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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What Happens During The Test
Depending on the type of scan you need, a dye may be injected into your vein so the radiologist can better see the body structures on the image.
After the dye is injected, you may feel flushed or you may have a metallic taste in your mouth. These are common reactions. If you notice shortness of breath or any unusual symptoms, tell the technician.
The technician will help you lie in the correct position on the examining table. The table will then automatically move into place for imaging. Lie as still as possible during the entire procedure. Movement could blur the images. You may be asked to hold your breath briefly while each X-ray image is taken.
What Will I Experience During And After The Procedure
You will feel a slight pin prick when the technologist inserts the needle into your vein for the intravenous line. You may feel a cold sensation moving up your arm during the radiotracer injection. Generally, there are no other side effects.
The bone scan itself is usually painless and is rarely associated with significant discomfort or side effects. No anesthesia is needed for skeletal scintigraphy, and sedation is rarely necessary. The test may be uncomfortable if you are having joint or bone pain. Try to relax by breathing slowly and deeply.
It is important to remain still during the exam. Nuclear imaging causes no pain. However, having to remain still or in one position for long periods may cause discomfort
Children in particular may experience discomfort from having to remain still during imaging. Parents are encouraged to stay with their children to help them remain calm and still during imaging. Comfort items such as pacifiers, blankets and books are also very helpful. Often, a television with children’s programming and/or children’s DVDs is available in the scanning room. For more information, see Children’s Nuclear Medicine.
Unless your doctor tells you otherwise, you may resume your normal activities after your exam. A technologist, nurse, or doctor will provide you with any necessary special instructions before you leave.
The amount of radiation is so small that it is not a risk for people to come in contact with you after the test.
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Additional Pet Scanning Faq
Is PET scanning safe?
While PET scanning does involve the use of radioactive tracers, these are diagnostic levels of radiation that are completely safe and have no known side effects.
How long does it take to get the results after a PET Scan?
Images are captured and created during the PET scan procedure, and afterward, a radiologist will utilize their training and experience to interpret the scan and produce a written report of findings and conclusions. This report is then transmitted to your referring physician who would then review those results with you and discuss any further treatment if needed.
What is it like for a patient to have a PET Scan?
Please watch this video we created that clearly walks one through the experience of having a PET scan and answers all common questions about PET scanning.
What Do My Test Results Mean
Your doctor will look at your test results to find out if the cancer has spread and how quickly it might be growing.
How far has my cancer spread?
The stage of your cancer tells you whether it has spread outside the prostate and how far it has spread. You might need scans, such as an MRI, CT or bone scan, to find out the stage of your cancer.
Depending on the results, your cancer may be treated as:
- localised prostate cancer its contained inside the prostate
- locally advanced prostate cancer its started to break out of the prostate or has spread to the area just outside it
- advanced prostate cancer its spread from the prostate to other parts of the body.
Is my cancer likely to spread?
Your doctor may talk to you about the risk of your cancer spreading outside the prostate or coming back after treatment.
Your prostate biopsy results will show how aggressive the cancer is in other words, how likely it is to spread outside the prostate. You might hear this called your Gleason grade, Gleason score, or grade group.
To work out your risk, your doctor will look at your PSA level, your Gleason score and the T stage of your cancer.
Low risk
Your cancer may be low risk if:
- your PSA level is less than 10 ng/ml, and
- your Gleason score is 6 or less , and
- the stage of your cancer is T1 to T2a.
Medium risk
Your cancer may be medium risk if:
- your PSA level is between 10 and 20 ng/ml, or
- your Gleason score is 7 , or
- the stage of your cancer is T2b.
High risk
What happens next?
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What Are The Risks Of A Bone Scan
The amount of the radionuclide injected into your vein for the procedure issmall enough that there is no need for precautions against radioactiveexposure. The injection of the tracer may cause some slight discomfort.Allergic reactions to the tracer are rare, but may occur.
