It is not uncommon to have a patient complain of pain in the lower back, pelvis, or upper thighs, an occurrence which generally is an indication that the prostate cancer isn’t any longer a prostate cancer, but metastatic disease cells that has spread to the ribs, pelvis, and other bones throughout the body.

The problem with the symptoms of prostate cancer is that they all actually could have other causes. For instance, an infection or prostate enlargement (BPH – benign prostate hypertrophy), may be the reason why urination is difficult and frequent and more painful; while regular bone pain may be caused by an injury or something. Considering that prostate enlargement is a natural result of the aging process, this is certainly not too farfetched. Therefore waiting for or diagnosing by symptoms may be a critical error.

Again, there are no early symptoms for prostate cancer, yet that is the time when the disease is most curable. Certainly it becomes most evident that actions have to be taken in order to detect and diagnose the disease early, so that early treatment can be accorded. To this end, most doctors perform screening tests during regular physical exams so as to identify prostate cancer early. These screening (diagnostic) tests include a digital rectal examination (DRE) and a PSA (prostate specific antigen) test.

During the DRE, the physician slips a gloved finger into the rectum to feel the size, shape, and firmness of the prostate; a prostate cancer will cause a nodule or some other prostate irregularity to be felt in this manner. The PSA test measures the level of the protein or enzyme in the blood of the patient. Men all have PSA in their blood, but prostate cancer cells overproduce it. There is cause for alarm when the PSA level hovers above 4.0ng/ml, although it does not conclude that there is prostate cancer. Other infections and disorders of the prostate often cause PSA spikes. Even certain drugs do as well.

Usually, only if the other tests warrant it is a biopsy of the prostate gland done to confirm or refute the prostate cancer diagnosis. The biopsy requires that a needle is inserted through the wall of the rectum to extract a tissue sample from the prostate; examined under a microscope for the presence of cancer cells, the biopsy will tell if the patient has prostate cancer or not.

Something does need to be done once one feels the symptoms of prostate cancer, regardless of the fact that they may be coming in late. After all, even advanced stage metastatic prostate cancer can be treated, even if not cured. Prostate cancer is generally a slowly progressing disease so that the lack of symptoms in its initial stages is understandable, though not acceptable.

The warning signs that eventually present themselves imply that the cancer is no longer sequestered in the prostate gland, but beginning to spread. They include difficult or painful urination as well as urination that appears to get more frequent at night; blood in the urine or semen is common; and pain in the lower back, pelvis, or upper thighs tend to follow up.

This last set of signs and symptoms of prostate cancer may signal that the cancerous cells have spread to the ribs, pelvis, and other bones. It is not uncommon to have them be symptoms of other disease and infections that may affect the prostate, though, because they tend to follow prostate enlargement as well, which generally occurs in aging men as what some might refer to as a natural result of the aging process.

Why these specific symptoms?

The prostate gland surrounds the prostatic urethra, therefore the changes that occur within the gland, perhaps due to disease or some other phenomena, therefore directly affect urinary function.

In addition, as a result of the vas deferens deposits seminal fluid into the urethra, and because secretions from the prostate gland itself are included in semen content, the prostatic adenocarcinoma may therefore also cause the problems with sexual function and performance ? hence difficulty achieving erection and/or painful ejaculation.

And like most other forms of cancer, prostate cancer grows and spreads. Advanced stage disease spreads to other parts of the body and generally causes the additional symptoms of bone pain in the bones of the spine, pelvis or ribs, and sometimes also in the other bones like the femur, skull, feet, etc. In fact, a metastatic tumor in the spine can compress the spinal cord enough to cause leg weakness and urinary and fecal incontinence.

Prostate cancer is one of those things that may go wrong in the body to cause a rise in the level of PSA in a man’s bloodstream. There are other diseases too that may cause a PSA spike, especially other so-called prostate disorders such as prostatitis and benign prostate hypertrophy (BPH). This is generally to say that the PSA levels in the blood of a patient alone do not provide sufficient information for a prostate cancer diagnosis – other tests generally have to be carried out as well, especially the diagnostic prostate biopsy.

The biopsy is a process whereby tissue samples from the prostate gland are extracted and studied under the microscope. If a man has prostate cancer, anomalies will be seen in the biopsy that will confirm it and even show the extent of deviation. However, the results of the PSA test come in handy afterward as effort is made to determine just how much the cancer has progressed and what stage it presently is in.

