How does it go over to the diagnosis of cancer of prostate?

Before the suspicion of cancer of prostate, (generally before increase of PSA or of urinal problems) the doctor practises a rectal tact. This exploration allows to the experienced doctor to recognize any irregular area or of hard consistency in the prostate that should correspond to a cancer.

Not to cause excessive inconveniences, the doctor uses, for the rectal tact, a rubber glove and introduces across the year a finger previously lubricated, so that the exploration is not painful.

If the suspicion is confirmed, there must be practised a biopsy, which is indicated, in principle, in men with PSA superior to 4 ng/ml or with aberrations in the prostate. With the biopsy and the study of the extirpated textile, it will discard or confirm the presence of a cancer of prostate.

To realize the biopsy, there is used a needle of the calls of sampling, which interferes across the rectum under the guide of the trans-rectal ultrasound scan, to be able to locate perfectly the area or areas to biopsiar.


To realize the trans-rectal ultrasound scan it is necessary to place previously an ultrasound scan probe inside the rectum which laying is a little uncomfortable, just as his presence. But, at all times, the person subject to the exploration must remember that it is realized by his good and that, despite the inconveniences, it should burden nothing can happen to him.


Nevertheless it can be supported perfectly and more bearing in mind that between laying of ecográfica probe and biopsy and achievement of the biopsy, it is taken in whole between 10 and 20 minutes. To bear in mind that the biopsy occupies a very little time.

The sampling needle allows the extraction of cylinders of textile of the prostate. When there is no area or suspicious areas those that to direct the needle, usually practise a minimum of 6 punctures on themselves up to a maximum of 14 or 15, to cover the whole extension of the prostate.

The abstracted samples are sent to the pathologist, so that it establishes the diagnosis and, if it is a question of a cancer, the grade of Gleason (see earlier, in the isolated "Cancer of prostate".


Are other tests practised for the diagnosis?

When he gets ready already of the diagnosis of cancer of prostate there is realized a series of complementary, conducive proofs to be known the general state of health of the person and to try to detect if the illness has spread beyond the prostate.

This way, there are requested blood test (finished hemogram and thrombocytes) and studies of the blood biochemistry (fosfatasa alkaline, transaminasas, gamaGT, bilirrubina, urea and creatinina, cholesterol, glycemia). They face towards the state of health of the person and towards the possible presence of metástasis in bones.

For objetivar if there is affectation of the ganglions of the pelvis and to discard the affectation of the liver, there is requested a TAC (computerized axial scanner) abdominal. Alternatively, there can be preferred the RNM (magnetic nuclear resonance)

Another test of big importance is the gammagrafía of the bones. It is realized by means of the intravenous administration of radioactive material that has the characteristic of settling in the bones. This way a "map" of the skeleton is obtained. The differences of reception of the radioactive material allow to detect, if they exist, metástasis in the bones. The radioactive material tends to be received more by the metástasis than by the normal bones.

To point out that the radioactive material that is used expresses very short waves and of an average life also very short.

The first characteristic, short waves, they do that this exploration, still using radioactive material, is not dangerous for the persons who surround the patient (relatives, friends).

The second characteristic, average life cuts, means that at a few hours the radioactivity has become extinct soon, with what the safety is entire.

In this moment, from the medical point of view: to what conclusion or conclusions can we come?

We are in situation to establish the called extension diagnosis, that is to say, we already know the quantity of cancer that there has a person determined with cancer of prostate. Namely all that has spread the tumor in the prostate, to the nearby textiles, to the lymphatic ganglions and to other organs. The extension diagnosis is the factor the most important and essential prognosis to choose the treatment.

Is the same diagnostic of extension, stadium and TNM?

Yes, but both stadiums and TNM are classifications that the doctors use so much to express the extension diagnosis of every patient as to facilitate the communication between doctors.

The system TNM was designed in 1944 by a French doctor, the doctor Pierre Denoix. It had a big success and extended everybody.

TNM is based on the survival of the patients in each of the situations. It serves to plan the suitable treatment and to establish the prognosis.

In prostate cancer there is used the classification TNM and not her in stadiums. The stadiums (in general 4) are like a synthesis of the diverse situations TNM, but, in prostate cancer the TNM is considered to be more useful.

The TNM: does it have only one form?

There are two types of TNM, the clinical one (that is established by the described tests and the exploration of the doctor) and called pathological TNM or pTNM.

The pTNM adds, also, all the information gathered to the microscope by the pathologist, when it examines the extirpated textiles.

What are the possible situations of the TNM in prostate cancer?

There are the following ones:

T1: Tumor not detectable nor palpable to the rectal tact, but in which cancerous cells are, is in a resection transuretral of the prostate, in a biopsy or in a prostatectomía.

The T1 subdivide in:

T1a: It is a T1 in which the study to the microscope shows that only 5 % of the extirpated textile contains cancerous cells, while 95 % remainder is benign. The PSA was normal.

T1b: A T1 with more than 5 % of cancerous textile. Normal PSA.

T1c: Any of the previous ones, but with carcinoma PSA sugerente.

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T2: The rectal tact has allowed to feel a tumor in the prostate, but inside the gland; that is to say, it has not spread towards out to the textiles and structures of around.

The T2 subdivide in:

T2a: The tumor is only in the right side or in the lefthander of the prostate.

T2b: Both sides, right and lefthander affects the tumor.

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T3: The tumor has spread beyond the capsule that surrounds the prostate.

The T3 subdivides in:

T3a: Unilateral or bilateral extracapsular extension, but not to other textiles or organs.

T3b: Affectation of the seminal vesicles, but not to other organs.

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T4: The fixed tumor (adhered to external structures) or it invades them.

ááááá The T4 splits in:

T4a: The tumor invades the neck of the urinal bladder, the external sphincter or the rectum.

T4b: The tumor invades the muscles elevators or it is fixed in the side wall of the urinal bladder.


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How does qualify the affectation of the lymphatic ganglions near to the prostate?

There are three situations:

NX: The ganglions cannot be valued.

N0: The cancer does not affect to the ganglions.

N1: Affectation of one or more (regional) nearby lymphatic ganglions.

And the metástasis?

In a way similar to the ganglions:

MX: the metástasis over a distance cannot be valued

M0: the cancer has not spread beyond the ganglions of the region.

M1: extension of the illness to lymphatic ganglions beyond the pelvis and/or to bones, liver, lungs, brain, etc.