Patients who are allergic to or sensitive to medications, contrast dyes, orlatex should notify their doctor.
If you are pregnant or suspect that you may be pregnant, you should notifyyour health care provider due to the risk of injury to the fetus from abone scan. If you are lactating, or breastfeeding, you should notify yourhealth care provider due to the risk of contaminating breast milk with thetracer.
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.
How Does The Procedure Work
Ordinary x-ray exams pass x-rays through the body to create an image. Nuclear medicine uses radioactive materials called radiopharmaceuticals or radiotracers. Your doctor typically injects this material into your bloodstream. Or you may swallow it or inhale it as a gas. The material accumulates in the area under examination, where it gives off gamma rays. Special cameras detect this energy and, with the help of a computer, create pictures that detail how your organs and tissues look and function.
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Getting My Scan Results
Your doctor or nurse will tell you how long it will take for the results of all the tests to come back. Its usually around two weeks.
Your doctor will use your scan results to work out the stage of your cancer in other words, how far it has spread. This is usually recorded using the TNM system.
- The T stage shows how far the cancer has spread in and around the prostate.
- The N stage shows whether the cancer has spread to the lymph nodes.
- The M stage shows whether the cancer has spread to other parts of the body.
Getting Ready For A Bone Scan
When you schedule your bone scan, the hospital or imaging center staff will tell you how to prepare. Usually, you do not need much special preparation before a bone scan, but it’s important to confirm this with the place giving you the test. If anything is unclear in the instructions, talk with your health care team. Here are some things that you can expect: What to eat. You can typically eat and drink normally before your appointment. Your usual medications. Tell your health care team about all medications you take, including over the counter drugs and supplements. Medicines that contain barium or bismuth can affect the test results. Your doctor may ask you not to take them before your scan. Personal medical history. Tell the staff if you have any drug allergies or medical conditions. Women should tell their health care team if they are breastfeeding or may be pregnant.What to wear. Before the test, you will need to remove metal objects, such as jewelry. You may also need to change into a hospital gown.
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What Happens On The Day Of The Test
Here’s what you need to know for the day of the test:
- Plan to arrive 15 minutes before your scheduled appointment time.
- Don’t eat or drink anything for 4 hours before your scan appointment.
- If you are told to drink a special solution to prepare for your scan, you will receive the solution and instructions. Follow the instructions carefully.
- Continue taking your medications as usual. Consult your doctor if you have questions.
- You will be asked to change into a hospital gown because snaps and zippers in street clothes can interfere with the scan. You also may be asked to remove your watch or any jewelry.
- Leave valuables such as jewelry or credit cards and other valuables at home.
- Allow 1 hour for your CAT scan. Most scans take from 15 to 60 minutes.
- After the test is done, a radiologist will review the results.
Improving Pet Scans Are Good News For Doctors And Patients Alike
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
A recent blog post discussed a newly approved imaging agent with an unwieldy name: gallium-68 PMA-11. Delivered in small amounts by injection, this minimally radioactive tracer sticks to prostate cancer cells, which subsequently glow and reveal themselves on a positron emission tomography scan. Offered to men with rising PSA levels after initial prostate cancer treatment , this sort of imaging can allow doctors to find and treat new tumors that they might otherwise miss. With currently available imaging technology, such tumors could potentially escape detection until they were larger and more dangerous.
But while gallium-68 PMA-11 is the latest PET tracer to win FDA approval, not everyone can get it. In the United States, its currently available only to patients treated at the University of California, Los Angeles, or the University of California, San Francisco, where the tracer is manufactured. However, two other PET tracers approved for prostate cancer imaging in the US are becoming more accessible.
In January 2021, a team at Stanford University published findings showing that one those tracers, called fluciclovine F18 , identified significantly more metastatic cancers than other conventional types of imaging. Axumin was approved in 2016, and these are among the first data to show how well the tracer performs in real-world settings.