In addition, a patient’s PSA levels are monitored conscientiously once he has been diagnosed, especially during and after treatment. For instance, if a patient happened to undergo a radical prostatectomy in order to cure the cancer, his PSA levels are expected to plummet to zero shortly afterwards. If this does not happen, then there is cause for concern.

Again, it does not imply that the patient is suffering a relapse of the condition, but at the very least, the supportive screening and diagnostic tests have to be carried out in order to determine if indeed he had been underdiagnosed earlier, or if the adenocarcinoma was actually coming back.

On a final note, there are forms or manifestations of prostate cancer that do not cause any notable changes in PSA levels, making them particularly difficult to diagnose. Such cancers, mostly small cell sarcomas are usually quite advanced before they are detected, and are often very aggressive in nature, and also very resistant to therapy. The safest way to be sure is to do the biopsy.

Problems that may take place in the prostate gland are typically called prostate disorders, and they are outlined in the next few lines for clarity and understanding:

BPH – This is the most common prostate disease, also known as benign prostatic hyperplasia/hypertrophy. It is a non cancerous condition of unknown cause that occurs in about 80 percent of men as they reach their 70s, which is about the same frequency of prostate cancer. Generally, BPH causes the gland to increase in size from 20 g about 150 g, constricting the urethra in the process and causing a partial obstruction of the bladder as a result. The thickenings of the bladder and urination problems that follow probably cause the symptoms of frequent urination, nighttime urination, a feeling of urgency to urinate, difficulty emptying the bladder, and a weak urinary stream.

Prostatitis – This is an inflammation of the prostate gland, which may be acute, chronic bacterial, chronic nonbacterial, or male chronic pelvic pain syndrome. Some are treated with antibiotics while the most common male chronic pelvic pain syndrome, which comprises about 95% of prostatitis diagnoses, is treated by a large variety of modalities including alpha blockers, phytotherapy, physical therapy, psychotherapy, antihistamines, anxiolytics, nerve modulators and more. The condition is most common in men ages 20 to 50. Symptoms range from pelvic pain, problems with urination, discomfort after ejaculation, and lower back pain, to infection, swelling, pain, and blood in urine, as well as an occasional fever.

Prostate cancer – This is the most common cancer in elderly men all over, the most common non skin cancer amongst American men, and the second most common cause of cancer-related death in men. There are few if any symptoms in early stages of the disease, but it can lead to difficulties with urination and bleeding in the urinary tract, and can spread to other areas of the body. Cancer of the prostatemay be identified by a digital rectal examination (DRE), a prostate-specific antigen (PSA) test, or a biopsy of the prostate gland. Treatment may vary between all the other known treatments for various forms of cancer – surgery, radiation, chemo, hormonal treatments, and so on. It is arguably the worst prostrate problem that there is.

There actually are two parts to stage D prostate cancer. Stage D1 is an instance in which the cancer is only out of the organ of origin but it has not yet metastasized to further areas, at the moment, likely still located in the lymph nodes and in the pelvis. Stage D2 occurs when the cancer has spread out as far as even the ribs. Other bones that are often affected by this are the bone of the thigh, the bones of the vertebral column, and the bones of the ribs. It is also possible that the phalanges in the feet, and the skull, are affected as well.

Stage D prostate cancer occurs only in about 10 percent of all freshly diagnosed cases of this disease in the United States. This is because of more widespread screening and improved diagnostics that allow for the majority of cancer of the prostate to be diagnosed early. Because of better treatment techniques also, most prostate cancers are likewise curable, guaranteeing as much as ten years of cancer free living. Even late stage this cancerous tumor (stage D) is very well treatable; however specialists are never keen on a cure because of the extent of invasion of other body tissues.

Stage D disease is characterized mostly by weaknesses in the structure of the infected bones, which may lead to bone fractures. This occurs because the metastatic cancer cells have caused parts of the bones to increase in density, and other parts to weaken, the contrast resulting in a brittleness that eventually makes the bone vulnerable. This can be observed in a ribonucleic bone scan, which is often carried out in order to ’stage’ the disease and determine the extent of damage done by the metastasis.

In order to stop the fractures from occurring, zoledronic acid is probably the best treatment. It is a biosphosphonate that has been shown to delay skeletal complications. Radiation treatment in patients with hormone refractory prostate cancer also may help delay some of the worst symptoms of this late stage of the disease. In order to reduce the bone pain that results, alphradin, oxydocone, and morphine may simply be the best bet for the patient. And to slow the progression of the disease while also increasing life expectancy, the doctor will likely settle for a radical prostatectomy.

