Diagnosis of Prostate Cancer:

• Digital Rectal Exam

  • Physician feels prostate through wall of rectum to determine hardness or lumps.
  • Can only identify tumors that are big enough to feel.

• Measurement of PSA (prostate-specific antigen) in the blood.

  • PSA is secreted by normal and cancerous prostatic cells, and the levels of circulating PSA often rise with prostate cancer.
  • Thus, PSA levels can serve as a warning that the prostate gland has gone awry.
  • Misses as many as 25% of men with cancer and misdiagnoses many others.
    

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• The DRE is particularly helpful because prostate cancer most frequently arises in the posterior peripheral zone, which is easily palpable through the rectal wall.

• Normal PSA is less than 3-4 ng/mL blood.
  • PSA is elevated in 80% of men with prostate cancer.
  • Sensitive but not specific.

• Over half of men with abnormally high PSA levels are actually cancer-free.

• PSA can be elevated in other conditions: prostatitis, BPH, increased age, may vary racially, recent ejaculation, finasteride medication (for BPH), UTI, recent prostate procedure (not DRE).

• It is thought that PSA rises more in CA b/c cancer damages barriers to bloodstream.