Possible prostate cancer diagnosis is generally driven by the PSA blood test, however at the end of the day the presence of prostate cancer can only be proven by biopsy. Diagnosis is much more accurate than it has been in the past. Treatments are becoming more effective, with less side-effects.
A paradox has caused a lot of controversy about prostate cancer diagnosis. Prostate cancer is the second commonest cause of male cancer death. Indeed, more men die of prostate cancer than women die of breast cancer. Nevertheless, there are many more indolent prostate cancers around that are not likely to cause any harm to the patient in the course of their natural life. The challenge is to find, diagnose and treat the cancers that are "wolves" without over-diagnosing and over-treating those that are "sheep".
The PSA level is only part of the picture. Many factors (e.g. family history, prostatic size, prostatic consistency, etc.) are considered by a urologist when advising a patient whether further investigation is needed. Not all patients with a high PSA will need further testing. On the other hand, some patients need further testing even when the PSA is normal.
If there is concern further evaluation may include an MRI scan followed by targeted biopsy of the prostate. If significant cancer is found, then further testing may be needed to check for possible spread before deciding on treatment.
Better diagnosis means better treatment choices for patients with clinically significant prostate cancer, with less over-diagnosis and over-treatment of those with indolent disease.
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