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How is prostate cancer diagnosed?

Before the discovery of prostate specific antigen (PSA), prostate cancer is usually diagnosed by physical examination. Physical examination (digital rectal examination) typically reveals an induration or nodularity of the prostate. Nodules of the prostate cancer are generally hard and painless. Patients with advanced prostate cancer may also present with bony pain (from bony metastases) and/or inguinal lymph adenopathy. 

PSA is a protein that serves as a tumor marker unique to the prostate gland. PSA test significantly increases the yield of digital rectal examination in the diagnosis of prostate cancer. PSA blood test can detect prostate cancer of very low volume and is used in initial diagnosis and diagnosis of recurrent disease after treatment. PSA is relatively sensitive and specific for the screening of prostate cancer, but it should be used with physical examination and other imaging studies, such as transrectal ultrasound (TRUS), for the diagnosis of the disease.

The standard method to diagnose prostate cancer is a true-cut prostate biopsy after a positive serum PSA test or DRE. The procedure is generally guided by TRUS. Your Urologist generally obtains six pieces of tissue by sampling the apex, midportion, and the base of both side of the prostate gland. Biopsy specimens are sent to pathology for further confirmation of the diagnosis. 

Occasionally, patient is diagnosed with prostate cancer during trans-urethral resection of the prostate (TURP) procedure for their benign prostatic hypertrophy (BPH). Patients with incidental finding of prostate during TURP are staged as early T1 diseases. These patients generally have favorable prognosis after treatment. 

After the pathological confirmation of the diagnosis, your urologist may order further imaging studies to assess the extent of the cancer. A bone scan is very sensitive for detecting bony metastases from prostate cancer in patients with high serum PSA level or bony pain. Routine use of bone scan for staging is not encouraged because the probability of a positive bone scan is very low if the patients' PSA level is less than 20 ng/mL and have no symptoms of bony metastases. 

CT scans and MRI are used to evaluate the extent of prostate cancer in the pelvis. They are usually used to detect the lymph adenopathy in the pelvis and low abdomen. However, these studies have not been shown to increase the prognosis of a patient, and they are not routinely used in early staged patients.

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