Diagnosis is the recognition of the nature of an illness or disease by the analysis of the symptoms a patient is experiencing. The diagnosis of prostate cancer usually begins with prostatitis. Prostatitis is a painful inflammation of the prostate that may or may not be caused by an infection. There are many signs and symptoms of prostatitis:
Hematuria (blood in the urine) or semen in urine
Burning or pain during urination
Difficult or painful ejaculation
Discharge from the urethra
Pain or discomfort in genitals, groin, lower abdomen and/or lower back.
Pain or pressure in the rectum
Urinary frequency
Urinary urgency
Decreased urinary stream
Trouble passing urine
Fever, chills, muscle aches
Recurring urinary tract infections
Issues with sexual intercourse and a decrease in libido
The National Institute of Diabetes and Digestive and Kidney Diseases in the United States classifies prostatitis into 4 types.
Acute bacterial prostatitis – symptoms begin instantaneously and may be quite severe, caused by a bacteria (least common, easiest to treat).
Chronic bacterial prostatitis – milder symptoms. Cause urinary symptoms like burning or pain during urination but does not cause fever or chills. (more common in older men with benign prostatic hyperplasia).
Chronic non-bacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS) – causes pain or discomfort in the pelvis that may come or go, caused by bacteria (most common type or prostatitis).
Asymptomatic inflammatory prostatitis – there are no symptoms involved with this type of prostatitis and it does not need to be treated. A patient would be diagnosed with asymptomatic inflammatory prostatitis when white blood cells are found in the prostate or prostatic fluid during other tests/screenings when looking for other conditions.
http://www.cancer.ca/en/cancer-information/cancer-type/prostate/prostate-cancer/prostatitis/?region=on#ixzz5WC0PITbx
If the doctor finds that prostatitis is present or suspected to be present, tests will be done to form a diagnosis. This includes physical exams like a digital rectal exam (DRE). The doctor will also perform urine tests and urinalysis to check for bacteria and white blood cells in the urine. They will also do a complete blood count (CBC), a prostate-specific antigen (PSA) test which is usually performed after the inflammation in the prostate is no longer present, as well as blood chemistry tests. The doctor may also do an ultrasound if the patient is having difficulty urinating, this allows the doctor to see how much urine is trapped in the bladder.
Urinalysis
A test that measures substances found in urine, such as electrolytes, hormones or waste products of metabolism. A urinalysis can be done for many different reasons:
To check for cancer in the urinary tract
As a routine check-up
To screen for metabolic and kidney disorders
To screen for urinary tract infections
To look for and measure substances that aren’t normally found in urine (cells lining the kidneys and bladder, red and white blood cells, bacteria or other organisms, substances that the kidney filters, such as glucose).
To perform a urinalysis test urine is collected in a clean container which is then sent to a laboratory to be examined and analyzed under a microscope. The laboratory technician will check for physical characteristics, such as appearance and the colour of the urine. A microscopic analysis is then done. A dipstick (a special reagent strip with chemicals on it) is dipped into the urine. It is then removed and compared to a chart. A series of chemical tests are then performed. Urine study results can be affected by factors such as stress, diet, medications and physical activities. When performing a urinalysis, the lab technician would look at:
Colour
pH
Protein
Glucose
Ketones
Blood
Bilirubin (a byproduct of red blood cell breakdown)
Urobilinogen
Nitrite
White blood cells (WBCs or Leukocytes)
Specific gravity (how concentrated or dilute the urine is)
Digital Rectal Exam (DRE)
An exam in which a healthcare professional inserts a gloved finger into the rectum to check for any abnormalities. DREs are most often done as part of a routine physical exam in adults. It can also be done to:
Check for enlargement of the prostate gland and any other abnormalities in men. This can be done with a PSA test in order to find prostate cancer in the early stages
Check for and diagnose colorectal cancer
Check the organs in the woman’s pelvis.
Help find the cause of blood in the stool, rectal bleeding, changes in bowel habits or urination, lower abdominal or pelvic pain
Check for hemorrhoids and growths in the rectum
A DRE is usually done alongside other tests to check for abnormalities. Despite the test results coming back as normal, a problem may still exist and further tests may be suggested.
Abnormalities may include:
Enlargement of the prostate or growths or tumours (in men)
Hemorrhoids, polyps, fissures or other problems in the rectum
Growths or tumours (such as cancer) in the rectum
Growths or tumours of the cervix, uterus or ovaries
If any abnormalities are found, the healthcare professional will decide any further tests, procedures, follow-up care or treatment that is necessary.
