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Prostate Cancer : Diagnosis
Western Medicine Chinese Medicine

Because prostate cancer is usually silent, there are very few symptoms or aspects of a person's history able to give clues that they may have prostate cancer. If close relatives have suffered from prostate cancer, especially at an early age (below the age of 50) your risk of developing it is higher. However, being a male over the age of fifty increases your risk enough to make it sensible to have your medical adviser check you once a year for signs of prostate cancer. This is usually done by feeling the prostate through the wall of the rectum with a finger, looking for enlargement, hardness or irregularity. The prostate is normally a smooth organ the size and shape of a walnut. However, diagnosing prostate cancers this way means the cancer is already quite advanced by the time it can be felt. In the late eighties, a blood test that measures a protein linked to prostate gland activity called the prostate specific antigen, (PSA), was developed to give an earlier warning of possible prostate cancer. Unfortunately, this test can be positive in people with normal prostates so some medical experts say it leads to unnecessary testing and anxiety. Things like a bladder infection or even just a prostate examination can raise PSA levels. However, it has been widely adopted in western countries like the USA and Australia, and as a result, many cases of prostate cancer are being diagnosed earlier.

If a case of prostate cancer is suspected, the next step is to take a tissue sample (a biopsy) using an ultrasound probe inserted into the rectum to locate the suspect prostatic tissue. The tissue sample will be examined by a pathologist who will then report on whether or not cancerous cells are present.

Because prostate cancer usually sends secondary tumours to the bone, a bone scan will be done to locate any secondary tumours, especially in the spine and pelvis. A computerised Tomography (CT) scan or Magnetic resonance Imaging (MRI) scan may also be done to determine whether the tumour has spread beyond the prostate. This information is used to "stage" the tumour, that is give it a numbered ranking, with stage one being the earliest and easiest to treat.

Other tests that may be done include a full blood count and biochemical profile, an electrocardiogram (ECG) and a general physical examination to determine whether you are a suitable candidate for the extensive surgery needed to remove a prostate cancer.

Diagnosis of prostate cancer mainly depends on western methodologies because the concept of a prostate organ did not exist originally in Traditional Chinese Medicine. Examination of a man's prostate organ through the rectum is usually done during routine physical check ups to detect its size and texture. Ultrasound and CT (computed tomography) scans are very helpful for diagnosis and locating areas to which the disease may have spread. Other measures include looking for cancer cells in prostatic fluid or from a fine needle biopsy of the prostate. Recently prostate specific antigen (PSA) blood tests have been used to screen for early prostate cancer in older men, usually those over fifty.

Prostate cancer can only be differentiated from benign prostatic hypertrophy by using modern medical investigations. Benign prostatic hypertrophy occurs when the prostate gland enlarges and puts pressure on the bladder and urethra (the urinary outflow tract from the bladder). In TCM and western medicine, there are no big differences between prostate cancer and benign prostatic hypertrophy symptoms. Likewise, the TCM tongue and pulse signs are similar for both conditions. However, benign prostatic hypertrophy, while able to cause significant discomfort and put dangerous backpressure on the kidney, is not a form of cancer and does not metastasize (spread to other parts of the body).

In TCM, the diagnosis is not prostate cancer per se but rather a classification of its symptoms into five different syndromes, which are outlined below. The general progression of prostate cancer from a TCM perspective goes from damp-heat flowing downward in the body to stagnation of qi and blood stasis to hyperactivity of heart-fire and hyperactivity of excessive ministerial fire, finally leading to kidney failure.

Diagnosis is based on four important examination techniques. The first is "questioning." The TCM practitioner will want to know important information such as what your current complaints are, your past medical history and family health history. The second technique is "observation." Looking at the physical features of the body such as the face, tongue, hair, nails, sputum and area of pain all give clues as to what the problem may be. The third technique is "hearing and smelling." Smelling the sputum and breath and listening to the sounds coming from the chest are important. The last technique used in examination is "touching." Feeling the pulse is a cornerstone of TCM diagnosis and gives the TCM practitioner a lot of information about imbalance in the body. If the TCM practitioner suspects there might be a serious problem that Chinese medicine alone cannot treat he or she may recommend that the individual see a western doctor for further follow up.

Features of the TCM syndromes associated with prostate cancer are:

Damp-heat is heavy and likes to flow downward and accumulate in the lower burner (bladder, large intestine) region, which results in frequent, difficult and/ or urgent urination. The tongue appears red with a yellow and greasy covering, and the pulse is rolling and rapid with this syndrome.

Kidney-Yin Exhaustion
Under normal conditions, kidney-yin & kidney-yang restrict, promote, and depend on each other in order to maintain a dynamic balance of yin & yang. This means the kidneys are kept in a constant state of functioning where they are not over or under functioning. When kidney-yin becomes exhausted and cannot perform its usual functions, kidney yang cannot be kept in check and the body experiences virtual heat symptoms. These symptoms manifest as urinary frequency and urgency, dry throat, restlessness, dry and hard stools, hot feelings in the palms, lower back, knee soreness and weakness of the lower extremities. The tongue appears red without a mossy covering, and the pulse feels thready and soft.

Decline of Kidney-Yang
This type is seldom encountered but is very serious. Kidney-yang is the main source of energy for life's activities. Therefore, if kidney-yang declines, the body will be unable to perform warming and promoting functions, causing a yang-deficiency in many other organs, which may lead to death. Individuals usually feel weak and fatigued. They have pale complexions, cold limbs, sore loins (waist area) and experience an aversion to cold temperatures. Urinary symptoms associated with this condition include urinary frequency, dribbling urination and a weak urine stream. The tongue appears pale with a thin fur layer, and the pulse feels deep and weak.

Stagnation of Qi
When qi movement is sluggish, it causes improper fluid circulation. Symptoms related to improper fluid circulation include difficulty urinating, inability to urinate, emotional depression, irritability, quick temper and chest and abdominal distension. The pulse is stringy, and the tongue is red with a yellowish, thin fur. Those who also have blood stasis (poor blood flow) will have a dark tongue with pinpoint bruises and a hesitant pulse.

Hyperactivity of Heart-fire
A kidney-yin deficiency can also affect the heart by disrupting its normal functions and creating a "heart fire evil" or heart-yang excess. When this happens, the blood vessels become damaged and the blood leaks out. Urinary symptoms related to this condition include haematuria (blood in the urine), prickling pain on urination and dark-colored urine. Other symptoms include insomnia, feeling annoyed and the presence of boils on the mouth and tongue. On examination, the tongue usually has a red tip, sometimes with a prickly appearance and a thin or yellowish fur coating. The pulse feels thready and rapid.

If one suffers from hyperactivity of excessive ministerial fire, symptoms such as hyper-sexuality, a red tongue with a thin or yellowish fur and a rolling and rapid pulse will be present. (See causes section under heat for further explanation.)

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