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Why Is A Nuclear Bone Scan Done
Bone scans can help diagnose several problems, including:
- Broken bones, especially hips, or stress fractures, which can be hard to see on X-rays
- Pagetâs disease of the bone, which affects how new tissue replaces the old
- Cancer that started in the bone
- Cancer thatâs spread to your bones from another place in your body
- Infection in your bone or in an artificial joint such as a hip or knee
- Dead bone tissue caused by poor blood supply
- Fibrous dysplasia, a condition passed down from your parents in which your body develops scarlike tissue instead of healthy bones
Preparing For A Nuclear Bone Scan
You can eat and drink as you usually would before your scan. You donât have to do anything special to prepare. But certain things can interfere with the tracer, so tell your doctor if you have:
- Taken an over-the-counter medication containing bismuth
- Recently had a test that used barium
Youâll need to remove jewelry and other metal objects before the scan. You may have to change into a hospital gown.
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What Happens Before The Cat Scan
If a dye is required for your CAT scan, you may be instructed to have a blood test first. The purpose of the blood test is to make sure your kidneys will be able to get rid of the dye. Not getting this blood test may delay your CAT scan appointment.
Drink only clear liquids after midnight the night before your scan. Clear liquids include things you can see through . Examples include clear broth, tea, strained fruit juices, strained vegetable soup, black coffee, and ginger ale. You may also eat plain Jell-O.
Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11 and 18F-DCFPyl , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body.
The pictures from a PET scan arent as detailed as MRI or CT scan images, but they can often show areas of cancer anywhere in the body. Some machines can do a PET scan and either an MRI or a CT scan at the same time, which can give more detail about areas that show up on the PET scan.
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Developing Landscape For Non
Non-metastatic CRPC prevalence has been estimated at 7% of PCa in the European Union . Owing to the advent of modern imaging, the prevalence of this subgroup has declined. These newer imaging agents i.e., fluciclovine or PSMA can identify local recurrence or metastases at PSA levels far below the traditional PSA threshold for other imaging modalities such as CT or bone scan. Some of the new PET agents can identify metastatic lesions at PSA values as low as 0.20.5 ng/mL, allowing the prompt identification of M1 CPRC . This is interesting given the recent randomized studies in this field , which show the efficacity of apalutamide and enzalutamide . The metastasis-free survival of patients with nmCRPC was previously estimated as ~2530 months, but can now be significantly prolonged using combination next-generation hormone therapy with ADT . The use of PSA doubling time to determine risk for progression can guide the appropriate timing for starting therapy. For instance, a PSA doubling time 10 months is appropriate to initiate therapy. There is no currently established standard of care option for treatment of this population, hence the need for enrollment in clinical trials .
About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
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Who Interprets My Scans
It is also important to understand that every medical imaging performed is read by a physician, and a dictated written report is issued. This interpreting physician will be either a radiologist or a nuclear medicine physician.
So although the scan may be ordered by a urologist, medical oncologist or radiation oncologist, the physician who interprets the imaging is someone different. He or she is an M.D. trained in a different area of medicine , and does not see patients in a clinic. Their job is to read, decipher and translate imaging into a dictated written report, which they provide to your ordering clinical physician.
The difference between radiology and nuclear medicine is basically whether or not a radiopharmaceutical is used. These injections are designed to adhere to certain types of tissues , and reveal a spot or uptake in that area.
For example, the bone scan is nuclear medicine, and cancer in the bone is revealed as a hot spot, or excess uptake of the radiopharmaceutical. PET scans are also nuclear medicine, and there are many different types of radiopharmaceuticals used which dictate the type of PET scan. F18 and FDG18 are currently utilized for bone imaging in the U.S. for prostate cancer.
A CT scan, on the other hand, may also involve an injection, but it is not a radiopharmaceutical, so CT is radiology, not nuclear medicine. MRI is radiology, even if an injection is used . Ultrasounds and X-rays are radiology.