Diagnosis and screening
Screening
Prostate cancer screening includes several examinations, such as a PSA blood test, digital rectal examination, and prostate biopsies. A staging workup can also determine whether the cancer is confined to the prostate or has spread. Once the stage of prostate cancer is established, the urologist will discuss the treatment strategy with the patient.
80% of cancers are diagnosed while still confined to the prostate. The major prognostic factor for this cancer is the stage at diagnosis. The PSA (Prostate-Specific Antigen) test is not reliable enough to diagnose cancer on its own, but an elevated level may prompt further examination (such as a digital rectal exam), which can lead to a definitive diagnosis. This may also follow surgical treatment of a prostate adenoma.*
*Institut National du Cancer (the French National Cancer Institute) – Panorama des Cancers en France (Overview of Cancers in France), 2024
Prostate cancer tests
PSA: measured by a simple blood test
In addition to producing seminal fluid, the prostate secretes a substance called prostate-specific antigen (PSA). This is a substance specific to the prostate that circulates within the prostate and the bloodstream. PSA is a tumor marker used at all stages of prostate cancer treatment. However, PSA is not specific to prostate cancer, as it can also increase in other prostate conditions: benign prostatic hyperplasia, prostate inflammation and infection. Therefore, PSA is only one step in the diagnosis of prostate cancer and must be complemented by other examinations. Between 5% and 10% of cancers detectable by digital rectal exam initially present with a normal PSA.
Sources:
Les traitements du cancer de la prostate (Prostate cancer treatments), from the collection Guides patients Cancer Info (Cancer Info: a patient’s guide), INCa, November 2010
La prise en charge du cancer de la prostate. Guide patient – Affectation de longue durée (Prostate cancer management. A patient’s guide –
A long-term condition), HAS, June 2010
L’antigène spécifique de la prostate ou PSA (Prostate-specific antigen or PSA), Prog Urol, 2011, 21, 11, 798-800, R. Boissier (www.urofrance.org)
Rectal examination
This examination is performed by a physician (general practitioner or urologist), who palpates the prostate through the rectum. It is a quick and painless examination aimed at assessing the size and consistency of the prostate, as well as detecting any abnormalities that can be felt on examination (enlargement, firmer areas, etc.).
Source:
Les traitements du cancer de la prostate (Prostate cancer treatments), from the collection Guides patients Cancer Info (Cancer Info: a patient’s guide), INCa, October 2016
MRI (Magnetic Resonance Imaging)
This examination, carried out before biopsies, can often show the suspected area or areas in the prostate and determine the extent of the lesion (involvement of the prostatic capsule, seminal vesicles, and pelvic lymph nodes). Not all
anomalies detected by MRI are forms of cancer.
Source:
Imagerie du cancer de la prostate: IRM et imagerie nucléaire (Prostate cancer imaging: MRI and nuclear imaging), Prog Urol, 2015, 25, 15, 933-946, R. Renard-Penna (www.urofrance.org)
Prostate biopsies
A prostate biopsy consists of taking tiny samples of prostate tissue and having them analyzed in a laboratory to study the types of cells contained in the collected specimens. Under local anesthesia, at least 12 tissue samples are taken from different areas of the prostate. These samples are then examined under a microscope by a pathologist, who will confirm or rule out the presence of cancer. The objectives of the biopsy are:
- to determine the aggressiveness of the cancer cells, defined according to a scale known as the Gleason score (the degree of tumor differentiation, i.e., the extent to which the tumor resembles normal prostate tissue)
- and to assess the number of positive biopsy cores (containing cancer cells), the characteristics of the tumor tissue, and whether cancer cells have extended beyond the prostatic capsule.
Source:
Les traitements du cancer de la prostate (Prostate cancer treatments), from the collection Guides patients Cancer Info (Cancer Info: a patient’s guide), INCa, October 2016
PET scan
PET scans are used to show locoregional and remote invasion.
Bone scintigraphy and scan
The urologist will sometimes prescribe a chest-abdominal scan and a bone scintigraphy. This test can detect the spread of prostate cancer to the bones.
For more information
The different stages of cancer
The stage of prostate cancer is determined by the amount of cancer present in the body and its location at the time of diagnosis.
Treatments
The treatment strategy is tailored to each individual case. It depends primarily on the characteristics of the cancer affecting the patient: its location, grade and stage.