What is Prostate Cancer?
Prostate cancer is the second-leading cause of cancer death for men in the United States. About 1 in 6 men will be diagnosed with this malignancy within their lifetime.
The prostate is the size of a walnut and goes all the way around a tube called the urethra. The main job of the prostate is to make fluid for semen. Prostate cancer cells can spread by breaking away from a prostate tumor. They can travel through blood vessels or lymph vessels to reach other parts of the body.
To check for prostate cancer, Dr. Steinberg will examine your prostate (digital rectal exam) and perform a prostate specific antigen (PSA) blood test. If either of these tests is abnormal, Dr. Steinberg may recommend other tests to determine your risk of prostate cancer.
What causes Prostate Cancer?
According to the American Cancer Society, researchers do not know exactly what causes prostate cancer. However, they have found some risk factors and are trying to learn just how these factors may cause prostate cells to become cancer. These associations may increase the risk of developing prostate cancer:
- Age: Most common in men ages 55-79 years
- Ethnicity: African–Americans are in the highest risk group.
- Family history: 2 to 11 times more at–risk
- Smoking: Risk may double for heavy smokers
- World Geography: Higher in North America and Northern Europe
- Diet: Diets higher in fat may increase risk
What are the symptoms of Prostate Cancer?
In the early stages, prostate cancer often causes no symptoms. When symptoms do occur, they can be similar to symptoms experienced with an Enlarged Prostate or BPH.
Read more about symptoms you shouldn't ignore here
How is Prostate Cancer diagnosed?
Dr. Steinberg is an expert at diagnosing, monitoring, and developing treatment plans for prostate cancer. Diagnosis of prostate cancer is a multi-step process:
Medical History and Physical Exam - During an initial office visit, Dr. Steinberg will perform a Digital Rectal Exam (DRE), inserting a gloved, lubricated finger into your rectum to examine your prostate. If your doctor finds any abnormalities in the size, shape or texture of the gland, further diagnostic tests may be needed to determine if you have prostate cancer. In addition, Dr. Steinberg may ask you about any symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors for prostate cancer, including your family history
PSA Test - The prostate-specific antigen (PSA) blood test is the main method for screening for prostate cancer. This blood test measures the level of prostate-specific antigen (PSA) in the blood. PSA is a protein made only by the prostate gland. Elevated PSA levels can be an early indication of prostate cancer as well as other benign prostate disorders. PSA levels of 4ng/ml and above are typically considered elevated, however there is no specific level that indicates cancer. Results from regular PSA screenings will show whether your PSA levels have changed year to year, and whether that change is cause for concern. In men diagnosed with prostate cancer, the PSA test, along with other diagnostic testing performed by Dr. Steinberg, is used to help determine the stage of prostate cancer, and can also help tell if your cancer is likely to still be confined to the prostate gland. PSA tests are also an important part of monitoring prostate cancer during and after treatment.
OTHER DIAGNOSTIC TESTS
Other diagnostic tests may be used to diagnose prostate cancer:
4K Score - Dr. Steinberg often utilizes the 4K Score, a blood test drawn in the office, which combines four prostate-specific biomarkers with clinical information, to provide men with an accurate and personalized measure of their risk for aggressive prostate cancer. The 4K score can be used to help determine the need for a prostate biopsy. After a negative biopsy, the 4K Score can predict the likelihood of cancer spreading to other parts of the body in the next 20 years. The blood sample is sent overnight to a reference lab and results are usually available and discussed with patients within one week.
Exosome DX Urine Test - This simple urine test performed in the office is often used to determine the risk of high-grade cancer on a subsequent prostate biopsy. This information can help guide the decision for recommending a biopsy. Results of the test are usually available in 24 hours. To learn more about the test, visit here.
Prostate MRI - An MRI of the prostate may be recommended if prostate cancer is suspected in order to detect hidden tumors within the prostate in advance of a biopsy.
Biopsy - Dr. Steinberg considers several diagnostic factors before recommending a prostate biopsy. If the results of a digital rectal exam, PSA test, 4-K score, Exosome DX test, or Prostate MRI suggest cancer, Dr. Steinberg may recommend a prostate biopsy to definitively determine the presence of cancer.
Transrectal Ultrasound-Guided Prostate Biopsy - A prostate biopsy typically takes about 15 to 20 minutes and is performed on an outpatient basis at Milford Regional Medical Center. Dr. Steinberg uses a local anesthetic and often oral sedation to reduce any discomfort during the procedure. The ultrasound examination is performed with the man lying on his side. An ultrasound probe (about the size of a finger) is gently inserted 3 to 4 inches into the rectum. The probe emits sound waves that are converted into video images corresponding to the different prostate zones. Fitted to the ultrasound probe is a biopsy needle that is used to extract small pieces of prostate tissue in less than a second. At least 12 tissue samples ("cores") are taken from the prostate. A pathologist examines the samples under a microscope to determine whether cancer is present. Dr. Steinberg routinely meets with the patient and family within 1 to 2 weeks to discuss the results of the biopsy and make further recommendations.
MRI/Ultrasound Fusion Prostate Biopsy - Dr. Steinberg has trained in this new technique which provides greater accuracy for prostate biopsy, which fuses ultrasound images with high-resolution pictures of the prostate made by a newer technology called multi-parametric magnetic resonance imaging (mp-MRI). Prostate tumors show up on mp-MRI as discrete dark areas. By adding mp-MRI images taken beforehand to the real-time ultrasound images, Dr. Steinberg can more accurately target suspicious regions of the prostate while steering clear of healthy tissue. Your biopsy will be performed by Dr, Steinberg at Milford Regional Medical Center. The procedure usually takes about 15 minutes or less and a local anesthetic and sedation is given to reduce any discomfort. While lying on your side, an ultrasound probe will be inserted into the rectum. This probe provides a clear visual of the prostate and allows the physician to guide the very fine biopsy needle into the prostate. Using the needle, Dr. Steinberg will take several tiny tissue samples (“cores”) from different areas of the prostate. These cores are the width of only 4 threads. The samples are sent to a pathologist, who determines if there is cancer present. Dr. Steinberg routinely meets with the patient and family within 1 to 2 weeks to discuss the results of the biopsy and make further recommendations.
Genetic Testing after Positive Biopsy:
Oncotype DX and Prolaris Test - If prostate cancer is detected on a biopsy, Dr. Steinberg may order an Oncotype DX or Prolaris test. These tests, performed on the biopsy tissue, were developed to help men with newly diagnosed early-stage prostate cancer make the most informed treatment decision for their individual disease, including active surveillance. Oncotype DX and Polaris are helpful in identifying those men who need treatment versus those who can confidently choose active surveillance. Using minimal tumor tissue from the original needle biopsy, the test builds on traditional clinical and pathologic factors to provide additional, clinically relevant insight into the underlying tumor biology of an individual patient before the prostate is removed. The result is a more precise and accurate assessment of future risk, which helps more men avoid the lifelong complications associated with treatments they do not need, while directing aggressive therapy to those men who require immediate treatment. The information gathered from these tests helps Dr. Steinberg recommend and discuss treatment options for patients. Learn more about Genetic Testing with Oncotype DX and Prolaris.