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.
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:
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.
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.”
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