Diagnosing Prostate Cancer

The prostate gland is a part of the male genitourinary system and its primary function is to produce the fluid required for semen production in males. The prostate gland lies beneath the urinary bladder. A tube called the urethra transports the urine from the bladder, all the way through the penis and helps excrete the urine. This tube passes through the prostate gland.

A normal prostate doesn’t block the urinary outflow. An enlarged prostate, however, compresses the bladder and the urethra and obstructs the passage of urine. An enlarged prostate can occur both is Benign Prostatic Hyperplasia (BPH) and in prostate cancer.

Benign Prostatic Hyperplasia (BPH) is a condition highly prevalent among older males. As its name suggests, it is benign; meaning it is not a cancerous condition. BPH does not lead to cancer, but it could co-exist with cancer or mask the presence of cancer. Since the signs and symptoms of Benign Prostate Hyperplasia are not too different and it is important to know the distinctions.

About one-third of men experience moderate symptoms of BPH by 60 years of age, in females, the urethra is much shorter and the route is straightforward in comparison. Since the genitourinary anatomy of females is vastly different, this condition doesn’t exist in females.

Prostate cancer is often diagnosed incidentally when undergoing a scan for a completely different reason or during regular health checkups. It does not produce specific symptoms initially. Aside from bladder outflow obstruction, other ways this cancer could present include lower urinary tract symptoms such as urinary urgency, inability to control the urge to urinate, difficulty in initiating urination, intermittent pauses while urinating, poor stream, dribbling, sense of incomplete evacuation of the bladder and increased frequency, especially at night. In advanced prostate cancer that may have metastasized, bone pain could be a feature due to secondary tumours in the bones.

A biopsy is the most definitive way to diagnose prostate cancer. Tissue samples are removed from the gland and studied to determine the presence of malignancy. An enzyme called Prostate Specific Antigen (PSA) is produced by the prostate gland, and this enzyme can be used for screening. A PSA value of less than 4ng/mL is considered normal and a value of 10ng/mL or more is suggestive of prostate cancer. Those who have a PSA value between 4 and 10, fall under a diagnostic grey area where the possibility of cancer cannot be eliminated, nor can the patient be reassured that he doesn’t have cancer. DRE or Digital Rectal Examination is done to physically assess the prostate gland. A firm and smooth prostate gland on DRE is indicative of BPH while an irregular or nodular gland which is hard in consistency could suggest the presence of prostate cancer.

Once the cancer has been verified, treatment options including surgery, radiotherapy and chemotherapy will be discussed by the physician depending on the stage of cancer and other parameters such as the age of the patient. As prostate cancer is an androgen-dependent cancer, androgen deprivation therapy could be required in advanced cases. In patients who are feeble due to old age and too fragile and to withstand surgery, the cancer is managed in a conservative way, where the treatment is limited to symptomatic relief.