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Usually, early prostate cancer does not cause any symptoms. Often it is diagnosed when having an elevated PSA noticed during a checkup. Before perform PSA test, it is advised to avoid sexual intercourse for 3 days prior to a PSA test. It is because, it may affects the outcome of the PSA test. Nevertheless, prostate cancer may cause some symptoms and the symptom often is quite similar to benign prostatic hyperplasia disease. These symptoms include frequent urination, increased urination at night time, difficulty to start and maintain a fixed stream of urine, blood in the urine, and felt painful when urination (Labrie et al., 2006).
Prostate cancer is related with urinary dysfunction as the prostate gland surroundings the prostatic urethra. Therefore, some changes within the gland will directly affect urinary function. For advanced prostate cancer can spread to other parts of the body, possibly will cause extra symptoms. The additional symptom can be bone pain in the vertebrae bones of the spine, pelvis, or ribs. If the prostate cancer is in the spine, it can cause compress to the spinal cord, and the patients will have leg weakness, urinary and fecal incontinence (van der Cruijsen-Koeter et al., 2005)
Screening of prostate cancer:
Screening for prostate cancer before having any symptoms is important. The following guidelines and procedures should be implemented, so to make sure early detection of prostate cancer (Grubb Iii et al., 2008) Screening can be defined as test that looking for cancer before a person has any symptoms. This can to help find cancer at an early stage. When cancer is detected early, it is easier to be treating. By the time symptoms perform, cancer may have begun to spread. Moreover, screening tests can be repeated on a regular basis. If a screening test result is abnormal, more tests are required to find out if have any cancer. This type of test is called diagnostic tests (Brawley et al., 2009).
There are two methods for prostate cancer screening: one is the digital rectal examination (DRE) which the physician will wear a glove and places lubricated finger into the rectum to examine the adjoining of the prostate. The other is the prostate-specific antigen (PSA) blood test, which measures PSA molecule concentration in the blood (Indications, 2009).
2.7.1 Prostate-specific antigen (PSA)
Prostate-specific antigen (PSA) is a protein molecules that produced by both malignant and benign prostate tissue. The PSA usually will helps to liquefy the semen. Normally, a small amount of PSA will enter the bloodstream. Cancer cells usually produce more PSA than benign cells (Kuroda et al., 2009).
Despite the fact having high PSA levels can be a sign of having prostate cancer, there are other conditions that will raise the PSA levels. These conditions will cause false-positive. The ratio to obtain prostate cancer is about one in four men who have a positive PSA test will have prostate cancer. The conditions that could cause an elevated of PSA level in male who do not have prostate cancer include the benign prostate enlargement (benign prostatic hyperplasia) and prostate infection (prostatitis) (Kuroda et al., 2009).
Besides that, the false negative can occur too. False negative is defined as a test result that incorrectly indicates patients don't have prostate cancer when patient do. This may due to some prostate cancers that grow quickly, may not produce much PSA (Kuroda et al., 2009).
Furthermore, for men ages are 75 and older do not require to get a PSA screening test for prostate cancer. The recommendations ages to have PSA testing are in between the ages of 40 and 75, and in men with higher risk of prostate cancer (Dalkin et al., 2008).
2.7.2 Digital rectal examination
Digital rectal examination (DRE) is a procedure where the physician will inserts a gloved, lubricated finger into the rectum to examine the prostate size, shape, and texture. If the areas is irregular, hard, or lumpy, further evaluation is required since may contain cancer. Even though the DRE only evaluates the back of the prostate, it is quite useful since around 85% of prostate cancers arise in back part of the prostate. However, for prostate cancer that can be felt on DRE generally is in more advanced stages (Loeb and Catalona, 2009).
Actually, the only test that cans exactly diagnosis of prostate cancer is a biopsy. The biopsy can be defined as remove a small pieces of the prostate tissue through surgery for microscopic examination. However, prior to a biopsy, some tools were used to collect more information about the prostate and the urinary tract. For example, digital rectal examination will allow physician to detect the prostate abnormalities. The cystoscopy , using a thin and flexible camera tube inserted down the urethra will shows the urinary tract from inside the bladder The transrectal ultrasonography will creates a picture of the prostate by using sound waves from a probe in the rectum (Deras et al., 2008).
If prostate cancer is suspected, a biopsy has to be done. Urologist or radiologist will obtains biopsy tissue samples from the prostate through the rectum. The procedures to obtain sample will be inserting a biopsy gun then removes the special hollow-core needles in less than a second. The biopsy gun usually will be inserted three to six times on each side of the prostate. The prostate biopsies usually are routinely done on an outpatient basis and seldom require hospitalization. However, there are around fifty-five percent of men reported to feel discomfort during prostate biopsy (Essink-Bot et al., 1998)
2.8.2 Gleason score
The biopsy tissue samples will be examined under a microscope to determine the present of cancer cell and also to evaluate the microscopic features or so call the Gleason score of cancer found. In addition, prostate specific membrane antigen is a transmembrane carboxypeptidase and will also exhibits folate hydrolase activity (Figueiredo et al., 2009) This types of protein will be overexpressed in prostate cancer tissues and is cause a higher Gleason score (Figueiredo et al., 2009).
2.8.3 Tumor markers
The biopsy tissue samples can be stained too to identify the presence of PSA and other tumor markers. The usage of staining is to determine the origin of malignant cells that have already metastasized (Chuang et al., 2007) . However, there is a type of prostate cancer that cannot be diagnosed using the PSA which is the small cell carcinoma. (Abbas et al., 1995) Fortunately, small cell carcinoma is rare type of prostate cancer but it is quite serious and quick to spread to other parts of the body (Chuang et al., 2007) .
2.8.3 Diagnostic tools under investigation
At the present time, researches are being done on non-invasive methods of prostate tumor detection. By modified adenoviruses to transfect tumor cells with harmless but distinct genes such as luciferase have proven to be capable of early detection the presence of cancer. Nevertheless, the researches of modified adenoviruses just reach the step of testing on an animal and LNCaP models (Otnes et al., 2008).
Another potential non-invasive method of early prostate tumor detection is through a molecular test. The molecular test will detects the presence of cell-associated PCA3 mRNA in urine. The PCA3 mRNA is expressed practically exclusively by prostate cells. The PCA3 mRNA will be highly over-expressed urine of prostate cancer patients. However, PCA3 is not a replacement for PSA but will be an additional tool to help determine the presence of prostate cancer. In other words, the higher the expression of PCA3 in urine, the greater to obtain a positive biopsy and also the presence of cancer cells in the prostate (Nilsson et al., 2009).
2.8.5 Prostate mapping
Prostate mapping is a method of diagnosis that can accurately determine the precise location and aggressiveness of the tumor. To done a prostate mapping require a combination of multi-sequence MRI imaging techniques, a template-guided biopsy system, and also involves taking multiple biopsies. The multiple biopsies will be carried out under general anesthetic, the specimen that obtain is through the skin that lies in front of the rectum instead of through the rectum (Onik et al., 2009).
As we known, the epithelial cells of the prostate have the ability to secrete prostasomes as well as PSA. The prostasomes can be defined as a membrane surrounded, prostate derived organelles that appear extracellularly. The prostasomes physiological function is to protect the sperm from attacks by the female immune system. In addition, for cancerous prostate cells will have the ability to continue synthesize and secrete prostasomes. It is baecause, the cancerous prostate cells want to be shield against immunological attacks by using prostasomes. Nowadays, several aspects of prostasomal involvement in prostate cancer research have been performed (Chen et al.).
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