Best Diagnostic Test For Prostate Cancer

Getting The Results Of The Biopsy

Your biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. Getting the results usually takes at least 1 to 3 days, but it can sometimes take longer. The results might be reported as:

• Positive for cancer: Cancer cells were seen in the biopsy samples.
• Negative for cancer: No cancer cells were seen in the biopsy samples.
• Suspicious: Something abnormal was seen, but it might not be cancer.

If the biopsy is negative

If the prostate biopsy results are negative , and the chance that you have prostate cancer isnt very high based on your PSA level and other tests, you might not need any more tests, other than repeat PSA tests sometime later.

But even if many samples are taken, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer , your doctor might suggest:

• Getting other lab tests to help get a better idea of whether or not you might have prostate cancer. Examples of such tests include the Prostate Health Index , 4Kscore test, PCA3 tests , and ConfirmMDx. These tests are discussed in Whats New in Prostate Cancer Research?
• Getting a repeat prostate biopsy. This might include getting additional samples of parts of the prostate not biopsied the first time, or using imaging tests such as MRI to look more closely for abnormal areas to target.

Prostate cancer grade

Gleason score

What Is The Psa Test

Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in the blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.

The blood level of PSA is often elevated in people with prostate cancer, and the PSA test was originally approved by the FDA in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the PSA test to be used in conjunction with a digital rectal exam to aid in the detection of prostate cancer in men 50 years and older. Until about 2008, many doctors and professional organizations had encouraged yearly PSA screening for prostate cancer beginning at age 50.

PSA testing is also often used by health care providers for individuals who report prostate symptoms to help determine the nature of the problem.

In addition to prostate cancer, several benign conditions can cause a persons PSA level to rise, particularly prostatitis and benign prostatic hyperplasia . There is no evidence that either condition leads to prostate cancer, but someone can have one or both of these conditions and develop prostate cancer as well.

Repeating The Psa Test

A mans blood PSA level can vary over time , so some doctors recommend repeating the test after a month or so if the initial PSA result is abnormal. This is most likely to be a reasonable option if the PSA level is on the lower end of the borderline range . For higher PSA levels, doctors are more likely to recommend getting other tests, or going straight to a prostate biopsy.

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How Do I Get Screened

The gold-standard test for prostate cancer screening is the PSA test.

The PSA test measures levels of prostate-specific antigen in the blood. PSA is a protein produced by the cells of the prostate. Because cancerous cells tend to produce more PSA, a spike in your PSA level may signify a problem, however, there are other benign conditions that may cause an uptick in PSA. Read more here about how to make sure your PSA test is as accurate as possible. If youre having a PSA test, it can often be added on to other blood work you may be having that day, and you may not need a separate blood draw.

Tracking your PSA over time can be valuable to distinguish a temporary increase from a gradual, yet persistent rise. Even if your level is still within normal range, but is higher than it was the last time it was tested, its worth checking further. After a single high PSA result, often the first step is to repeat the test a couple of weeks later to confirm that it is, in fact, elevated. This should be done at the same lab as the previous test, to avoid fluctuations due to different equipment.

Recent Advances: Molecular Markers

Currently, risk stratification for men who have recently been diagnosed with prostate cancer by biopsy is accomplished with the combination of prostate-specific antigen level, clinical stage, and Gleason score or Grade Group. The limitation of using these parameters for risk stratification is that collectively they do not address specific biologic features of prostate cancer, specifically the aggressiveness of tumor cells. In addition, many studies have shown that localized prostate malignancy can vary in potential for progression in different patients, despite similar risk-stratifying characteristics.

This problem has sparked the advent of research and use of biological/genomic assays to help risk stratify men diagnosed with localized prostate cancer. The theory behind utilizing genomic assays is to identify genes in biopsy specimens that potentiate cellular proliferation.

Cooperberg et al aimed to validate the application of the cell cycle progression score in identifying men at risk for recurrent disease after radical prostatectomy. The CCP score identifies genes that promote cellular proliferation. In this study, the CCP score was compared with the Cancer of the Prostate Risk Assessment post-Surgical , which risk stratifies recurrence after prostatectomy based on pre-procedural PSA, Gleason score, and clinical staging, and has been shown to have good accuracy.

• Confirm MDx
• Oncotype DX
• Promark

References

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Biopsy During Surgery To Treat Prostate Cancer

If there is more than a very small chance that the cancer might have spread , the surgeon may remove lymph nodes in the pelvis during the same operation as the removal of the prostate, which is known as a radical prostatectomy .

