If you have signs or symptoms that worry you, start by seeing your family doctor or a general practitioner. If your doctor suspects you may have a problem with your prostate, you may be referred to a urinary tract specialist (urologist). If you're diagnosed with prostate cancer, you may be referred to a cancer specialist (oncologist) or a specialist who uses radiation therapy to treat cancer (radiation oncologist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
Prior to the appointment
Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including any major stresses or recent life changes.
Make a list of all medications, as well as any vitamins or supplements, that you're taking.
Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Write down questions to ask your doctor.
During the appointment
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For prostate cancer, some basic questions to ask your doctor include:
Do I have prostate cancer?
How large is my prostate cancer?
Has my prostate cancer spread beyond my prostate?
What is my Gleason score?
What is my PSA level?
Will I need more tests?
What are my treatment options?
Is there one treatment option you think is best for me?
Do I need cancer treatment right away, or is it possible to wait and see if the cancer grows?
What are the potential side effects of each treatment?
What is the chance that my prostate cancer will be cured with treatment?
If you had a friend or family member in my situation, what would you recommend?
Should I see a specialist? What will that cost, and will my insurance cover it?
Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions at any time that you don't understand something.
SCREENING & DIAGNOSIS
Screening for Prostate Cancer
Most prostate cancer is discovered through routine screening. Still, testing men who have no prostate symptoms for prostate cancer is controversial. Medical organizations don't agree on the issue of screening and whether it has benefits. Some medical organizations recommend men begin prostate cancer screening in their 50s, or sooner for men who have risk factors for prostate cancer. Other organizations advise against screening. Discuss your particular situation and the benefits and risks of screening with your doctor. Together you can decide whether prostate cancer screening is appropriate for you.
Prostate screening tests might include:
Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of your gland, you may need more tests.
Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's normal for a small amount of PSA to enter your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer.
PSA testing combined with DRE helps identify prostate cancers at their earliest stages, but studies haven't proven that these tests save lives. For that reason, there is much debate surrounding prostate cancer screening.
Diagnosing prostate cancer
If an abnormality is detected on a DRE or PSA test, your doctor may recommend tests to determine whether you have prostate cancer, such as:
Ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to make a picture of your prostate gland.
Collecting a sample of prostate tissue. If initial test results suggest prostate cancer, your doctor may recommend a procedure to collect a sample of suspicious cells from your prostate (prostate biopsy). Prostate biopsy is often done using a thin needle that's inserted into the prostate to collect tissue. The tissue sample is analyzed in a laboratory to determine whether cancer cells are present.
Determining whether prostate cancer is aggressive
When a biopsy confirms the presence of cancer, the next step, called grading, is to determine how aggressive the cancer is. The tissue samples are studied, and the cancer cells are compared with healthy prostate cells. The more the cancer cells differ from the healthy cells, the more aggressive the cancer and the more likely it is to spread quickly. More aggressive cancer cells have a higher grade.
The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Scoring can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer).
Determining how far the cancer has spread
Once a cancer diagnosis has been made, your doctor works to determine the extent (stage) of the cancer. Many men won't require these additional tests. But if your doctor suspects your cancer may have spread beyond your prostate, imaging tests such as these may be recommended:
Computerized tomography (CT) scan
Magnetic resonance imaging (MRI)
Once testing is complete, your doctor assigns your cancer a stage. This helps determine your treatment options. The prostate cancer stages are:
Stage I. This stage signifies very early cancer that's confined to a microscopic area that your doctor can't feel.
Stage II. Your cancer can be felt, but it remains confined to your prostate gland.
Stage III. Your cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
Stage IV. Your cancer has spread to lymph nodes, bones, lungs or other organs