Meeting with your doctor

If you have symptoms, your doctor will want to know:

• How long have you been suffering symptoms?
• Are your symptoms getting worse over time?
• To what point are your symptoms affecting your daily life?
• What is your family history?
• What is your medical history?

Your doctor will see if your symptoms are actually because of:

• Another health problem that is not prostate cancer
• The medication you are taking
• Your chosen lifestyle

Finding the cause of your symptoms

To determine the cause of your symptoms and to help decide on a course of treatment, your doctor may decide to proceed with:

• A urine analysis. Antibiotics will be prescribed if the test detects an infection.
• A physical examination. This examination evaluates your general health and checks for any sign of illness, including any signs associated with prostate cancer. During this exam, your doctor will perform a digital rectal exam.
• A bladder diary assessment. In a journal, record your drinking habits (quantity and type) and frequency of urination.

Digital Rectal Exam (DRE)

Why? A digital rectal exam checks for changes in size and appearance. While the majority of prostate cancers affect parts of the prostate that are closer to the rectum, other abnormalities can be detected with a simple touch.

How? To check your prostate, your doctor will ask you to either stand and bend forward or lie on your side with your knees brought up to your chest. He will insert a gloved and lubricated finger into your rectum, pressing against your rectum wall, to feel your prostate to determine its size and detect any hard or abnormal areas. This exam can be uncomfortable for some men, but does not last longer than 10 to 15 seconds.

Results. If your doctor finds that the size of your prostate is larger than expected for your age, it is possible that you are suffering from benign prostatic hyperplasia (BPH). However, if your doctor finds lumps or abnormalities on the surface of your prostate, it could be cancer. This exam is not fool-proof — a cancerous prostate may feel normal to the touch.

What happens next? If your doctor detects an abnormality, they may order a prostate‑specific antigen (PSA) test. Depending on your PSA results, your doctor may refer you to a specialist, usually a urologist, who will conduct other tests such as a transrectal ultrasound (TRUS) prostate biopsy.

Prostate-Specific Antigen (PSA) test

The prostate-specific antigen (PSA) test measures PSA levels in the blood. A new blood sample is drawn each time you take a PSA test.

Depending on the results, it is possible that you and your doctor may decide to monitor your PSA levels on a regular basis to see if it changes with time.

If the total level of PSA in your blood is extremely high compared to the norm for your age, a transrectal ultrasound (TRUS) prostate biopsy may be suggested.

You will need to wait about a week before obtaining the results of your PSA test. While the PSA test is one of the best screening tools for prostate cancer, “false positive” or “false negative” results are still possible.

False-positive

• A false-positive PSA test result is possible when there is no cancer present if a man has elevated PSA levels. Such results can not only cause anxiety for the man and his family, but can also lead to more tests which have additional side effects. A prostate biopsy, for example, can cause infections, pain, and bleeding.
• Most men with an elevated PSA level do not have cancer. Only about 25% of men who underwent a prostate biopsy because of elevated PSA levels actually had prostate cancer.

False-negative

• A false-negative PSA test result occurs if a man shows normal PSA levels despite the presence of prostate cancer.
• Such results can give the patient a false sense of security and the impression that he does not have cancer even though medical attention or treatment may be required.

The next step

If your doctor believes that other tests are needed to confirm whether or not you have prostate problems, he will refer you to a urologist who will make you retake certain tests. It is possible that you will be asked to undergo another PSA test in the near future to see if your PSA levels are increasing. Depending on the results, you will decide together with your doctor what step to take next.