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Diagnosis and classification

Prostate cancer detection

PSA - measurable by standard blood test

In addition to producing seminal fluid, the prostate secretes a molecule known as prostate-specific antigen or PSA. Once prostate cancer is diagnosed, tracking the PSA value is used to monitor the progress of the disease. Depending on the stage of the disease and the treatment used, your doctor's interpretation of the PSA test may not be based on the same criteria. PSA tests are often recommended for men over the age of 50. Although a high PSA content is indicative of a functional disorder involving the prostate, it is not a reliable tool for diagnosing cancer. This is why additional examinations are necessary in order to diagnose cancer.

Digital rectal examination

This examination is performed by a general practitioner during a normal consultation. The physician inserts a finger into the patient's rectum in order to feel the prostate. This is a quick, painless procedure.

Prostate biopsies

A biopsy is performed to determine if a patient is suffering from prostate cancer. This involves removing tiny fragments of the prostate that are then analyzed in a laboratory to study the types of cells contained in the samples. Before the examination is performed, the patient is given an enema (washing out the rectum with a liquid solution) and an antibiotic treatment. The examination is performed under local anesthesia. Guided by an ultrasound scanner (inserted into the rectum with a probe) that produces an image of the prostate, the physician collects at least 12 tissue fragments from different parts of the prostate. These samples are then examined under a microscope by an anatomopathologist who will confirm whether or not cancer is present. Its objectives are:

  • To specify the aggressiveness of the cancer cells defined according to a scale called Gleason score (the tumor's degree of differentiation, i.e. the tendency of the tumor to resemble normal prostate tissue).

  • To evaluate the number and distribution of positive biopsies (showing cancer cells), characteristics of the tumor tissue, and the crossing of the cancer cells beyond the prostate capsule.

Gleason score

The Gleason score is determined after analyzing prostate biopsies. There are five types of prostate cells: type 1 cells are normal and type 5 are those in which cancer is most advanced. The Gleason score is calculated by observing which of the cell types are most numerous in the specimen and adding them together. The score ranges from 6 to 10, depending on the aggressiveness of the cancer, with 10 being the most aggressive form.
Degree of risk or aggressiveness, based on the Gleason score:

  • 6 or 7: low or intermediate-risk cancer

  • Between 8 and 10: high-risk cancer

The Gleason score is generally expressed as follows: Gleason 7 (3+4). In the parentheses, the first digit indicates the most numerous cell type in the biopsy specimens and the second digit is the second most numerous cell type.

Staging

When prostate cancer has been diagnosed, the diagnosis must be refined by performing a series of imaging examinations for the staging assessment. The purpose of the staging assessment is to accurately determine whether the cancer is localized (i.e. wholly contained within the prostate gland) or has spread.

Scan

This painless examination, which lasts between 10 and 15 minutes, uses X-rays to produce a very accurate image of the target area, in this case the abdomen and groin (abdominopelvic scan). The scan will reveal whether the prostate cancer has remained within the gland or has reached the prostatic capsule (i.e. the membrane surrounding the prostate), or the lymph nodes.

Magnetic resonance imaging (MRI)

An MRI scan is similar to an X-ray scan except it uses a magnetic field rather than rays. This examination provides a very accurate image of the body's soft tissue, allowing the physician to see whether the cancer has spread to any other organs.

Bone scintigraphy (bone scan)

This examination reveals whether a prostate cancer has reached the skeleton. Bone scintigraphy is a painless procedure in which a product is injected into the blood in order to reveal any bony metastases on the images subsequently produced.

 

Different stages of prostate cancer

The type of treatment prescribed for cancer is largely determined by the disease's stage of development. The following scale indicates the degree of progression for prostate cancer, from least-advanced to most-advanced:

 

Prostate cancer stages T1, T2, T3, T4

Localized cancers:

  • Stage T1: corresponds to a tumor not detectable by a digital rectal examination. Only a few cells are cancerous. The patient does not experience any symptoms of the disease.

  • Stage T2: corresponds to a cancer that is detectable by a digital rectal examination (a hard lump can be felt) and appears to be fully contained within the gland, whether in both lobes of the prostate or just one.

Advanced cancers:

  • Stage T3: corresponds to a cancer that extends beyond the prostate and/or seminal vesicles.

  • Stage T4: corresponds to a cancer that has spread to other organs near the prostate (such as the bladder and/or rectum).

 

Last update 7 february 2017.

  • Glossary
  • Antibiotic
    Drug used to treat bacterial infections by killing the bacteria responsible.
  • Biopsy
    Examination that involves removing small fragments of tissue from an organ in order to examine them under the microscope.
  • Bladder
    Organ in which urine accumulates before being expelled from the body.
  • Bone scintigraphy (bone scan)
    Medical imaging technique used to view the skeleton and detect metastases.
  • Digital rectal examination
    Examination in which the physician inserts a finger into the patient's rectum in order to feel the prostate.
  • Gland
    Small organ that produces one or more substances in the body.
  • Gleason
    See Gleason score
  • Gleason score
    Result obtained after studying prostate cancer cells under the microscope. This score provides a measure of the degree of aggressiveness of the cancer.
  • Lymph node
    Small "lump" located on the lymphatic vessels. Lymph nodes play a major role in protecting the body against infections and cancerous cells.
  • Magnetic resonance imaging (MRI)
    Magnetic field-based painless medical imaging technique.
  • Prostate
    Gland in the male genital system that plays a role in semen production.
  • PSA (prostate-specific antigen)
    Substance secreted by the prostate that circulates in the bloodstream.
  • Rectum
    Final section of the large intestine, ending at the anus.
  • Scanner
    X ray-based painless medical imaging technique that produces "sliced" images of the human body.
  • Seminal fluid
    Liquid comprising secretions from the seminal vesicles and the prostate. It combines with sperm to form semen.
  • Seminal vesicles
    Glands connected to the prostate that produce the main constituent of seminal fluid.
  • Tumor
    Mass of abnormal cells. A tumor may be either benign or malignant (cancer).
  • Ultrasound
    Painless medical imaging examination performed using an ultrasound scanner.
  • X-rays
    Invisible rays that pass through certain components of the human body. This property is harnessed for X-ray examinations and scanner imaging, for example.
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