Prostate Cancer: Symptoms and Diagnosis

 Prostate Cancer: Symptoms and Diagnosis

The first sign of cancer in the prostate is often a rising PSA level. Are there any other symptoms or warning signs? When should a biopsy be done? Can the tissue removal be replaced by other examinations?

For men suspected of having prostate cancer, this text offers an overview of the most important diagnostic tests for suspected cancer. Interested parties and experts will also find link tips and references to other sources of information.

Cancer warning signs: early symptoms are absent

Most men today learn of a suspected cancer from a PSA test. It measures the level of the prostate-specific antigen in the blood. Elevated values ​​can indicate a carcinoma. Many doctors do not see any cause for concern in PSA values ​​that are not too much above the normal range: First of all, the value must first be checked further.

Even if the PSA level is significantly too high, many people do not notice any changes in health or typical symptoms.

Which general symptoms can indicate changes in the prostate?

Common prostate cancer complaints and warning signs - these are the symptoms to look out for:

  • Typical warning signs for prostate cancer are missing.
  • What is the first possible complaint can just as easily be triggered by a benign change in the prostate or an infection.
  • Urination problems are possible. However, this is much more often a benign prostate enlargement, a so-called benign prostatic hyperplasia, than a carcinoma. Almost all men of advanced age are affected by this. You should go to the doctor anyway. Even a benign enlargement of the prostate gland can cause serious long-term health problems.
  • Carcinomas usually only press on the urethra when they are already relatively large, because: Most tumors arise on the back of the prostate gland, i.e. in the part of the prostate that faces the intestine.
  • Blood or noticeable discolouration in urine or seminal fluid should be clarified. These symptoms could be signs of inflammation and infection. But they can also indicate a carcinoma.
  • Prostate cancer usually only causes pain when tumor cells have spread beyond the organ: Discomfort when urinating and during sexual intercourse, when defecating, or bone pain are possible. 

Where do you go if you have high and rising PSA levels or complaints?

Does the PSA test yield abnormal values? Usually, the doctor who first suspects the disease will also arrange for further clarification. As a rule, this is initially another blood sample, depending on the level of the value only after a few weeks, or even at a significantly longer time interval. 

Or are there other signs that suggest prostate disease, such as pain? Then the first point of contact is the urologo cdmx urologist. If cancer is suspected, the outpatient department of a specialized hospital can carry out further examinations.

The first tests for prostate cancer and to rule out other diseases can almost always be carried out on an outpatient basis. Hospitalization is not required for this.

Act how fast?

The suspicion of prostate cancer is not an emergency situation that should be acted upon immediately. Carcinomas grow rather slowly in many patients. Isn't the PSA level too high and are there no other symptoms? Then even further checks are sufficient initially, as experts have confirmed in the currently valid medical  guidelines . Because:

For early stages of the disease, experts even discuss whether immediate treatment might actually do more harm than good - with regular, close monitoring , therapy can often be postponed for a long time or even avoided entirely.

Then you can almost always take the time to talk to the doctor about the various examination procedures.

  • You should also ask about the consequences of further examinations for later treatment options.

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Who bears the cost of diagnostics?

If cancer is suspected, the health insurance bears all examination costs. This also applies to the measurement of the PSA value. This test has a permanent role in clarifying a suspected cancer.

For "cancer prevention", i.e. for pure early detection without complaints or symptoms, you often have to pay it yourself.

Diagnostic steps: only if the suspicion of cancer is confirmed

At the examination appointment, the doctor generally asks about symptoms or changes in the state of health. It is important to measure the prostate-specific antigen (PSA) in a blood sample. For cancer screening this investigation is indeed controversial. When investigating a suspected cancer, however, measuring the PSA level is routine.

Then the doctor examines the prostate through the rectum. This digital rectal palpation examination is, however, too imprecise to reliably detect smaller tumors.

If a carcinoma is suspected, an ultrasound examination can be added, which is also carried out from the rectum. It is technically known as transrectal sonography , abbreviated to TRUS. However, the TRUST is not a must for all patients.

No further examinations are necessary, at least for the first investigation. For example, experts advise against newer variants of ultrasound examinations, such as ultrasound examinations with contrast media.

Reliable diagnosis only after tissue removal?

A cancer diagnosis can only be confirmed by removing prostate tissue, a biopsy: The doctor performing the procedure takes several tissue samples from different parts of the prostate to be on the safe side. These are examined under the microscope for tumor tissue. The result of the biopsy decides how to proceed.

For more information, see the section Biopsy: Collecting Tissue for Examination under a Microscope.

Can't the biopsy be bypassed or replaced?

There are a number of approaches in clinical research that eliminate the need for a biopsy through other tests. So far, however, a biopsy cannot be replaced.

Because: Studies aim to obtain more information about the findings through additional examinations, such as more certainty about the actual tumor size.

So far: none of these tests are standard. Most of them have to show how reliable they are in clinical trials.

The examination begins with the question of the general condition, complaints or previous illnesses.

Then the doctor examines the prostate from the rectum with a finger. During a palpation examination or digital rectal examination (DRE) of the rectum, however, the doctor can usually only feel larger changes. The examination is carried out anyway: Benign enlargements can also be responsible for complaints and must be treated.

At the doctor's appointment: physical examination and palpation examination (DRU)

The examination begins with the question of the general condition, complaints or previous illnesses.

Then the doctor examines the prostate from the rectum with a finger. During a palpation examination or digital rectal examination (DRE) of the rectum, however, the doctor can usually only feel larger changes. The examination is carried out anyway: Benign enlargements can also be responsible for complaints and must be treated.

No special preparation is required for this examination. You don't have to do a colon cleanse and don't have to purge it beforehand.

  • Does the doctor feel a magnification? Then experts recommend a biopsy, regardless of the PSA value.

Did you see a doctor about ailments? Then he will look for other possible causes of symptoms with appropriate examinations. For example, he looks for swollen lymph nodes in the pelvic area. Or he looks for causes that could explain bone pain.

The prostate-specific antigen, or PSA for short, is a protein that is produced by cells in the prostate. It is part of the prostate secretion and is used to liquefy the semen. The PSA also passes into the blood in small quantities - this can be detected with a laboratory test from a blood sample. To do this, the doctor takes a few milliliters of blood from the arm vein.

Experts give the normal value for healthy men with zero to a maximum of four nanograms per milliliter of blood, abbreviated ng / ml. 

Prostate cancer with PSA values ​​below four nanograms per milliliter is unlikely. But it is not excluded either. Malignant tumors of the prostate that do not produce PSA at all are extremely rare. These include, for example, prostate sarcomas.

  • For values ​​below one nanogram PSA per milliliter of blood, the test should be repeated after four years at the earliest, according to the current guideline .
  • If the PSA is between 1 ng / ml and 2 ng / ml, a new test after two years is sufficient.
  • PSA over 2 ng / ml should be checked annually.

If a man is actually suffering from a carcinoma that needs treatment, his blood usually has higher PSA levels.

Even blood levels of four to ten nanograms and sometimes even above can still indicate inflammation or other benign changes in the prostate tissue; More rarely, extensive urinary tract infections are also noticeable through an increased PSA level. The prostate also releases PPE when it is subjected to pressure, physical exertion or sexual intercourse.

What to do if the PSA value is higher than 4 ng / ml, or if it rises rapidly with several measurements in a row?

Or if there are other indicators for changes, such as a palpable finding?

  • Then the current medical guidelines name a prostate biopsy as the next step.

If a palpation examination has not yet been carried out, this should be done. Further examinations, for example with ultrasound, are not absolutely necessary and ultimately cannot replace the biopsy.

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