Tests To Diagnose And Stage Prostate Cancer
Most prostate cancers are first found as a result of screening. Early prostate cancers usually dont cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.
If prostate cancer is suspected based on results of screening tests or symptoms, tests will be needed to be sure. If youre seeing your primary care doctor, you might be referred to a urologist, a doctor who treats cancers of the genital and urinary tract, including the prostate.
The actual diagnosis of prostate cancer can only be made with a prostate biopsy .
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Additional Tests That May Aid Prostate Cancer Diagnosis
There are few other diagnostic tools or tests, which can be performed before you have a prostate biopsy, that may help your physician gather more information about your specific case. These procedures may help determine the likelihood of the presence of cancer and its aggressiveness and increase the accuracy of a biopsy when performed. Those tests include:
4Kscore blood test is a molecular test that helps predict the likelihood and risk of a patient having aggressive prostate cancer. If you’re a patient whose PSA values are borderline for a prostate biopsy or you have a condition that could be aggravated by a biopsy, your physician may use this test before to help determine whether you should get a biopsy or a repeat biopsy.
Urine sample testlooks for biomarkers that may indicate the presence of prostate cancer cells in a patient’s body. This test may also be helpful when trying to determine whether a patient should be rebiopsied or not.
Multiparametric MRI
The use of multiparametric MRI imaging of the prostate gland before a biopsy has been a game changer in prostate cancer diagnosis, increasing the accuracy of biopsies over standard biopsies. The mpMRI doesn’t replace the standard biopsy, but by improving its accuracy, it may help decrease the number of biopsies needed.
The mpMRI has a higher resolution than a standard prostate ultrasound. This increases the ability to see suspicious lesions in the prostate, providing additional targets for the biopsy to sample.
New Prostate Biopsy Procedure Eliminates Risk Of Infection
Urologists at Northwell Healths Smith Institute for Urology recently started offering a new biopsy procedure which samples tissue from the prostate to potentially detect cancerand eliminates the risk of infection.
The procedure, known as a transperineal biopsy, is an important step forward for prostate health because it avoids risk of infection by inserting needles into the perineum to reach the prostate. The standard technique, transrectal biopsy, guides the needles through the rectal wall, where fecal bacteria can cause contamination.
We are looking at the transperineal biopsy because transrectal procedure has a history of causing sepsis, with up to five percent of men getting infections, which has been cited in scientific urologic literature nationally for decades, said Michael Schwartz, MD, director of laparoscopic and robotic surgery at the Smith Institute for Urology. Patients with these infections need to be hospitalized and require intravenous antibiotics. The transperineal biopsy is a huge advantage and offers patients a safe alternative with a virtually zero risk of infection.
Schwartz said the transperineal biopsy, which takes about 10 to 15 minutes, is performed in an outpatient setting under local anesthesia. Using the standard rectal ultrasound, the new technology allows physicians to pass a needle through the perineum and perform multiple biopsies through one entry and easier access to certain areas of the prostate.
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A New Biopsy Technique To Diagnose Prostate Cancer And Reduce Risks Of Infections
Each year, over 1 million men undergo prostate biopsies to diagnose or rule out prostate cancer. For these men who need a biopsy, there is now an alternative approach that is safer, with significantly lower risks of infection, and potentially higher rate of tumor detection.
While most prostate biopsies are performed through the rectum , there is a means to obtain prostate tissue samples through the perineum using an external entry point at the skin. The technique, known as transperineal biopsy, is now offered to men who are good candidates for this approach. In this modification of the standard transrectal approach, doctors take samples of the prostate tissue through needles directed through the perineum, the area of skin located between the rectum and the base of the scrotum.
In contrast to the transrectal approach, which typically involves 12 or more separate needle punctures from inside the rectum, a specially designed device used with the transperineal approach limits the number of biopsy needle insertion points to two – one for each side of the prostate. This further reduces the chance of infection and other side effects.
Fox Chase Cancer Centers urologic oncologist group has expertise in transperineal biopsy techniques and recently began offering this alternative procedure to patients.
What Happens After A Prostate Biopsy
Your recovery process will vary depending on the type of anesthesia that isused. If you were given general anesthesia, you will be taken to a recoveryroom for observation. Once your blood pressure, pulse, and breathing arestable and you are alert, you will be taken to your hospital room ordischarged to your home.
If local anesthetic was used, you may go back to your normal activities anddiet unless otherwise instructed. You may feel the urge to urinate or havea bowel movement after the biopsy. This feeling should pass after a fewhours.
There may be blood in your urine or stool for a few days after the biopsy.This is common. Blood, either red or reddish brown, may also be in yourejaculate for a few weeks after the biopsy. This, too, is normal.
The biopsy site may be tender or sore for several days after the biopsy.Take a pain reliever for soreness as recommended by your healthcareprovider. Aspirin or certain other pain medicines may increase the chanceof bleeding, so be sure to take only recommended medicines.
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Increase in the amount of blood in your urine or stool
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Belly or pelvic pain
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Trouble urinating
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Changes in the way your urine looks or smells or burning with urination
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Fever and/or chills
Your healthcare provider may give you other instruction, depending on yoursituation.
