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Prostate Cancer (cont.)

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What specialists treat prostate cancer?

There are several different types of specialists involved in the identification and treatment of prostate cancer.

  1. The primary provider (PCP) may be the initial medical doctor to become concerned about the risk of prostate cancer (because of abnormal rectal examination and/or elevated PSA) during your routine evaluations or due to symptoms and refer you to a urologist for further evaluation.
  2. Urologists are the specialists who will initially be involved in the diagnosis of prostate cancer and will perform the prostate biopsy. Depending on the grade and stage of the prostate cancer at the time of the diagnosis, additional specialists may be involved in your care. Urologists perform surgical based treatments for prostate cancer (radical prostatectomy), minimally invasive treatments (cryotherapy, brachytherapy), and prescribe medications (hormonal therapy).
  3. Medical oncologists are medical doctors who specialize in the treatment of cancer. Medical oncologists treat prostate cancer with a variety of medical therapies, including chemotherapy, immune/vaccine, and hormonal therapy.
  4. Radiation oncologists are specialists who treat cancer with ionizing radiation. This radiation may be given externally (external beam radiation therapy) or internally through the placement of small radioactive pellets into the prostate (brachytherapy).

What tests do health-care professionals use to diagnose prostate cancer?

The diagnosis of prostate cancer most commonly involves a combination of three tests:

Digital rectal examination (DRE): As part of a physical examination your doctor inserts a gloved and lubricated finger into your rectum and feels toward the front of your body. The prostate gland is a walnut or larger sized gland immediately in front of the rectum, and beneath your bladder. The back portion of prostate gland can be felt in this manner. Findings on this exam are compared to notes about the patient's prior digital rectal examinations.

The exam is usually brief, and most find it uncomfortable due to the pressure used to adequately examine the prostate gland. Findings such as abnormal size, lumps, or nodules, may indicate prostate cancer.

The national comprehensive cancer network (NCCN) notes that a DRE should not be used as a stand-alone test for detection of prostate cancer but should be performed in men with an elevated PSA. The NCCN also notes that DRE may be considered as a baseline test in all patients, as it may help identify high-grade cancers associated with a normal PSA.

Prostate specific antigen (PSA) blood test: The PSA blood test measures the level of a protein found in the blood that is produced by the prostate gland and helps keep semen in liquid form. The PSA test can indicate an increased likelihood of prostate cancer if the PSA is at an increased or elevated level, but it does not provide a definitive diagnosis. Prostate cancer can be found in patients with a low PSA level but this occurs less than 20% of the time.

If the PSA level is elevated (levels can depend upon your age, on the size of your prostate gland on examination, certain medications you may be taking, or recent sexual activity), further testing may be needed to rule out prostate cancer.

PSA measurements are often tracked over time to look for evidence of a change. The amount of time it takes for the PSA level to increase is referred to as PSA velocity. The time it takes for the PSA to double, known as the PSA doubling time, can be also tracked. PSA velocity and PSA doubling time can help your doctor determine whether prostate cancer may be present.

The presence of an abnormal result on digital rectal examination, or a new or progressive abnormality in a PSA test may lead to a referral to a surgeon who specializes in diseases of the urinary system (a urologist) who may perform further testing, such as a biopsy of the prostate gland.

Prostate biopsy: A biopsy refers to a procedure that involves taking of a sample of tissue from an area in the body. Prostate cancer is only definitively diagnosed by finding cancer cells on a biopsy sample taken from the prostate gland.

The urologist may have you stop medications such as blood thinners before the biopsy. An antibiotic is often prescribed to help prevent an infection related to the procedure. Some urologists may actually place a small swab into your rectum a week or so prior to the procedure to determine the best antibiotic to give you (selective target antibiotic prophylaxis). On the day of the biopsy, the doctor will apply a local anesthetic by injection or topically as a gel inside the rectum over the area of prostate gland. An ultrasound probe is then placed in the rectum. This device uses sound waves to take a picture of the prostate gland and helps guide the biopsy device. The device used is a spring-loaded needle that allows the urologist to remove tiny cores of tissue from the prostate gland. Usually, 12 cores are obtained, six from each side. Two cores are taken from the upper, middle, and lower portions of each side of the prostate gland. The cores are examined under the microscope by a pathologist (a doctor who specializes in examining tissues to make a diagnosis). Results may take several days.

A biopsy procedure is usually uncomplicated, with just some numbness, pain, or tenderness in the area for a short time afterward. Occasionally, a patient has some blood in the urine or the ejaculate after the procedure. Rarely, the patient may develop an infection after a biopsy procedure (urinary tract infection, prostate infection, testis infection) or be unable to urinate. If one develops a fever after the procedure, has continued blood in the urine or ejaculate, or has troubles urinating, further evaluation by the performing doctor is needed.

Medically Reviewed by a Doctor on 11/9/2016



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