Prostate cancer: early diagnosis is essential
Posted on 2 June 2017
June is Men’s Health Month. We asked a Mediclinic urologist how prostate cancer is diagnosed and treated.
As a general rule, men over the age of 45 should have a prostate examination at their GPs every year. This involves having a rectal examination and a PSA blood test. PSA means prostate-specific antigen, a protein produced by the prostate. The reason for this test is that PSA levels are often raised with prostate cancer, explains Dr Werner Botha, a urologist at Mediclinic Cape Town.
‘If a patient presents with an abnormal rectal examination or an elevated PSA level, the doctor will regard it as a suspicion of prostate cancer and refer the patient to a urologist for further investigation,’ Dr Botha continues.
‘The urologist will do a digital rectal examination. This is only the first step towards an accurate cancer diagnosis and will indicate whether we need to biopsy the patient.
‘We then arrange to do a specialised MRI scan of the patient’s prostate. Called a multiparametric MRI, it allows us to get multiple views of the prostate from different angles.
‘A few days later, the patient will receive the results of the MRI scan, and we will admit the patient to hospital to perform a targeted prostate biopsy. This allows us to get a sample of the suspicious lesion, which is then sent to the pathologist,’ says Dr Botha.
The pathologist is the specialist who makes the diagnosis of prostate cancer by grading the cancer.
Grading the cancer
‘The grading is done according to an international score called the Gleason grading system,’ says Dr Botha. ‘In simple terms, the pathologist identifies the most predominant cancer cells and grades them from 1 to 5. Then the second most predominant cancer cells are graded from 1 to 5. Adding the two scores together gives the pathologist a figure out of 10, called the Gleason sum.’
The urologist will then use the test results to stage the cancer. ‘For example, if the prostate feels normal but there is an elevated PSA level, we call it a T1c lesion. If we feel a small nodule on one side of the prostate but less than half of the lobe, it’s a T2a lesion, and as the lesions grow bigger and involve more of the lobes, they are called T3 lesions,’ Dr Botha explains.
There are different treatment options for prostate cancer, and obviously the earlier the diagnosis, the more options available. Once the urologist has the PSA reading, the grading score and has staged the cancer, the patient is stratified into a risk group:
- Low-risk, organ-confined
- Intermediate risk
- High risk
‘The risk assessment shows the risk of the cancer cells being outside the skin of the prostate,’ Dr Botha explains. ‘Once we’ve stratified the patient into a risk group, we can look at different treatment options.’
Some of the options that urologists offer in the low-risk organ-confined group include:
- Robotic surgery or open surgery: The whole prostate gland is removed. This option is usually reserved for younger patients.
- Radiotherapy: This is done either by using traditional treatments or by implanting radioactive seeds into the prostate, which is called brachytherapy.
- Active surveillance: ‘We closely monitor the patient and test their PSA levels every three months. We also periodically follow up with MRI scans and repeat biopsies to ensure the grading hasn’t changed,’ says Dr Botha.
His final advice for patients is never to panic or delay seeking help. ‘If you’re worried, see your GP. You might be pleasantly surprised and find that your tests come back clear.’