRCA2 genes increase the risk of breast, ovarian, and prostate cancer in some families.
- Diet: Studies have indicated that there may be a link between a high-fat diet and the cause or prevention of prostate cancer.
- Chemical exposure: Exposure to certain chemicals such as pesticides and herbicides may have higher than average rates of prostate cancer. Veterans who were exposed to the defoliate Agent Orange are 49% more likely than non-exposed veterans to be diagnosed with prostate cancer.
- Firefighter: Recent studies have reported that firefighters are at a 28% higher risk to prostate cancer than the general population.
How is prostate cancer treated?
Not all prostate cancer requires treatment. Depending on the level of risk and stage of the disease, there are many different approaches to treating prostate cancer. Common approaches include:
- Active surveillance: This is often recommended for patients with low-grade prostate cancer. Prostate cancer can take a long time to grow. Active surveillance uses the latest imaging technologies to watch it and make sure it is not progressing.
- Surgical treatment options: Surgeons continually integrate innovative approaches into their practice to offer patients safer and more effective treatments. Minimally invasive surgical treatments include laparoscopic surgery and robotic-assisted surgery. Patients may also undergo removal of the prostate through more conventional surgery.
- Brachytherapy (radioactive seed implantation): In this treatment, radioactive seeds are implanted permanently in the prostate to give off radiation and provide localized treatment to the tumor.
- Intensity-modulated radiation therapy (IMRT): By targeting intense radiation on prostate tumors, urologists can minimize or even destroy them completely.
- Surgery, radiation, and hormonal therapy: These approaches can cause erectile dysfunction and other complications related to sexual health. However, within two years most men regain their potency and return to the sex life that they had before treatment.
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Marks LS, Bostwick DG. Prostate Cancer Specificity of PCA3 Gene Testing: Examples from Clinical Practice. Rev Urol. 2008;10(3):175-181. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556484/