There are those who refer to bone metastasis of prostate kind of cancer as bone cancer, probably due to the similarity of symptoms, but that would be inaccurate and dangerous, because the best treatment for one is not the same as the treatment for the other. The bone scan really is one of the best and most commonly used tests to determine if the prostate condition has spread to the bones, especially when the oncologist is certain that the malignancy is no longer confined to the prostate. It is used to detect areas of bone damage due to the cancer throughout the skeleton.

The scan requires the injection of a certain material into the body which collects in the areas of higher bone density, causing them to show up as hot spots in the scan. Conversely, the regions of lower density show up as cold spots. No relief there anyhow, because neither situation is a brilliant one. Bone scan results of prostate type cancer diagnosis are easy to read. The areas of bone with increased growth or breakdown compared to normal bone will absorb increased amounts of tracer and will appear as “hot spots” in the pictures taken by the gamma camera.

You should know that hot spots can be due to a number of conditions ranging from cancer, to fracture, to infection, and certain types of arthritis, as well as other chronic bone diseases. But if you have already confirmed a prostate carcinoma diagnosis, you know that what you are looking at is bone metastatic prostate condition. Also, it is not very often that you get to see cold spots in a bone scan for prostate type of cancer metastasis because they are more synonymous with multiple myeloma and certain other metabolic bone conditions.

In most cases, the results of all these tests are all that an oncologist needs so as to decide on the best course of treatment for a prostate carcinoma patient. However, there are several instances also in which the merits of the case vary in an interesting manner. A patient might have reservations about a treatment procedure; the doctor might have an instinct about the patient or a therapy; the patient could somehow turn out to have severe reactions to an intervention, or any number of other things of that nature. As a result, something may have to be worked up for the patient specially.

Ordinarily, bone metastasis of prostate form of cancer is best treated by chemotherapy, or hormone treatments, and some radiation. In some cases, the doctor might believe a combination of therapies will work best; it all depends on the results of the bone scan and other tests.

Errors of this nature may be understandable, but that does not make them acceptable. Usually, staging of prostate cancer involves the use of the results that were gotten from the PSA test and the biopsy, including further results obtained from CAT and MRI scans, with the inclusion of bone scans to determine bone metastasis. On the one part, cancer specialists desire more accurate means of diagnosing the sarcoma, and on the other hand, they also are looking for newer findings with respect to noninvasive screening tests for detecting even microscopic prostate tumor. Of course, this is the form of the condition that happens to be the most amenable, when it comes to curing it.

The PSA test is not a bad effort, really. It measures the level in the blood of prostate-specific antigen (PSA), a protein released by prostate cells. Normal and malignant prostate cells secrete the substance, but the levels rise when prostate condition is present. As such, one can rely on elevated PSA levels warning of the presence of carcinoma in the prostate even if the DRE test does not suggest anything.

But sincerely, the prostate specific antigen test really is not that specific because as many as 25 percent of men with prostate cancer will have normal PSA levels (somewhere around 4ng/mL) of blood, while more than half of men with higher PSA levels are actually cancer-free. As such, it is necessary to either find ways to minimize the error rate or find alternative means that are much more reliable.

In the meantime, though, while the medical and research community admits that the use of PSA testing for mass screening remains controversial, and while further research seeks better ways of staging and diagnosing a debilitating malignancy of cells of the prostate gland, the PSA is still very important and they are bound to use it, especially since they really don’t always want to carry out a biopsy before they know that a patient has the disease, and also since doctors may do more harm than good by exposing large numbers of men to PSA testing and follow-up tests.

Until the facts are concluded, you should hope your PSA testing numbers for prostate cancer never exceed the 4ng/ml mark because that will mean that they have to carry our more test, whether or not you have the condition . In any case, if you do have the ailment, they’d be doing you a favor; and if you don’t, it’s only a little discomfort worth the rest of your life? for that year ? you have to be back at least once next year for the same procedure.

In any case, the definitive prostate cancer diagnostic test is the prostate biopsy. In order to carry out a biopsy for this cancerous tumor, the specialist would often first go through a series of screening tests – such as the DRE and PSA (digital rectal examination and prostate specific antigen) tests which are meant to justify the biopsy- or not. If the DRE shows that there is a lump or some irregularity with the prostate gland, and the PSA test reveals a higher level in the blood than is considered safe (anything over 4.0ng/ml is considered to be indicative of a disease and dangerous), they will more than likely do the biopsy.

