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Advanced Prostate Cancer
Detecting
 In the United States, widespread use of PSA testing has resulted in approximately 90% of all prostate cancers being detected at an early stage, when cancer is confined to the prostate gland or the nearby region. When detected early, the prognosis is very good for prostate cancer, with nearly 100% of patients surviving at least 5 years and often longer after diagnosis. Men with early-stage prostate cancer are closely monitored so any progression of the disease can be detected early. Your doctor can use a variety of ways to detect prostate cancer that has advanced, including the PSA blood test (Table 1), DRE, imaging tests, biopsy, and additional blood tests and urine studies (urinalysis).
Table 1. Prostate-Specific Antigen Facts
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Prostate-specific antigen (PSA) is a protein produced in the prostate gland by both normal and cancer cells, and the PSA test measures the amount of the antigen in the blood.
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Most healthy men have PSA levels under 4 nanograms per milliliter (ng/mL) of blood, but 15% of men with a PSA below 4 will have prostate cancer diagnosed on the basis of biopsy fi ndings.
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As the PSA level goes up, the chance of having prostate cancer goes up.
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A PSA between 4 and 10 ng/mL is considered borderline and carries a 25% chance of having prostate cancer.
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A PSA greater than 10 carries a 50% chance of having prostate cancer.
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PSA levels rise slowly as you get older, even if there is no prostate abnormality.
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When PSA levels increase after treatment for prostate cancer with surgery or radiation, it often means the cancer has returned (recurred).
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PSA
In addition to its use as a screening tool for prostate cancer, the PSA test may be used to detect advanced prostate cancer. Your doctor will compare PSA values over time and watch for an increase in the PSA level, which may indicate that the prostate cancer has advanced or returned (recurred) after treatment. The rate at which the PSA value has increased is an important factor in the prognosis.
Imaging Tests
Imaging tests such as x-rays, CT, or MRI may be used to identify areas of cancer outside the prostate and to determine if cancer has recurred after treatment. A relatively new type of scan, the ProstaScint scan, is sometimes used to detect areas of locally advanced prostate cancer or cancer that has spread to lymph nodes. Painful symptoms usually involving the urinary tract or bones may signal advancing disease and the need for tests to identify the location of the new sites.
Urinary symptoms might include the need to urinate more often and a slow or weak urinary stream. You might see blood in your urine or have trouble getting an erection.
If cancer spreads, it is likely to go first to nearby lymph nodes, and then to the bones. Weakness, fatigue, and weight loss can be symptoms of advanced disease. A bone scan can identify prostate cancer that has spread to the skeletal system. When prostate cancer spreads to other parts of the body, it is metastatic prostate cancer for example, if prostate cancer spreads to bones, the disease is metastatic prostate cancer, not bone cancer.
If the cancer metastasizes to the liver, you may have abdominal pain. A CT or MRI scan of the abdomen or pelvis can determine if the prostate cancer has advanced locally or has spread to the pelvic lymph nodes or the liver, or if the tumor is blocking the urinary tract. Chest pain and coughing may indicate that the cancer has spread to the lungs, and a chest x-ray can be used to help identify metastases in the lungs.
Biopsy
A biopsy is the only sure way to identify and diagnose prostate cancer. A biopsy is the removal of cells or tissue for microscopic examination by a pathologist (a doctor who specializes in diagnosis of disease using organs, tissue, and body fluids). To see if the cancer has advanced, your doctor may suggest that biopsy samples of your pelvic lymph nodes are evaluated. This procedure is usually done with use of a local anesthetic.
Laboratory Tests
Additional laboratory tests, including blood tests, and an urinalysis, will likely be performed to detect abnormalities that may warrant further studies.
Additional Sources of Information
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