Complete Blood Count (CBC)
A blood test that looks at the numbers and features of blood cells. It examines 3 types: red blood cells (RBCs), white blood cells (WBCs) and platelets (a type of blood cell that helps blood to clot). A CBC is usually done in a community lab or hospital. Blood is usually taken from a vein in the arm. Blood is collected in a tube and examined by a lab technologist using microscopes and other special equipment. A CBC measures the:
Total number of RBCs
Total amount of hemoglobin (a protein found in RBCs that carries oxygen and gives blood its red colour) in the blood.
Percentage of blood made up of RBCs (the hematocrit)
Average RBC size (the average corpuscular volume)
Average weight of hemoglobin per RBC (the average corpuscular hemoglobin)
Average amount of hemoglobin per RBC (the average corpuscular hemoglobin concentration)
Total number of WBCs
Number of each type of WBC, including neutrophils (a type of WBC that defends the body against bacteria, viruses and types of fungus
Number of platelets
A low RBC count may be caused by a Hodgkin’s lymphoma or other lymphomas and can be related to cancers of the blood, like leukemia and multiple myeloma. A low WBC count may be due to leukemia or other bone marrow diseases, but can also be caused by bone marrow suppressions that may be triggered by chemotherapy or radiation therapy. A high WBC can be a sign of leukemia or other types of cancers, such as bronchogenic carcinoma. A low platelet count may be due to leukemia, lymphomas, and treatments such as chemotherapy or radiation therapy, while a high platelet count can also be caused by some types of leukemia.
Prostate-Specific Antigen (PSA)
A blood test that measures the amount of prostate-specific antigen is in the blood. PSA is a protein found in semen and blood that is made by the prostate cells. Ejaculation and certain types of medications can affect PSA levels in the body. PSA tests are done to:
Help diagnosis prostate cancer early on (specifically in men who have not experienced any signs or symptoms).
Find cancer in men who have experienced signs or symptoms of prostate cancer
Confirm if a patient has prostate cancer
Help form a prognosis for prostate cancer
Determine if the cancer has spread outside of the prostate
Help make a treatment plan for the patient with prostate cancer
Monitor individuals with prostate cancer (if the treatments are working or if the cancer has recurred following treatment)
A PSA test can find prostate cancer early on before it spreads outside of the prostate or grows to dangerous sizes. This will make the prognosis better and treatments will have better results. Although this is the case, PSA testing can also provide false-positive and false-negative results. A false-positive result is when the PSA test shows that the individual has prostate cancer when he doesn’t. A false-negative result is when the PSA test suggest the individual has a normal level of PSA even though he does have prostate cancer. PSA testing can also lead to overdiagnosis. This means diagnosing a prostate cancer that is not harmful to the patient’s health. This is a risk as unnecessary treatments may be given, these treatments can cause more problems for the man, including erectile dysfunction and urinary incontinence.
PSA levels vary depending on the man’s age. Older men naturally have higher PSA levels, these levels can fluctuate for many reasons. Higher prostate-specific antigen levels can usually be a sign of prostate cancer, but it can also be due to prostatitis, benign prostatic hyperplasia, UTI, transrectal ultrasound, biopsy, urinary catheter, ejaculation, warmer climates, etc. PSA levels can also go up temporarily after a few years of having radiation therapy to treat the prostate, known as a “PSA bounce”. There are multiple kinds of PSA testing:
Serial PSA testing: used to monitor a man’s response to cancer treatment (not as useful in diagnosis) by looking at how PSA levels change overtime.
Free and bound PSA: looks at whether the PSA is bound, or unbound (free) to other proteins.
PSA density and PSA of the transition zone: PSA density is the level of PSA in the blood related to the size of the prostate (measured during a TRUS). PSA of the transition zone is the level of PSA in the blood related to the volume of the transition zone of the prostate (more accurate in identifying a benign prostatic hyperplasia or prostate cancer).
Transrectal Ultrasounds
An imaging test using high-frequency sound waves emitted from an ultrasound transducer (also called a probe) that is inserted into the anus. The sound waves bounce off of the wall of the rectum and into the prostate to form a picture, which are then analyzed by a computer that displays the images on a screen. A radiologist will examine the images and can decide on further tests, procedures or additional treatments if they are needed. Transrectal ultrasounds can be done to:
Look at the size, location and structure of soft tissue organs
Look for abnormal areas in the prostate
Differentiate fluid-filled cysts from solid tumours
Act as a guide for a doctor performing a biopsy
Gleason staging
Show the direction and how fast blood flows through vessels.
Prostate Biopsy: used to determine if specific tissue is cancerous or not. A biopsy needle (along with an ultrasound probe) is inserted into the rectum. The ultrasound helps the doctor guide the needle through the rectum and into the prostate which then removes a 8-12 sample of tissue.