UNDERSTANDING THE PATH TO DIAGNOSIS
How prostate cancer is diagnosed. What you need to know.
PSA Test
Prostate-specific antigen (PSA) is a protein produced in the prostate gland and helps semen transport sperm. PSA is commonly found in semen, but a small amount can be found in the bloodstream. PSA test measures the amount of PSA in the bloodstream in nanograms per milliliter(ng/ml). High levels of PSA (≥4ng/ml) may indicate prostate cancer. However other conditions such as enlarged prostate or urinary tract infection, and old age can cause PSA levels to rise. An increase or decrease in PSA is not sufficient data to determine prostate cancer.
PSA doubling time measures the duration to double your PSA level. It can determine the level of activity or aggressiveness of the cancer. If your PSA level doubles in a short time (≤6 months for example), it suggests that the cancer is growing rapidly. If it takes longer to double (10 months or more), the cancer grows slowly and may not need a new treatment right away.
Digital Rectal Exam
DRE is the simplest procedure to check the size and texture of the prostate. The physician digitally examines the prostate through the rectum using a gloved and lubricated finger. As the prostate is in front of the rectum, the physician can detect any irregular or abnormal areas that could be a sign of a tumor. Since DRE doesn’t examine every part of the prostate, it is typically performed along with a PSA test and/or other imaging tests.
General Health Tests
Medical and Family History
Physicians will enquire about your previous treatments, health, habits, details of medications you are taking, any symptoms you have, and how your quality of life is affected. As some cancers can be genetically inherited, you will be queried about your family and the health problems they might have or had. Be ready to inform the team if any relative died from cancer.
Physical Exam
Your physician will check for signs of the disease by examining your lymph nodes in the groin, underarms, and neck for enlargement, etc.
Blood and Urine Tests
A sample of blood and urine is taken from the patient to be examined for the disease or other conditions. Higher levels of PSA may lead to additional tests to help decide if a biopsy is required. Some of the blood tests include 4Kscore, PHI and IsoPSA, etc. Urine tests required include SelectMDX, ExoDx, miR, MPS, and Sentinel.
Diagnosis and Biopsy
When prostate cancer is detected early it is nearly 100% survivable! To detect prostate cancer, a patient will be given a PSA test and DRE from their general practitioner or urologist. If a patient has an elevated PSA test result and/or an abnormal DRE the physician may recommend a biopsy of the prostate. To be diagnosed with prostate cancer a patient must have a biopsy of the prostate gland.
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Genetic Testing
Genetic testing helps in locating gene abnormalities. Genes are segments of DNA found in every cell. It contains the instructions necessary for producing proteins in cells to carry out important functions in the body. When a gene develops abnormalities(mutations), their function changes leads to producing the wrong protein or no protein. This can affect the cell and lead to diseases such as cancer. Mutations can be inherited(germline) or developed. The two types of genetic tests for prostate cancer include:
Germline Testing
A family history of cancer increases the risk of certain cancers and can be passed on to your children. This might lead to your physician’s request for a genetic germline test. The germline test helps assess your level of risk of inheriting cancer. This test looks for mutations in every cell of your body. Urine, blood or sputum is the sample used.
For prostate cancer changes in these genes are observed:
BRCA1, BRCA2, ATM, CHEK2, MLH1, MSH2, MSH6, PALB2, PMS2, etc. BRCA1 and BRCA2 are also related to breast, ovarian, and pancreatic cancer. Mutations in MSH2, MSH6, MLH1, and PMS2 are also associated with colorectal and uterine cancers.
Germline testing is recommended for prostate cancer patients and the following:
- A family history of cancer
- High-risk or advanced prostate cancer despite family history
- Ashkenazi Jewish ancestry
- Having any type of cancer
Molecular Biomarker Testing
A biomarker is anything that can be measured in your body to assess your health. Biomarker testing is considered for those with localized, regional or advanced prostate cancer. A sample from the biopsy is examined to look at its molecular composition. This determines the level of risk and the ability of the cancer to spread. Biomarker test enables the care team to plan your treatment options and know how your body is responding to prostate cancer treatment.