Routine screening with the PSA test and rectal exam has transformed how prostate cancer is diagnosed and treated over the last decades. But these methods only suggest possible prostate cancer; they do not diagnose it.
To determine whether you have cancer cells in your prostate requires further testing. Many of these tests can help your doctor decide whether you need to undergo a biopsy or can safely defer it. Other tests you may have include:
- Blood tests to measure other biomarkers (in addition to PSA) that can help determine whether you need a biopsy. These tests may include:
- 4K score which measures PSA along with three similar proteins, called fPSA, iPSA and hK2
- Free PSA (fPSA) percentage measures the ratio of unbound or free PSA to total PSA in the blood. Lower levels (especially less than 10%) mean there is a greater chance that cancer is present.
- IsoPSA and PHI are tests that measure a specific type of PSA
- Urine tests such as PCA3 and Select MDx measure levels of genetic material related to prostate cancer that can be found in urine.
- Prostate MRI scan uses magnetic fields and pulses of radio waves to take pictures of your body and identify any suspicious areas on the prostate. In many cases, a negative prostate MRI (in addition to other clinical findings) can help patients avoid the need for a prostate biopsy.
- Other imaging tests such as prostate specific membrane antigen positron emission tomography (PSMA PET/CT) can provide detailed images of the inside of your body to learn whether cancer may be found in other body areas such as lymph nodes, bones or other organs.
- Biopsy takes a sample of tissue or cells from the prostate to be examined in a laboratory to determine if cancer is present and other characteristics that help guide treatment decisions. It’s the only way to officially diagnose prostate cancer. Roswell Park performs fusion or targeted prostate biopsy where we target the specific area of concern by fusing the MRI images with real-time ultrasound images.
- Genetic tests can reveal whether your prostate cancer might be caused by a certain gene mutation and guide decisions about screening for related cancer types (breast, ovarian, colorectal, uterine and pancreatic) and screening recommendations for your family members.
- Molecular tumor tests analyze cells from your biopsy to look at their molecular components and can help distinguish between a low-risk cancer that is less likely to spread and a high-risk one.
What happens during a prostate biopsy?
The most common prostate biopsy is a core needle biopsy. For this procedure, you will lie on a table with your knees bent, and medication will be applied to numb the area around the prostate. A lubricated ultrasound probe is gently placed in your rectum to produce a video image of your prostate.
The urologist uses this image to guide a hollow needle into the prostate to extract a small core sample of prostate tissue. Your doctor will take about 12 random core samples, in addition to three to five more cores from any suspicious looking areas identified on a previous MRI. These are sent to be examined by a pathologist.
A specialized, multiparameter prostate MRI scan is recommended first for several reasons, including to avoid performing unnecessary prostate biopsies. The prostate MRI helps to discern significant prostate cancers from low-grade ones. If your MRI does not show any suspicious areas, you may be able to safely avoid a biopsy.
If the MRI does identify suspicious areas, it can map them so that a biopsy can target these areas rather than take blind samples.
Your Roswell Park physician will recommend a biopsy of your prostate only if necessary. We first evaluate your other testing such as blood and urine tests, and a multiparameter prostate MRI.
If you have a suspicious prostate MRI, using a special machine, Roswell Park can fuse the MRI image with a real-time ultrasound image, to localize the abnormal area on the ultrasound. We can then target this specific area of concern. Fusion or targeted biopsy reduces the risk of missing clinically significant prostate cancers.
Types of prostate cancer
Your prostate cancer type is based on the type of cell that the cancer started in. Prostate cancer types include:
- Acinar adenocarcinoma is the most common type of prostate cancer that arises from the glands within the prostate. More than 90% of patients have this type of prostate cancer.
- Ductal and intraductal adenocarcinoma begins in the ducts or channels within the prostate. This type is often more aggressive than acinar adenocarcinoma. Sometimes PSA level will not increase with this cancer, making it hard to detect.
- Neuroendocrine prostate cancer is a very rare subtypes that affect less than 1% of patients. It is considered very aggressive and may be due to treatment resistance.
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