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Prostate Cancer - Diagnosis

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Prostate Cancer

Nearly 90 percent of all prostate cancers are currently diagnosed at an early stage and, therefore, men are surviving longer after diagnosis. There are two tests that are commonly used to detect prostate cancer in the absence of any symptoms. The first is the digital rectal exam (DRE) where your doctor feels the prostate on exam. The second is a blood test used to detect a substance made by the prostate called prostate-specific antigen (PSA).

Since the start of widespread use of PSA testing in screening for prostate cancer there has been a 50% decline in death from prostate cancer.[1] Both the National Comprehensive Cancer Network(NCCN) and the American Urological Association(AUA) recommend discussing prostate cancer screening starting at the age of 45 and 55 respectively[5, 6]. The AUA also recommends that men at a higher risk of prostate cancer may consider an individualized approach to prostate cancer screening that could include starting even earlier. The diagnosis of prostate cancer is made on the basis of a prostate biopsy performed under ultrasound guidance generally in the physician's office. Further refinements and advancements continue to help aid in the diagnosis of prostate cancer in certain situations such as MRI fused biopsy and biomarkers[7].

Sources:

1. Welch, H.G., D.H. Gorski, and P.C. Albertsen, Trends in Metastatic Breast and Prostate Cancer--Lessons in Cancer Dynamics. N Engl J Med, 2015. 373(18): p. 1685-7.

2. Andriole, G.L., et al., Mortality results from a randomized prostate-cancer screening trial. N Engl J Med, 2009. 360(13): p. 1310-9.

3. Schroder, F.H., et al., Screening and prostate-cancer mortality in a randomized European study. N Engl J Med, 2009. 360(13): p. 1320-8.

4. Shoag, J.E., S. Mittal, and J.C. Hu, Reevaluating PSA Testing Rates in the PLCO Trial. N Engl J Med, 2016. 374(18): p. 1795-6.

5. Carroll, P.R., et al., NCCN Guidelines Insights: Prostate Cancer Early Detection, Version 2.2016. J Natl Compr Canc Netw, 2016. 14(5): p. 509-19.

6. Carter, H.B., et al., Early detection of prostate cancer: AUA Guideline. J Urol, 2013. 190(2): p. 419-26.

7. Siddiqui, M.M., et al., Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA, 2015. 313(4): p. 390-7.