Prostate Cancer Screening

Providence offers numerous screening and diagnostic methods to detect prostate cancer. Talk with your doctor to understand which is best for you.

This simple blood test is used to measure the level of prostate-specific antigen (PSA), which may indicate the presence and extent of cancer activity. PSA level can also be elevated in non-cancerous conditions such as an enlarged or inflamed prostate. However, a PSA level higher than 2.5 - 4.0 usually leads to further testing for evidence of prostate cancer.

PSA occurs in two major forms in the blood. One form is complexed, or attached to blood proteins, while the other circulates freely (unattached). This is important because the percentage of free PSA is lower in men who have prostate cancer, and a low percent-free PSA may be a further indication that one should have a biopsy.

The PSA test should be done in combination with a digital rectal exam (DRE). These are the primary screening tools used to detect prostate cancer early.

The DRE is a simple and only slightly uncomfortable physical examination. The physician examines the prostate gland by inserting a gloved, lubricated finger into the rectum to check for any evidence of abnormalities in its texture, shape or size. The DRE, along with the PSA test, helps to detect prostate cancer in men who have no symptoms of the disease.

In this screening test, a small ultrasound probe is inserted into the rectum so the physician can view an image of the prostate gland on a video screen and check for abnormalities. The procedure is performed in a doctor's office or outpatient clinic and takes less than 15 minutes. To clear your rectum, you may be asked to use an enema or suppository beforehand.

The extended field biopsy is considered the "gold standard" in prostate cancer screening. It involves examining 10 to 12 core samples of the prostate. On repeat biopsies or when the prostate is particularly large even more cores are obtained. A transrectal ultrasound probe is used to guide the biopsy needle into different sections of the prostate so the cores can be extracted. Local anesthesia (peri-prostatic analgesia) is administered to alleviate discomfort during the procedure.

For individuals with extensive disease, a bone scan may be ordered to determine whether prostate cancer has spread to the bone. This nuclear imaging technique utilizes a radioactive tracer often referred to as a "radionuclide," which is injected into the patient's blood stream to be collected in the bones. Areas that absorb little or no amount of tracer appear as dark or "cold" spots, while areas of rapid bone growth or repair absorb increased amounts and show up as bright or "hot" spots in the pictures. These spots may indicate cancer or other bone activity.

Active surveillance is an investigational way to manage low-stage small volume prostate cancer. While on active surveillance, you will have no treatment for the prostate cancer. However, you will have repeated Prostate Specific Antigen (PSA) tests, physical exams and other testing to detect when the cancer is becoming a greater risk, which may require you to begin treatment. You may also choose active surveillance if the risks and possible side effects of treatment outweigh the possible benefits. Your doctor may offer this choice if you are older or have other serious health problems. Your doctor will offer you treatment if symptoms occur or get worse.

Urologic oncology physicians provide individual consultations to develop a personalized treatment plan that assures the best possible outcome for each patient. They also meet with patients who have received recommendations through other prostate cancer treatment programs and are seeking a second opinion.