The lymph nodes and the prostate are then sent to the lab to be looked at. The lab results are usually available several days after surgery.

If Screening Test Results Arent Normal

If you are screened for prostate cancer and your initial blood PSA level is higher than normal, it doesnt always mean that you have prostate cancer. Many men with higher than normal PSA levels do not have cancer. Still, further testing will be needed to help find out what is going on. Your doctor may advise one of these options:

• Waiting a while and having a second PSA test
• Getting another type of test to get a better idea of if you might have cancer
• Getting a prostate biopsy to find out if you have cancer

Its important to discuss your options, including their possible pros and cons, with your doctor to help you choose one you are comfortable with. Factors that might affect which option is best for you include:

• Your age and overall health
• The likelihood that you have prostate cancer
• Your own comfort level with waiting or getting further tests

If your initial PSA test was ordered by your primary care provider, you may be referred to a urologist for this discussion or for further testing.

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Greater Accuracy And Changing Treatment

Approximately 300 men were enrolled in the Australian trial, all with newly diagnosed localized prostate cancer , and all were considered to have high-risk disease. For all men in the trial, the planned treatment was either surgery or radiation therapy to the prostate only.

Half the men were randomly assigned to initially undergo a CT and bone scan, and the other half to PSMA PET-CT.

Based on the imaging, PSMA PET-CT was 27% more accurate than the standard approach at detecting any metastases . Accuracy was determined by combining the scans sensitivity and specificity, measures that show a tests ability to correctly identify when disease is present and not present.

PSMA PET-CT was more accurate for both metastases found in lymph nodes in the pelvis and in more distant parts of the body, including bone. Radiation exposure was also substantially lower with PSMA PET-CT than with the conventional approach.

The trial investigators also tracked how imaging results influenced clinicians treatment choices. Based on imaging findings, the initial treatment plan was changed for 15% of men who underwent conventional imaging compared with 28% of men who underwent PSMA PET-CT.

Another key finding, Dr. Hofman noted, was that PSMA PET-CT was much less likely to produce inconclusive, or equivocal, results .

Thats important, he continued, because if you have a scan with equivocal findings, it often leads to more scans or biopsies or other tests.

Prostate Cancer Enzyme Tests

Some tests check for enzymes that prostate cancer produces to see if cancer is present and gauge whether it may be aggressive or fast growing. These tests use either blood or urine samples to determine a persons overall risk for prostate cancer.

Doctors usually recommend these tests for males who have high PSA scores or whose doctors find abnormalities during a digital prostate exam.

A newer blood test is the 4Kscore test, which measures a persons risk of prostate cancer.

This test does not completely replace the need for a biopsy, but it can help identify who should have one. As a result, it may help doctors

4Kscore test is also effective for testing African American and Afro Caribbean men for prostate cancer.

Enzyme tests cannot identify every case of prostate cancer, but neither do biopsies. Instead, blood and urine screenings can identify the most aggressive presentations of the disease.

Some forms of prostate cancer are slow growing rather than aggressive. Slow growing prostate cancer is unlikely to be fatal.

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Prostate Specific Antigen Test

A blood test called a prostate specific antigen test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.

As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.

PSA levels also can be affected by

• Certain medical procedures.

Ct Scanning Mri And Bone Scanning

Men with PSA levels above 10 ng/mL, high-grade histology , or physical findings that suggest stage T3 disease should probably undergo a staging computed tomography scan and bone scan. CT scanning is the one modality with evidence-based guidelines. The CT scan can be used to evaluate extension into the bladder and lymph nodes to help stage the patient’s cancer or to consider lymph node sampling prior to treatment.

According to the National Comprehensive Cancer Network , technetium-99m-methyl diphosphonate bone scan is indicated in the initial evaluation of patients at high risk for skeletal metastases, as indicated by any of the following :

• T1 disease, PSA 20
• T3/T4 disease
• Symptoms suggestive of osseous metastasis

The NCCN recommends pelvic CT or magnetic resonance imaging in patients with any of the following:

• T3 disease
• T4 disease
• T1-T2 disease and nomogram-indicated probability of lymph node involvement > 10%

Conventional endorectal MRI is helpful for localizing cancer within the prostate and seminal vesicles and for local staging. Dynamic, contrast-enhanced MRI and MR spectroscopic imaging are complementary in local staging, but their use is currently limited to a research setting.

Although MRI is superior to bone scanning in evaluating bone metastasis, it is impractical for routine total-body surveys. Instead, it is used to determine the etiology of questionable lesions found on bone scans. Bone-scan examples are seen below.

