Digital Rectal Exam

During a DRE, the doctor inserts a

gloved, lubricated finger into the
patients rectum to examine his
prostate, which is adjacent to the
rectum.

If the doctor finds any

abnormalities in the texture, shape
or size of the gland, the patient
may be referred for further tests.
Digital Rectal Exam
 Prostate-specific Antigen (PSA) Test
A blood sample is drawn from a vein
in arm and analyzed for PSA, a
substance that's naturally produced
by prostate gland.
It's normal for a small amount of PSA
to be in the bloodstream. However, if
a higher than normal level is found, it
may indicate prostate infection,
inflammation, enlargement or cancer.
Prostate-specific Antigen (PSA) Test
 Transrectal Prostate Ultrasound

Prostate ultrasound uses a probe about the

size of a finger that’s inserted a short distance
into the patient’s rectum.

This probe creates harmless sound waves. A

machine records the sound waves and turns
them into videos or photos of your prostate
gland.

The probe can provide images at different

angles to help your doctor estimate the size
of your prostate and spot abnormal growths.
 Prostate Biopsy
A prostate biopsy uses transrectal
ultrasound imaging (meaning it
goes through the lining of your
rectum) to guide several small
needles through the rectum wall
into areas of the prostate where
the doctor sees something
unusual.
The needles remove a tiny amount
of tissue.
Transrectal Prostate Ultrasound and Prostate Biopsy
 (CAT) Computerized Axial Tomography Scan

A CAT scan uses X-rays and computers

to produce an image of a cross-
section of the body.
This image allows the doctor to check
for swollen or enlarged lymph nodes,
which might mean that cancer has
spread.
 Cystoscopy or Bladder Scope Test

A cystoscopy is a test to check the health of

your urethra and bladder. You might also hear
it called a cystourethroscopy or, more simply, a
bladder scope.

The doctor inserts a tube into your urethra. If

you’re a man, the opening is at the end of
your penis.
The test lets your doctor check the complete
length of your urethra and the bladder for
polyps, narrow areas called strictures,
abnormal growths, and other problems.
 Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) of
the prostate uses a powerful magnetic
field, radio waves and a computer to
produce detailed pictures of the
structures within a man's prostate
gland.

It is primarily used to evaluate the

extent of prostate cancer and
determine whether it has spread.
 Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) of
the prostate uses a powerful magnetic
field, radio waves and a computer to
produce detailed pictures of the
structures within a man's prostate
gland.

It is primarily used to evaluate the

extent of prostate cancer and
determine whether it has spread.
Prostate Cancer Grading & Prognostic Scoring
The Gleason Score is the grading system used
to determine the aggressiveness of prostate
cancer.
This grading system can be used to choose
appropriate treatment options.
The Gleason Score ranges from 1-5 and
describes how much the cancer from a biopsy
looks like healthy tissue (lower score) or
abnormal tissue (higher score).
Most cancers score a grade of 3 or higher.
Since prostate tumors are often made up
of cancerous cells that have different
grades, two grades are assigned for each
patient.
A primary grade is given to describe the
cells that make up the largest area of the
tumor and a secondary grade is given to
describe the cells of the next largest area.
If the cancer is almost entirely made up of
cells with the same score, the grade for
that area is counted twice to calculated the
total Gleason Score.
Typical Gleason Scores range from 6-10. The higher the
Gleason Score, the more likely that the cancer will grow
and spread quickly.

Scores of 6 or less describe cancer cells that look similar

to normal cells and suggest that the cancer is likely to
grow slowly.
A score of 7 suggests and intermediate risk for aggressive
cancer. Scoring a 7 means that the primary score (largest
section of the tumor) scored a 3 or 4.
Tumors with a primary score of 3 and a secondary score
of 4 have a fairly good outlook, whereas cancers with a
primary Gleason Score of 4 and a secondary score of 3,
are more likely to grow and spread.
Scores of 8 or higher describe cancers that are likely to
spread more rapidly, these cancers are often referred to
as poorly differentiated or high grade
 How Important is the Gleason Score?

The Gleason Score is very useful for predicting the

behavior of a prostate cancer. However, other
factors also contribute to determining the stage of
prostate cancer, including:
1. The PSA level
2. Findings from a rectal exam
3. The number of biopsy core samples that contain
cancer
4. The percentage of cancer making up each
biopsy core sample
5. If cancer is found in one or both sides of the
prostate
6. If the cancer has spread outside the prostate
The new prostate grading system is an
extension of the current Gleason grading scale
for determining the stage of prostate cancer.
This system is designed to provide a simplified
and more accurate grading stratification system
than the current Gleason Score.
This new method is especially focused on
better representing low grade disease to reduce
unnecessary treatment of indolent prostate
cancer.
Thank You for Listening!