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Know Prostate Cancer

What to expect once you decide to be tested

The roadmap below gives you a quick view on what you could to expect once you decide to be tested. Not everybody’s road will be the same, but it is better to be prepared for what may lie ahead. All the information in this roadmap are unpacked in the section below.

Roadmap
Where to go for PC screening?

Where to go for PC screening?

 

Prostate Cancer screening involves two very basic tests, a blood test and/or a physical exam. These tests are performed at your local public or some private health clinics, or at a general practitioner. 20
 

A PSA test is a blood test and the first step of screening. It does not take a long time to have blood drawn but you may have to wait a few days for the results.21 A PSA test may require you to pay a fee, but this will depend on where you have the test done, and your means of income. The cost of a PSA test at a private laboratory can cost between R250 and R350.22 Look out for Prostate Cancer drives in your area where screening tests are offered free of charge.

A Digital Rectum Exam (or the “finger” test) is a very simple, inexpensive test that can give you an instant indication of how healthy your prostate is but is never used without a PSA test. This test is only needed if you are already experiencing symptoms.23

Prostate Cancer tests and scans

When it comes to testing for Prostate Cancer, there are screening tests and diagnosing / staging tests.

Screening Tests

PSA test

PSA test (Prostate-Specific Antigen test) ⁴

Blood test

 

  • Level of PSA is measured in the blood (normal ± 1 ng/ml)
  • The rate at which it is rising is also measured (repeat tests).
  • Abstain from strenuous exercise or ejaculating for 48 hours before this test.

DRE

DRE (Digital Rectal Examination) / the "Finger" Test ²,⁴

Physical exam

 

  • A gloved, lubricated finger is inserted into the rectum.
  • The prostate is examined for any irregularities in size, shape, and texture. Test should take about 10-15 seconds.
    •  

PSA-levels

If PSA-levels are somewhat high, but your DRE-test are normal, your doctor will repeat the PSA test. 5

When both screening tests show abnormalities, and considering your personal level of risk, diagnosis / staging tests are done. 5

Diagnosis / Staging Tests

Specialist (Urologist / Oncologist)

Specialist (Urologist / Oncologist)

Magnetic Resonance Imaging (MRI) 3,5,8

 

  • A strong magnet, radio waves and a computer make a series of detailed pictures of areas of the prostate and nearby tissue.
  • This scan identifies if there are cancer cells, and its exact location for a more precise biopsy. 
  • Is usually done before a biopsy is considered.

 

 

 

 

Specialist (Urologist / Oncologist)

Specialist (Urologist / Oncologist)

Prostate Biopsy 3,5,8

 

  • A thin needle is inserted into the prostate either via the rectum or through the skin between the rectum and the scrotum. A small amount of tissue is removed and viewed under a microscope to identify and grade cancer cells. A few samples are taken.
  • Usually done only if there is strong indication or risk of the presence of cancer. 
  • Is used to definitively diagnose cancer and grade the cancer. 

How is the stage of Prostate Cancer determined?

There are a few main components to final staging of Prostate Cancer: 4

 

  • The PSA level
  • The grade of the tumour (done via biopsy), called the Gleason Score
  • The stage of the tumour (termed the “T-stage” as it considers if the cancer is contained completely within the prostate or moved to nearby tissue) 
  • At later stages, getting imaging (a type of photo) to determine if the cancer has spread to lymph nodes (called the “N-stage”) or to bones or other organs (called the “M-stage”).

PSA levels:

The majority of men have a PSA under 1 ng/ml. 4

A few factors may influence the PSA level, such as age, other conditions, medications used and infections. This is why it is important to repeat PSA tests if the level seems elevated (higher than 3 ng/ml) on a single test. 4,5

The higher the PSA level over time, the higher the risk of Prostate Cancer being diagnosed and the disease being more severe. 3

Gleason Score / Grading of the tumour

The Gleason score is based on what the tumour cells, taken in the biopsy, looks like. 3,4,8 When the cells are looked at under a microscope, the specialist considers the shape of the cells. 3,8

Gleason Score / Grading of the tumour
  • Not all the cells in a sample taken from the tumour will look the same.
  • The specialist will decide what shape most cells in the tumour sample have and write down that score.
  • The specialist will then check what shape the second most cells in the tumour have and write that score down.
  • The two numbers are then added together, and this becomes your Gleason score. 3,8
  • The closer your Gleason score are to 6 or lower, the lower your risk of the Prostate Cancer being severe, and it will most likely grow slowly.
If your score is close to 10, your risk of the Prostate Cancer growing aggressively and causing severe symptoms in the future are higher. 3,8

Tumour stage

By looking only at the tumour, the size to which it has grown defines its tumour stage.3,4

T1

T1:

The tumour could not be felt with the finger during screening, and was found by accident through a biopsy, which you received because your PSA levels were high.

T2

T2:

The health care provider felt a bump or bumps on your prostate during the rectal exam.

T3

T3:

The tumour has spread just outside of the prostate capsule into some of the surrounding fat or vesicles (tubes).

T4

T4:

The tumour has spread to other organs and tissue, such as the rectum or bladder (advanced Prostate Cancer).

Determine the Node- or Metastatic score

When the cancer appears more aggressive (e.g. PSA levels >20, Total Gleason score of 8 to 10 or tumour stage T3-4) imaging scans (a type of photo) are used to determine whether the Prostate Cancer has spread. 4

 

The technology used could be MRI (Magnetic Resonance Imaging), CT (computed tomography) or a bone scan, or newer and more sensitive imaging such as molecular PET imaging. 4

 

Prostate cancer cells may spread to various sites throughout the body, most commonly in bones, and sometimes the liver or lungs. 4

 

If the imaging shows that the cancer has spread, and it is found in your lymph-nodes, you will be assigned a N-score (node-score). How far it has spread (or metastasised) to other organs becomes your M-score (metastatic-score). 5 The spread of the cancer is called "metastasis". 

Determine the Node- or Metastatic score

Understanding other terminology

Based on the staging and other tests done during the diagnosis process, some terminologies may be used. It will be important to know what these terms mean, as it will help you understand where you are in the Prostate Cancer journey, and what treatment options are available.

The cancer has not spread outside the prostate gland. 4

The cancer has spread to nearby tissue, but not to the lymph nodes or other organs yet. 4

The cancer has spread to other parts of the body, such as the bones, liver, lungs and lymph nodes. 4

Cancer cells will stop growing or die if hormones (testosterone) are removed, or levels of testosterone in the body are lowered 4

Cancer cells gain the ability to grow even if there are low levels of hormone (testosterone) in the body. Treatment that lowers hormone levels in the body is less effective to stop the cancer. 4