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Transrectal Ultrasound Scan Guided Biopsy

Your doctor takes a series of small tissue samples from the prostate to examine under a microscope. You have the biopsy through the back passage using a transrectal ultrasound scanner.

A TRUS guided biopsy can be uncomfortable. You usually have a local anaesthetic to numb the area and reduce any pain.

• Find out more about having a TRUS guided biopsy

New Prostate Cancer Blood Test

If you have an abnormal PSA score, your doctor may recommend another newertest that gives a better sense of yourprostate cancer risk. The prostate health index is one such test that is a more accurateblood test and measures your risk for having prostate cancer. Its approvedby the FDA for men who have PSA scores between 4 and 10.

What are the benefits of the PHI test?

• Fewer unnecessary biopsies: Some men who have elevated PSA scores are unsure about getting an invasive biopsy. This tool can be used to better determine whether your risk is high enough to warrant a biopsy.
• More accurate: This test is better at detecting prostate cancer. It can also detect whether you have a more aggressive type of cancer. This information can guide doctors to a more targeted treatment plan for you.

If you score low on the PHI test, your doctor may recommend monitoring youover time to see if your levels rise enough to cause concern.

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Prostate Cancer Caregiver Podcast Series

We are proud to announce a new podcast series geared toward helping give support, hope and guidance to prostate cancer caregivers. The goal of this Prostate Cancer Caregiver Podcast Series is to help others connect with a diverse group of people who have felt the impact of prostate cancer in their lives and empower them on their journey.

What Are The Current Screening Guidelines For Prostate Cancer

The American Cancer Society currently recommends men discuss with their health care provider the routine screening options available for prostate cancer. The discussion should take place at:

• Age 50 for men of average risk
• Age 45 for men at high risk, including African-American men and those with a first-degree relative who was diagnosed with prostate cancer before the age of 65
• Age 40 for men at highest risk, including those with two or more first-degree relatives who had prostate cancer at an early age

Based on your discussion, your provider may screen you with a prostate specific antigen test and possibly a digital rectal examination. Depending on the initial screening results and other risk factors, the screening may be repeated annually or once every two years.

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How To Improve Trus Prostate Biopsy Technique

The gold standard to diagnose PCa with an elevated PSA is the 12 core extended sextant TRUS, the TRUS-guided prostate needle biopsy. However, as show in the figure below, the TRUS non-targeted technique carries a risk of sampling error , of missing an aggressive cancer and of overdiagnosing an indolent cancer . As most lesion are now small and sometime located in regions that are not identifiable by DRE and TRUS, different protocols or strategies to improve the detection of clinically significant cancer were evaluated and published.

Metastatic Signs And Symptoms

Metastatic symptoms include weight loss and loss of appetite bone pain, with or without pathologic fracture and lower extremity pain and edema due to obstruction of venous and lymphatic tributaries by nodal metastasis. Uremic symptoms can occur from ureteral obstruction caused by local prostate growth or retroperitoneal adenopathy secondary to nodal metastasis.

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When Should You Start Screening

First, talk to your doctor at your next checkup to go over your particular risk factors. You may have more than one risk factor at play and thus have a greater chance of developing prostate cancer than other men.

In general, discussions with your doctor about screening for prostate cancer should begin in your 40s. Here are some rough guidelines:

Should I Have A Psa Test

If you have no symptoms of prostate cancer and are thinking about having a PSA test, you should ask your doctor about the risks and benefits.

While some studies suggest PSA reduces mortality on a population basis, the test picks up large numbers of cancers that would have caused no symptoms or harm in the patient. This is known as overdiagnosis. Overdiagnosis of prostate cancer can lead to unnecessary treatments that have side effects such as sexual impotence, urinary incontinence and bowel problems.

It is important to balance the potential benefit of detecting a prostate cancer early against the risk that detection and treatment may not be necessary. Treatment may affect your lifestyle but it may also save your life.

Make your own decision about whether to be tested after a discussion with your doctor. Ensure you get good quality information to make an informed decision.

Screening tests for breast, bowel and cervical cancer can save lives, but there is still confusion around PSA testing for prostate cancer. Find more information here.

Remember, if you have any concerns or questions, please contact your doctor.

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What Are Some Common Prostate Problems

The most common prostate problem in men younger than age 50 is inflammation, called prostatitis. Prostate enlargement, or benign prostatic hyperplasia , is another common problem. Because the prostate continues to grow as a man ages, BPH is the most common prostate problem for men older than age 50. Older men are at risk for prostate cancer as well, but it is much less common than BPH.