Screening, Risk and Diagnosis

Prostate cancer mostly affects older men, but younger men with a strong family history and African American men may develop prostate cancer at a younger age. The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide if treatment is needed. Some slow-growing prostate cancers, especially in older men, may initially be handled with active surveillance. Specialists at Siteman excel in using technology and experience to make an accurate diagnosis, often down to the genetic level, so the best treatment options may be identified.

Symptoms of Prostate Cancer

Usually there are none, but some men will experience:

  • Weak or interrupted (“stop-and-go”) flow of urine
  • Sudden urge to urinate
  • Frequent urination (especially at night)
  • Trouble starting the flow of urine
  • Trouble emptying the bladder completely
  • Pain or burning while urinating
  • Blood in the urine or semen
  • A pain in the back, hips, or pelvis that doesn’t go away
  • Shortness of breath, feeling very tired, fast heartbeat, dizziness, or pale skin caused by anemia


These symptoms are similar to another non-cancerous condition called benign prostatic hypertrophy (BPH), an enlargement of the prostate that can occur as a man ages. The prostate may get bigger and block the urethra or bladder, causing trouble urinating or sexual problems. Although it is not cancer, surgery may be needed.

Risk Factors

  • Older age
  • African-American


Differentiating between prostate cancer and BPH — and if cancer, the stage — often takes more than one approach:

The following tests and procedures may be used:

  1. Physical exam and a careful history:
    These look at the patient’s past illnesses and treatments, and any signs of disease, or abnormalities.
  2. Digital rectal exam:
    The doctor or nurse inserts a gloved finger into the rectum to check for an enlarged prostate, lumps or abnormal areas.
  3. Prostate specific antigen (PSA) test: This blood test measures the level of PSA, a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate or BPH. Siteman physicians pioneered this test as a screening for prostate cancer and have successfully developed the free PSA test as a way of increasing the accuracy of cancer detection.
  4. Gleason score: This test predicts how aggressive the cancer is by looking at the cells under a microscope and then rating them from 2-10.
  5. Transrectal ultrasound: During this test, a probe that is about the size of a finger is inserted into the rectum to check the prostate. The probe is used to bounce high-energy sound waves (ultrasound) off internal structures to create a picture. It may also be used to guide a biopsy.
  6. MRI: This helps the urologist identify which part of the prostate to biopsy and know if the cancer has spread outside the prostate.
  7. Transrectal biopsy: A thin needle is inserted through the rectum into the prostate to remove cells for examination.

After prostate cancer has been diagnosed, additional tests may be done to determine if the cancer has spread to other parts of the body.

However, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level or a high Gleason score.

A bone scan may be done in patients with bone pain.

CT Scan with or without contrast dye shows detailed pictures of organs to determine how deep the cancer is within the prostate or if it is outside the prostate.

Pelvic lymphadenectomy: Sometimes pelvic lymph nodes are removed to test for cancer.

Staging of prostate cancer

Staging is ranked I through IV and recurrent, meaning the cancer comes back after treatment. Stage is an important factor in treatment options.


Chances of recovery and treatment options depend on the following:

  • The stage of the cancer — whether the cancer has spread to other places in the body
  • Gleeson score
  • Magnitude of PSA elevation
  • The patient’s age


Treatment options also may depend on whether the patient has other health problems, expected side effects of treatment, past treatment for prostate cancer and the wishes of the patient.

Most men diagnosed with prostate cancer do not die of it. Clinical trials are a good option for getting the latest treatment.