Yes. Two tests are commonly used to detect prostate cancer in the absence of any symptoms. One is the digital rectal exam (DRE), in which a doctor feels the prostate through the rectum to find hard or lumpy areas. The other is a blood test used to detect a substance made by the prostate called prostate specific antigen (PSA). Together, these tests can detect many silent prostate cancers, those that have not caused symptoms.

Currently, the National Cancer Institute is supporting research to learn more about screening men for prostate cancer. This research will try to determine whether the blood test for PSA, along with digital rectal examination, can help reduce the death rate from this disease. It will also assess the risks and benefits of screening. At present, it is unclear whether routine screening of men who are not at unusually high risk will prove to save lives and outweigh the extra surgery, radiation, and complications of therapy for large numbers of patients, many of whom do no have aggressive or life-threatening tumors.

HOW RELIABLE ARE THE TWO TESTS?

Neither of the screening tests for prostate cancer is perfect. Most men with mildly elevated PSA do not have prostate cancer, and many men with prostate cancer have normal levels of PSA. Also, the digital rectal exam can miss many prostate cancers.

HOW IS PROSTATE CANCER DIAGNOSED?

The diagnosis of prostate cancer can be confirmed only by a microscopic examination to identify cancerous prostate tissue. This is done by a biopsy performed in the doctor's office.

Prostate cancer is characterized by both grade and stage. Grade is a term used to describe how closely a tumor resembles normal tissue. Based on the microscopic appearance of a tumor, pathologists (doctors who identify diseases by studying tissues under a microscope) May describe it a low-, medium-, or high-grade cancer. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. The higher the score, the higher the grade of the tumor. High-grade tumors grow more quickly and are more likely to spread than low-grade tumors. Staging of prostate cancer means determining the site and location of the disease. Early prostate cancer, stages 1 and 2, is localized to the prostate gland. Stage 3 prostate cancer is locally advanced outside the gland. Stage 4 prostate cancer has spread to other organs or tissues.

HOW IS LOCALIZED PROSTATE CANCER TREATED?

There are three generally accepted options for treatment of patients with localized prostate cancer: radical prostatectomy, radiation therapy, and surveillance (also called watchful waiting) A new technique called Cryo Therapy is getting great results also.

Radical prostatectomy is a surgical procedure to remove the entire prostate gland and nearby tissues. Sometimes lymph nodes in the pelvic area (the lower part of the abdomen, located between the hip bones) are also removed. Radical prostatectomy may be performed using a technique called nerve-sparing surgery that may prevent damage to the nerves needed for an erection and prevent damage to the opening of the bladder.

Radiation therapy involves the delivery of radiation energy to the prostate. The energy is usually delivered in an outpatient setting using an external beam of radiation. The energy can also be delivered by placing radioactive seeds in the prostate during a surgical procedure.

A third option, surveillance, is recommended by doctors for some patients, particularly those who are older or have other medical conditions that are likely to compromise their health. There patients are followed with regular examinations. If there is evidence of cancer growth, active treatment may be recommended.

HOW DOES A PATIENT DECIDE WHAT IS THE BEST TREATMENT OPTION FOR LOCALIZED PROSTATE CANCER?

Choosing a treatment option involves the patient and his family and doctor. Considerations include the grade and stage of the cancer, the patients's age and health, and the individual choices that each patient makes about the benefits and risks of each treatment option. Because there are several reasonable treatment options for most patients, the decision can be difficult. Patients may hear different opinions and recommendations. They should try to get as much information as possible. There is rarely a need to make a decision without time to understand the pros and cons of various approaches.

source: National Cancer Institute, National Institutes of Health, Bethesda, MD