Questions to Ask Your Doctor: PSA Screening and Biopsy

Depending on your age and family history, your doctor might suggest a PSA or prostate specific antigen test. This is a simple blood test that is used to screen for prostate cancer. Based on those results, your doctor may want to run further tests.

About PSA Screening

  • If I have a family history of prostate cancer, should I be screened more frequently?
  • If my results come back showing a high PSA, what’s next?
  • Should my PSA results ultimately lead to a biopsy? If so, what can I expect?
  • What kind of information does a biopsy provide?
  • How often does a biopsy miss the diagnosis of prostate cancer?
  • I’ve been told that prostate cancer is a slow-growing cancer.  If the biopsy finds cancer in my prostate, is treatment always required?

If You Need a Biopsy

A prostate cancer screening by a primary care physician or urologist may reveal results that prompt a doctor to recommend a biopsy. Other supplementary tests and considerations may help you and your doctor decide if a biopsy is necessary.  

  • What percentage of my prostate gland was sampled during biopsy and how many tissue sections of “cores” were removed during my biopsy?
  • I’m worried about infection from the biopsy.  What precautions do you take to lower my risk?
  • How representative of my entire prostate are these tissues cores likely to be?
  • What did the pathologist look for when she or he examined my tissue samples under a microscope?
  • What is my Gleason Score?
  • What is the value of an MRI-guided biopsy for prostate cancer?  

About Your Biopsy Results

  • Aside from my Gleason score, will the biopsy results include any genetic tests?
  • What is high-grade prostatic intraepithelial neoplasia, or PIN? Is this cancer?
  • Can I get a second opinion from another pathologist on my biopsy?
  • If I have prostate cancer, what is my clinical stage? Do I need treatment?
  • My biopsy results are negative, but my PSA is still elevated, what’s next?
  • Will I need a repeat biopsy? 

Terms to know from this article:

Screening

Checking for disease when there are no symptoms.

Biopsy

The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.

urologist

A doctor who has special training in diagnosing and treating diseases of the urinary organs in females and the urinary and reproductive organs in males.

Prostate gland

A gland in the male reproductive system just below the bladder. The prostate surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen.

Pathologist

A doctor who identifies diseases by studying cells and tissues under a microscope.

Gleason

Gleason Score (GS) - Gleason Grade: A system of grading prostate cancer cells based on how they look under a microscope. Gleason scores range from 2 to 10 and indicate how likely it is that a tumor will spread. A low Gleason score means the cancer cells are similar to normal prostate cells and are less likely to spread; a high Gleason score means the cancer cells are very different from normal and are more likely to spread.

Grade

The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer.

Prostatic

Of or pertaining to the prostate gland.

Intraepithelial

Within the layer of cells that form the surface or lining of an organ.

Neoplasia

Abnormal and uncontrolled cell growth.

PSA

prostate-specific antigen (PSA): A substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate.