Prostate Cancer

When you are referred to your Urologist for evaluation of Prostate Specific Antigen (PSA) blood testing or for suspicious findings on Digital Rectal Examination (DRE), these are screening tests for prostate cancer.

PSA is produced by cells in the prostate, both normal and cancerous.  It is natural for PSA to increase as men get older because the prostate naturally grows larger over the same period, producing proportionally more PSA; this process is called Benign Prostate Hyperplasia (BPH).  When BPH occurs, the prostate may grow to such a size or configuration that it ends up obstructing or “choking off” the urethra under bladder and limiting the flow of urine.  Symptoms of BPH might include one or more of the following:  getting up at night to urinate frequently, slow urine flow, a delay in starting your urine flow, needing to strain to push the urine out during peeing, and a feeling of incomplete emptying after urination.  BPH may also lead to secondary signs such as: blood in the urine, urinary tract infections, prostate infection, and bladder/kidney obstruction/dysfunction.

Prostate cancer produces more PSA per cell than benign prostate cells, and will also tend to grow faster than normal cells, and for these two reasons, PSA increases related to prostate cancer will be faster and higher than with BPH.

DRE allows your doctor to feel the prostate for examination.  The prostate is located directly under the bladder, between the bladder outlet and the outside penile urethra and in front of the rectum.  Suspicious areas can be felt by a finger in the rectum directed towards the prostate gland.  BPH feels like an overall, symmetric enlargement of the gland, and prostate cancer feels like very discrete hard nodules as bumps off the surface of the prostate, or as areas of general hardness of the prostate, or notable asymmetry of the prostate gland.

Based on what is found in terms of your PSA and DRE, your doctor will discuss with you whether a prostate biopsy should be ordered.  The only definitive way to know whether prostate cancer is present or not is to have a sample analyzed under a microscope in Pathology.  The biopsy is usually performed under ultrasound guidance, and involves a trip to the Radiology Department where you will be admitted for the day procedure.  Prior to this, you will be asked to only drink clear fluids the night leading up to the procedure, self administer an enema to clear out the lower colon, and take preventative antibiotics to limit the risk of post procedural infection.  At the procedure room, you will be placed in the lithotomy position (feet in stirrups) or on your side with knees bent, and anesthetic jelly will be inserted per rectum.  An ultrasound probe will be inserted per rectum, and a series of needle biopsies of the prostate taken according to a template will be performed.  The needle passes through the rectum and into the prostate gland, guided by the ultrasound images to remove a sliver of tissue.  At least 8 and up to 20 needle passes are required to complete the procedure.   The procedure is usually well tolerated and takes about 30minutes to complete.  You will then be recovered in the daybed unit for about an hour and discharged if well.

Results from the Pathology examination of the biopsy specimens will be available in about a week after the procedure.

Potential complications from Transrectal Ultrasound Guided Prostate Biopsy (TRUS bx) may include: bleeding from penetration of blood vessels in and around the prostate and rectum which may be  significant, infection of the prostate or bladder as a result of pushing bacteria from the rectum into the prostate or bladder or surrounding structures.  Pain may also be a complication after TRUS bx.  Blood in the urine, blood per rectum, and blood in the ejaculate might also be noted after the procedure, all of which should get better on their own.

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