To carry out the biopsy of the prostate gland, a tissue sample will have to be extracted from the prostate via a needle inserted into the organ, usually through the rectum of the patient. It is often a painless procedure with minimal risk to the patient. Most times a local anesthetic is used, and it can all be done in the doctor’s office. The needle in question is a special hollow core needle that is hardly ever longer than six inches. There may be some discomfort to the patient but this does not happen too often.

The tissue thus extracted is examined underneath a microscope to observe for any deviations of the extract from normal prostate gland cells. The biopsy also has the ability to help distinguish a benign tumor from a malignant tumor, so that the urologist or oncologist will know whether treatment is needed or not. If the tumor is deemed cancerous, the specialist will have to grade the disease based on the degree of variation. On a scale of 1 to 5, the most deviation (or mutation) is 5, and the least gets a ‘Gleason’ number of 1. This score is awarded both to most abnormal cells observed and to the least mutated cells. Adding these two numbers together provides the Gleason score for the patient’s disease.

The Gleason score gotten from the biopsy virtually goes all the way to determine also if the cancer require a mono therapeutic approach or something more aggressive due to the nature of the cancer’s own aggression.

To do the test, a small sample of blood is taken from a vein in the arm and tested for the presence of PSA. The test is done in a lab and the results return with a number, which is what the doctors seek. The equipment used to test prostate specific antigen is a spectrum analyzer, which differs from manufacturer to manufacturer; a fact that may cause the results to vary somewhat as well, although there is a Stanford Protocol agreed upon by all manufacturers a while back by which they will calibrate their equipment to produce comparable results.

The PSA test assay is solid-phase, two site, monoclonal antibody immunoradiometric. The PSA in serum binds to a unique monoclonal antibody fixed on a plastic bead. Simultaneously, a separate distinct epitope of the PSA molecule is detected with a second radiolabelled monoclonal antibody. Six calibrators are used in this test at different concentrations covering the range of the test. Radioactivity is quantitated using a gamma ray counter and concentration is calculated from a standard reference curve using a plot of total counts per minute versus the log of the dose (ng/ml), connecting a straight line between each of the calibrator points.

With laboratories generally guaranteeing accuracy of no more than 80% it is understandably difficult to measure accurately in nanograms without reasonable error. However, accuracy is critical if the test is to be relied upon in spite of the even more pertinent reason for systematic errors – being instruments that have not been properly calibrated, or delayed tests in which the samples extracted are hardly valid anymore, or well – human errors.

Again it should be categorically stated that most prostate disorders lead to a spike in the PSA levels in the body; in addition, certain rare forms of prostate cancer may not even result in raised PSA levels. As a result, the test is only an indicator and a prostate biopsy is more often than not required to confirm the diagnosis.

The PSA test is a screening test that is used heavily by specialists when they are trying to detect prostate cancer in a patient. The test measures levels of the prostate-specific antigen in the blood because prostate malignant tumor cells naturally overproduce this protein and cause an elevation of it the blood. The catch is that a higher PSA level in a patient’s blood does not necessarily indicate that he is suffering from prostate cancer. Infections also can cause PSA level rises in the blood, as can certain drugs that are administered for certain diseases. Worse, there are forms of prostate kind of cancer that do not even cause PSA rises, and could be quite advanced before they are even suspected.

So, why trust so much in the test? Why do it at all if it is no help? After all, all forms of prostatic carcinoma can be confirmed by a biopsy of the prostate. Might as well just go right ahead and do the biopsy.

True there are concerns about the accuracy of the PSA test and its usefulness in screening, but the biopsy is invasive and many patients do not like it. Many cancer specialists in fact also loathe to needlessly poking of metal into body parts to extract tissue, putting the patient at untold risk, however little. The PSA test can be done by simply extracting a small blood sample and running it through the pathology lab – its results often justify or veto the need for a biopsy.

Further, the PSA level in a patient that has already been diagnosed with the killer disease suddenly becomes very important in that it aids in determining the stage and aggression of the disease when compared to the results gotten from other tests like the biopsy, a CAT scan, an MRI, and bone scans. For instance, if tissue samples are stained for the presence of PSA and other tumor markers, it can help to determine the origin of malignant cells that have metastasized to other parts of the body.

In addition, the PSA level of a patient should drop to 0 after prostate cancer treatment by radical prostatectomy with the intention of curing the disease. If this does not happen – if the PSA of such a patient continues to rise – then it suggests a more aggressive form of the disease and thus more aggressive treatment. Of course, these will only be done after other diagnostic and staging tests have been conducted.