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How Should I Prepare
Prior to a prostate biopsy, tell your doctor about all the medications you take, including herbal supplements. List any allergies , recent illnesses, and other medical conditions.
You may need to stop taking blood thinners for seven to 10 days before the procedure. This will help prevent excessive bleeding during and after the biopsy. The doctor may check your blood clotting on the day of the procedure. Ask your doctor and the hospital radiology clinic or department for more information.
You may need to take oral antibiotics a day before and the morning of the biopsy. This will help prevent infection.
If you are having an MRI-guided biopsy, you will need to wear metal-free clothing and remove any metallic objects, such as jewelry, watches, and hearing aids.
A technologist will walk through an MR imaging safety checklist with you. Tell your technologist about prior surgeries and metal implants, such as pacemakers, aneurysm clips, and joint replacements.
An MRI-guided procedure may use an injection of gadolinium contrast material. Because gadolinium does not contain iodine, it can be used safely in patients with contrast allergies.
Your MRI procedure may use an endorectal coil. This is a thin wire covered with a latex balloon. The doctor will lubricate this assembly and gently insert it into your rectum. Tell the doctor if you are allergic to latex so they may cover the coil with a latex-free balloon.
Day After The Prostate Biopsy
After your biopsy, you will have to drink many fluids so that you may provide us with two separate urine samples from two separate voids. The most common complication is blood in the urine after the biopsy. We would like to make sure that your urine is in the process of clearing before we send you home for the day. It is normal to see blood in the urine and bowel movements for 1-2 weeks after the procedure. It should progressively diminish over that time-period. If you find that, you cannot urinate or if you are passing a large number of blood clots, then report to the office or nearest emergency room for evaluation. A physician may have to insert a catheter into the bladder for a few days to allow you urine to be drained. You should continue to drink more than your usual intake of fluids to keep your urine diluted and to prevent formation of blood clots within the bladder.
You may also experience a dull ache in the perineum for many days after the biopsy. It is recommended that you halt sexual intercourse for 3-5 days after the biopsy to allow some initial healing. Do not be surprised if you see blood in your semen after ejaculation. This is normal and does not cause an infectious concern for your sexual partner. This may take months to resolve. In addition, you cannot pass along cancer to your partner via your semen either.
If you have fever or chills, please take your temperature with an oral thermometer and call your physician if it reads above 100.8 F.
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Medical History And Physical Exam
If your doctor suspects you might have prostate cancer, you will be asked about symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors, including your family history.
Your doctor will also examine you. This might include a digital rectal exam , during which the doctor inserts a gloved, lubricated finger into your rectum to feel for any bumps or hard areas on the prostate that might be cancer. If you do have cancer, the DRE can sometimes help tell if its only on one side of the prostate, if its on both sides, or if its likely to have spread beyond the prostate to nearby tissues. Your doctor may also examine other areas of your body.
After the exam, your doctor might then order some tests.
What Can You Expect During A Prostate Ultrasound And Biopsy
The procedure is short and generally only takes about 10 minutes. Your urologist, a doctor specializing in mens genital and urinary problems, will perform the procedure.
- Upon arrival in the examination room, you will be given antibiotics to prevent infection.
- You will be asked to lie on your side and bring your knees to your chest.
- The area being tested may be numbed to help reduce any discomfort.
- A lubricated probe is inserted into the rectum to generate the ultrasound.
- A small needle is inserted through the probe to take several tiny tissue samples from the prostate. Some men may feel mild pressure or discomfort during the procedure.
- After tissue samples are taken, they are sent to a lab for an analysis.
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What Is Free Psa
The routine PSA test measures total PSA in your blood. But there are two types of PSA. Bound PSA is attached to a protein. Free PSA is not. The free PSA test breaks the results down and provides your doctor with a ratio. Men with prostate cancer tend to have lower levels of free PSA than men who dont have prostate cancer.
Its a simple blood test, but theres no consensus among doctors on the ideal ratio of free to bound PSA. The free PSA test is valuable in that it gathers more information, which can help in the biopsy decision.
On its own, the free PSA test cant confirm or rule out a prostate cancer diagnosis.
What Will I Experience During And After The Biopsy
If you receive IV contrast for the MRI-guided procedure, you may feel coolness and a flushing sensation for a minute or two following the injection. The IV needle may cause some discomfort when the doctor inserts it and you may have some bruising when they remove it.
Rarely, patients may experience side effects from MR contrast material, such as nausea and local pain, hives, itchy eyes, or other reactions. If you have allergic symptoms, a radiologist or other doctor will be available for immediate assistance.
When the doctor inserts the ultrasound probe or endorectal coil into the rectum, you will feel pressure and may have some temporary discomfort.
You will hear a clicking noise when the biopsy needle samples the prostate and you may feel a stinging or burning sensation in the area.
Some patients find it uncomfortable to remain still during an MRI. Others experience a sense of being closed-in . Sedation is available for patients who anticipate anxiety.
If you feel heating on your skin at any time during MR imaging, tell the MR technician so they can closely examine the area.
