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Medical History and Physical Examination

The first step in the evaluation of patients with suspected prostate cancer is a comprehensive medical history and physical examination. During this initial evaluation, the physician will:

• Ask about signs and symptoms that may be suggestive of prostate cancer
• Determine the presence of risk factors for prostate cancer
• Perform a physical examination to include the abdomen and a digital rectal exam or DRE (inserting one gloved and lubricated finger into the rectum) to assess shape and consistency of prostate.

Laboratory Evaluation

A variety of laboratory tests may be performed for patients with signs and symptoms suggestive of prostate cancer:

• Prostate Specific Antigen - PSA is a protein produced by the cells of the prostate gland. Because is can be used to detect disease, it is sometimes called a "biological marker" or "tumor marker". Low levels of PSA are normal in men, however a variety of conditions (inflammation, infection, trauma, cancer) can cause the PSA levels to rise. PSA levels alone do not provide enough information to distinguish between benign prostate conditions and cancer. However the PSA is taken into account when deciding to check further for the presence of cancer.

• Complete Blood Count - helps to determine the presence of infection (usually reflected in an elevated white blood cell count) or anemia (low red blood cell count)

• Blood Chemistries - to evaluate kidney function and electrolyte balance (potassium, sodium, chloride)

• Urinalysis and Urine Culture - to evaluate for the presence of infection as well as kidney function

Radiological Evaluation

Imaging studies that may be used in the evaluation of patients with suspected prostate cancer include:

• Transrectal ultrasound (TRUS) - This procedure allows the physician to visualize the prostate gland and surrounding tissues to determine the presence of abnormalities. The procedure is performed with the patient lying on his side and involves using a small cylinder-shaped device ("transducer") inserted into the rectum. The transducer directs high-frequency sound waves, which are transmitted to a monitoring device, which creates an image (sonogram).

• Computed Tomography (CT) - Commonly known as a CAT scan, this procedure uses special x-ray equipment to obtain images from different angles around the body and then uses computer processing of the information to show a cross-section of body tissues and organs. It usually requires injection of intravenous contrast and drinking of oral contrast to enhance the images.

• Magnetic Resonance Imaging (MRI) - MRI uses radiofrequency waves and a strong magnetic field rather than x-rays to provide remarkably clear and detailed pictures of internal organs and tissues.

• ProstaScint is a new nuclear medicine study that involves injection of a small amount of radioactive material called "Indium 111" through a vein, that travels through the body and attaches to areas where prostate cancer cells may be located. These areas will be visible to a special camera called a gamma camera, which may reveal disease that does not appear on other types of diagnostic tests. Initial computerized tomographic images are obtained on the day of the injection and additional images are acquired 4-7 days later to allow time for the ProstaScint to travel through your body and target the areas your doctor wants to study.