What is a diagnosis of prostate cancer?
Developments in Prostate Cancer Screening
The U.S. Preventive Services Task Force recently finalized their recommendation that men ages 55 to 69 should speak with their health care providers about prostate cancer screening using the prostate-specific antigen, or PSA.
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Prostate cancer screening consists of:
UCLA Urologists follow the American Urological Association’s guidelines for prostate cancer screening.
Screening is not without controversy – the PSA test, for instance, is often elevated when there is no cancer, and may not be elevated when there is (though this is rare). In addition, PSA alone cannot distinguish life-threatening tumors from those that are so slow-growing that they would be unlikely to pose any problem before the patient dies of something else. Patients should discuss the pros and cons of screening with their physician.
Early detection is key to achieving cure in men with prostate cancer. At UCLA, our ability to identify men at an early stage is enhanced by our cutting edge prostate imaging program, which utilizes the most advanced MRI technology to find tumors that conventional approaches such as ultrasound can miss. We also use specialized testing to evaluate men at high risk for prostate cancer who have had prior negative prostate biopsies.
Targeted biopsy is being used at UCLA’s Prostate Cancer Program to diagnose prostate cancer. Targeted prostate biopsy refers to using advanced MRI (and occasionally PET) imaging techniques to identify areas of the prostate suspicious for cancer, and then directly biopsying them. This leads to more accurate detection and diagnosis of prostate cancer. More about Targeted Biopsy >
If cancer is confirmed by the biopsy, the tumor’s aggressiveness can be characterized using the Gleason grading system. Looking at the cellular structure of the tumor, a pathologist will assign a Gleason score based on whether it is likely to grow quickly and spread outside the prostate. Further tests can help determine whether the tumor remains confined to the prostate or, if not, the extent to which it has already spread. This process is called staging.
The Gleason grading system assigns a grade to each of the two largest areas of cancer in the tissue samples. Grades range from 1 to 5, with 1 being the least aggressive and 5 the most aggressive. The two grades are then added together to produce a Gleason score. A score of 2 to 6 is considered low grade; 7, intermediate grade; and 8 through 10, high grade. A tumor with a low Gleason score (6) typically grows slowly enough that it may not pose a significant threat to the patient in his lifetime. A newer grading system that more clearly delineates aggressive from nonaggressive tumors is also increasingly used. The system grades cancers on a scale of 1 through 5, with 1 being indolent and 5 being the most aggressive. A score of 1 correlates with Gleason grade 3+3=6, while 5 is equivalent to Gleason score of 5+5=10. Your physician will help you to understand the risk your tumor poses.