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DIAGNOSIS
If you have a symptom or test result that
suggests cancer, your doctor must find out whether it is due to
cancer or to some other cause. Your doctor will ask about your
personal and family medical history. You will have a physical
exam. You may have lab tests. Your visit may include a digital
rectal exam, a urine test to check for blood or infection, and a
blood test to measure PSA level.
You also may have other exams:
a Transrectal ultrasound: The doctor inserts a probe into the man's
rectum to check for abnormal areas. The probe sends out sound waves
that people cannot hear (ultrasound). The waves bounce off the
prostate. A computer uses the echoes to create a picture called a
sonogram.
a Cystoscopy: The doctor uses a thin, lighted tube to look into the
urethra and bladder.
a Transrectal biopsy: A biopsy is the removal of tissue to look for
cancer cells. It is the only sure way to diagnose prostate cancer. The
doctor inserts a needle through the rectum into the prostate. The
doctor takes small tissue samples from many areas of the prostate.
Ultrasound may be used to guide the needle. A pathologist checks for
cancer cells in the tissue.
You may want to ask the doctor these questions before having a biopsy:
a Where will the biopsy take place? Will I haveto go to the hospital?
a How long will it take? Will I be awake? Will ithurt?
a What are the risks? What are the chances ofinfection or bleeding
after the biopsy?
a How long will it take me to recover?
a How soon will I know the results?
a If I do have cancer, who will talk to me aboutthe next steps? When?
If Cancer Is Not Found
If the physical exam and test results do not suggest cancer, your
doctor may suggest medicine to reduce symptoms caused by an enlarged
prostate. Surgery also can relieve these symptoms. The surgery most
often used in such cases is transurethral resection of the prostate
(TURP or TUR). In TURP, an instrument is inserted through the urethra
to remove prostate tissue that is pressing against the upper part of
the urethra and restricting the flow of urine. You should talk to your
doctor about the best treatment option.
If Cancer Is Found
If cancer is present, the pathologist studies tissue samples from the
prostate under a microscope to report the grade of the tumor. The
grade tells how much the tumor tissue differs from normal prostate
tissue. It suggests how fast the tumor is likely to grow. Tumors with
higher grades tend to grow faster than those with lower grades. They
are also more likely to spread. One system of grading prostate cancer
uses G1 through G4. Another way of grading is with the Gleason score.
The pathologist gives each area of cancer a grade of 1 through 5. The
pathologist adds the two most common grades together to make a Gleason
score. Or the pathologist may add the most common grade and the
highest (most abnormal) grade to get the score. Gleason scores can
range from 2 to 10.
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