1. Prostate Cancer Slideshow Pictures
2. Medical Illustrations of the Prostate Image Collection
3. Screening Tests Every Man Needs Slideshow Pictures

Medical Author:

Kevin C. Zorn, MD, FRCSC, FACS

Kevin C. Zorn, MD, FRCSC, FACS

Dr. Kevin Zorn is a dual-board-certified (US and Canada), minimally-invasive uro-oncology, fellowship trained urologist at the University of Chicago. His main focus of clinical and scientific interest is in the surgical treatment of renal and prostate cancer. He is also an expert in performing surgery with the DaVinci Surgical Robotic System to manage localized prostate cancer and small renal masses. Dr. Zorn studied medicine and urology at McGill University in Montréal.

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Coauthor:

Pierre-Alain Hueber, MD, PhD

Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical interview and physical examination:

A proper medical interview and physical examination are essential in the diagnostic workup of any man in whom prostate cancer is suspected. He may be referred to a physician who specializes in urinary tract diseases (a urologist) or in urinary tract cancers (a urologic oncologist). A man will be asked questions about his medical and surgical history, lifestyle and habits, and any medications he takes. Risk factors including family history of prostate cancer will be assessed (see prostate cancer risk factors).

Digital rectal examination (DRE) is part of the physical examination: All men with firm swelling, asymmetry, or palpable nodularity of the prostate gland require further diagnostic studies to rule out prostate cancer, particularly if they are over the age of 45 or have other risk factors for the disease (see risk factors of prostate cancer).

Because urological symptoms (see prostate cancer symptoms) can indicate a variety of conditions, a man may undergo further testing to pinpoint their cause. Initial screening tests include blood testing for PSA and urine testing for blood or signs of infection.

Prostate specific antigen (PSA):

PSA is an enzyme produced by both normal and abnormal prostate tissues. It may be elevated in noncancerous conditions, such as prostatitis (inflammation of the prostate) and benign prostatic hypertrophy (noncancerous enlargement of the prostate), as well as in cancer of the prostate. Therefore, confirmation of an elevated serum PSA is advisable prior to proceeding to prostate biopsy.

PSA values over time may also be more helpful for monitoring recurrence of cancer and the response to treatment than in diagnosing a previously unknown cancer.

The following standards have been set for PSA levels:

• Less than 4 ng/mL: Normal value. The management of men with lower PSA elevations (<4 ng/mL) is less clear since most will have negative biopsies. However, a substantial number of men with prostate cancer do have a serum PSA concentration less than 4 ng/mL.
• 4 to 10 ng/mL: Prostate biopsy is usually recommended for men with a total serum PSA between 4 to 10 ng/mL, regardless of the digital rectal examination findings, in order to increase the chances of diagnosing disease while it is organ-confined. In men with PSA in this range, approximately one in five biopsies will reveal cancer.
• Greater than 10 ng/mL: Prostate biopsy is strongly recommended. Although the chance of finding prostate cancer is over 50 percent, benign prostatic disease does produce a marked increase in serum PSA in some men.
• Less than 0.2 ng/mL: After the prostate is surgically removed.

Traditionally, a PSA of 4 ng/mL has been used as a cutoff value for deciding for or against doing a prostate biopsy. However, some experts now recommend lowering that to 2.5 ng/mL and performing the biopsy in men who have levels in excess of this threshold. The American Urological Association guidelines (2009) do not define a definite cutoff point but advise that all the other risk factors for prostate cancer be taken into account while making a decision on whether to proceed for a biopsy. One of the important factors that needs to be considered is the rate at which the PSA value has increased over time on repeated measurements (referred to as the PSA velocity).

Based upon the symptoms, physical examination, DRE and PSA level, further blood tests may include:

• Complete blood cell count (CBC): The relative amounts of different blood cells are checked. Anemia is a common sequel to cancers, as are certain other blood irregularities.
• Hepatic transaminases: These are enzymes produced in the liver. They are called alanine aminotransferase (ALT) and aspartate aminotransferase (AST). In known prostate cancer, these levels are usually elevated when the cancer has spread to the liver. However, levels of these enzymes can be abnormally high in a number of different conditions that have nothing to do with cancer.
• Alkaline phosphatase: This enzyme is found in the liver and in bone. It is a sensitive indicator of both liver and bone cancer.
• BUN and creatinine: These measures are used to assess how well the kidneys are working. Levels can be elevated in a number of conditions (such as kidney failure) and may suggest an obstruction.

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