Diagnosis of Prostate Cancer
When a PSA test or a digital rectal exam (DRE) reveals abnormal results, the next step is further testing to determine whether prostate cancer is present, or if there is another, benign (non-cancer) explanation.
Your doctor will evaluate your test results and any symptoms you may be experiencing and recommend the next tests you may need. The most common diagnostic tests for the prostate include:
Ultrasound: A transrectal ultrasound involves inserting a small ultrasound probe into the rectum. The ultrasound machine sends out sound waves and then measures the “echoes” that bounce back off body structures to create an image of the “landscape” of the structure. It can provide images that show the extent of prostate enlargement or abnormalities.
MRI: Magnetic resonance imaging (MRI) is used to create a more detailed set of images than an ultrasound can provide. Results will be reported as a PI-RADS score.
- PI-RADS 1: very low—clinically significant cancer is highly unlikely to be present
- PI-RADS 2: low—clinically significant cancer is unlikely to be present
- PI-RADS 3: intermediate—the chance of clinically significant cancer is neutral
- PI-RADS 4: high—clinically significant cancer is likely to be present
- PI-RADS 5: very high—clinically significant cancer is highly likely to be present
Biopsy: A biopsy entails taking samples of tissue for examination under a microscope. Prostate tissue is obtained via needles inserted into the prostate. Ultrasound is used to guide the needles to the exact area of concern. Biopsy technology is advancing quickly and can be combined with imaging techniques to increase accuracy:
- TRUS-guided biopsy: A trans-rectal ultrasound–guided biopsy is the most common way prostate cancer is diagnosed in the U.S. An ultrasound probe is placed in the rectum to allow visualization of the prostate. Then at least 12 needles are placed into the prostate to take samples that are examined for abnormal cells. (Twelve needles sounds like a lot, but the more varied the sample, the greater the chance of catching any abnormal cells.) If a patient had magnetic resonance imaging (MRI) before the biopsy, the MRI images may help target areas that looked suspicious.
- Trans-perineal biopsy: A biopsy sample can also be obtained by placing a needle through the perineum, the skin between the scrotum and anus. This method is becoming more common.
- Incidental procedures: Sometimes, doctors performing surgery in a nearby area actually see something amiss with the prostate and can take a sample during the same procedure.
The prostate tissue is then examined under a microscope by a pathologist, to confirm the presence or absence of cancerous cells.
Biopsy technology continues to improve. Research is ongoing to increase accuracy of biopsies, to hone in on suspicious areas. The goal is a minimally-invasive biopsy procedure that has the greatest chance of sampling cells more likely to be cancerous, with less damage to surrounding tissues. Targeted, or fusion biopsies are increasingly being utilized at select centers that use an MRI, in addition to the ultrasound, to better visualize tumors within the prostate and help guide biopsy needles.
Next steps
Your doctor will review your test results with you and discuss what the next steps will be—whether it’s best to repeat the tests after an interval of time, or whether you should consider treatment options for prostate cancer.
Learn more about how prostate cancer is assessed, or “staged.”