Some patients experience a small amount of bleeding from the rectum or perineum immediately after the biopsy. If this does occur, it will cease with gentle pressure.
If you did not receive sedation, no recovery period is necessary. Light general anesthetic or sedation may leave you feeling groggy for a day or so.
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Precancerous Cells And Pin
Sometimes, the results will show that precancerous cells, or prostatic intraepithelial neoplasia , are present.
If these PIN are low grade, the doctor will not consider this a matter of concern. Many males have low grade PIN. However, if the PIN are high grade, there is a chance that cancer may develop. In these cases, a doctor may suggest further tests.
If a person already has prostate cancer, the grade of the PIN does not matter, as it does not affect the severity or the Gleason score of the cancer.
Carcinoma in situ refers to cells that have the potential to become cancerous. They can occur almost anywhere in the body.
What Is A Prostate Biopsy
The prostate gland is found only in males. It sits below the bladder andwraps around the urethra . Theprostate helps make semen.
A biopsy is a procedure used to remove a small piece of tissue or cellsfrom the body so it can be examined under a microscope.
In a prostate biopsy, prostate gland tissue is taken out with a biopsyneedle or during surgery. The tissue is checked to see if there are canceror other abnormal cells in the prostate gland.
A prostate biopsy may be done in several different ways:
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Transrectal method. This is done through the rectum and is the most common.
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Perineal method. This is done through the skin between the scrotum and the rectum.
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Transurethral method. This is done through the urethra using a cystoscope .
Ultrasound is usually used to look at the prostate gland and guide thebiopsy needle.
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What Happens After The Procedure
Depending on the type of biopsy you have, after the procedure you may see a small amount of blood in your urine or bowel motions for a few days, and blood in your semen for a couple of months. After a TPUS biopsy, the risk of infection is extremely low. There is a greater risk of infection with a TRUS biopsy, but the risk is still low.
The samples are sent to a laboratory, where a specialist doctor called a pathologist looks for cancer cells in the tissue. Waiting for the results can be a stressful time. It may help to call Cancer Council 13 11 20.
What Does A Digital Rectal Exam Do
In a digital rectal exam , the doctor inserts a gloved finger into your rectum to feel for irregularities of the prostate. Its a common part of a mans routine physical examination.
Your doctor might perform a DRE alone or with a PSA test for routine screening. Its a quick and simple test. Although a DRE can signal a problem, such as an enlarged prostate, it cannot determine if its due to prostate cancer.
Prostate cancer is diagnosed 15 to 25 percent of the time when abnormal findings on a DRE lead to biopsy.
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Four New Diagnostic Devices For Men With Suspected Prostate Cancer Which Reduce The Chances Of Biopsy Related Sepsis Have Been Recommended For Use By Nice
15 February 2022
The new diagnostics guidance looks at local anaesthetic transperineal prostate biopsy, using the freehand needle positioning devices PrecisionPoint, EZU-PA3U device, Trinity Perine Grid, and UA1232 puncture attachment, which are recommended as options for helping to diagnose prostate cancer.
Prostate cancer is the most diagnosed cancer in men in the UK according to Cancer Research UK. It mainly affects people over 50 and the risk is higher for people of African family background and people with a family history of prostate cancer.
At present NICE guidance recommends offering people with suspected clinically localised prostate cancer a multiparametric MRI as the first-line investigation.
If prostate cancer is still suspected based on the MRI image, a prostate biopsy is offered so that samples of the prostate can be collected for analysis. There are two ways of doing a prostate biopsy. In a transrectal ultrasound guided biopsy samples are collected using a biopsy needle inserted through the rectal wall via the anus.
However TRUS can be associated with serious infections, sometimes requiring hospital admission and antibiotics.
Both diagnostic procedures take place under local anaesthetic.
Evidence presented to the committee suggested that the detection rates of cancer did not differ significantly between a TRUS biopsy and an LATP biopsy using a freehand needle positioning device.
Study: New Prostate Cancer Test Could Avoid Unnecessary Biopsies
Urine test found to be extremely accurate at detecting aggressive prostate cancer with few false negatives.
A urine test based on University of Michigan Rogel Cancer Center research could have avoided one third of unnecessary prostate cancer biopsies while failing to detect only a small number of cancers, according to a validation study that included more than 1,500 patients. The findings appear in the March issue of the Journal of Urology.
The MyProstateScore test, which is being commercialized by LynxDX, a U-M startup company, measures levels of cancer-specific genes in a patients urine. It is based on U-M research that discovered that half of all prostate tumors harbor a certain genetic anomaly in which the genes TMPRSS2 and ERG relocate on a chromosome and fuse together creating an on-switch for prostate cancer development.
Currently, one of doctors best methods for detecting prostate cancer is a blood test for prostate-specific antigen, commonly known as the PSA test. Elevated PSA levels may indicate cancer, but the majority of men with an elevated PSA do not actually have prostate cancer.
Our ultimate goal was to determine whether the MyProstateScore test could be a practical, reliable test that could rule out the need for more costly or invasive testing in men referred for a prostate biopsy, says study lead author Jeffrey Tosoian, M.D., M.P.H., a clinical lecturer in urology at Michigan Medicine.
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