Diagnostic Tests For Prostate Cancer

How Is Prostate Cancer Diagnosed

A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope.

A biopsy is a procedure that can be used to diagnose prostate cancer. A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope to see if there are cancer cells.

A Gleason score is determined when the biopsy tissue is looked at under the microscope. If there is a cancer, the score indicates how likely it is to spread. The score ranges from 2 to 10. The lower the score, the less likely it is that the cancer will spread.

A biopsy is the main tool for diagnosing prostate cancer, but a doctor can use other tools to help make sure the biopsy is made in the right place. For example, doctors may use transrectal ultrasound or magnetic resonance imaging to help guide the biopsy. With transrectal ultrasound, a probe the size of a finger is inserted into the rectum and high-energy sound waves are bounced off the prostate to create a picture of the prostate called a sonogram. MRI uses magnets and radio waves to produce images on a computer. MRI does not use any radiation.

What If My Test Results Are Abnormal

If the results of early detection tests like the PSA test or the digital rectal exam suggest that you might have prostate cancer, your doctor will conduct further testing. The PSA may be repeated, or you may be sent to a specialist for more tests such as a transrectal ultrasound and a prostate biopsy.

In a prostate biopsy, a tissue sample is taken from your prostate. Cancer can only be diagnosed with a tissue sample.

In addition to a PSA test, DRE , and a biopsy, research has yielded additional tests that can detect if cancer is present, and if so, how aggressive that cancer might be:

• Phi
• The Prostate Health Index combines three blood tests that give a more accurate Phi Score, which gives accurate information based on a high PSA to better determine the probability of finding cancer during a biopsy.

PCA3

A urine test that more accurately detects the possibility of prostate cancer by examining the expression of PCA3 a gene specific to prostate cancer. The PCA3 score is used to determine the need for repeated biopsies. Research has continued for years to look into whether PCA3 can replace or serves as a substitute for the PSA test.

4KScore

ExoDx Prostate

A simple, non-invasive urine test to assess your risk of having clinically significant high-grade prostate cancer. The ExoDx Prostate Test does not require a digital rectal exam and provides an individualized risk score that can help determine to whether to proceed or defer a prostate biopsy.

Screening For Prostate Cancer

Prostate cancer is typically treatable if caught early. More than 90 percent of prostate cancers are found when the disease is in the beginning stages, confined to the prostate and nearby organs.

Unlike screenings for breast cancer and colon cancer, there are no universal screening guidelines for prostate cancer. The U.S. Preventive Services Task Force recommends that men age 55 to 69 weigh the benefits and risks before deciding whether they should undergo screening, which is typically performed with a blood test that measures levels of a protein called prostate-specific antigen .

However, men in high-risk groupssuch as those who are of African-American descent and/or have a first-degree relative diagnosed with prostate cancer before age 65should consider speaking with their doctor about starting screenings at an earlier age.

Men older than 70 shouldnt be routinely screened for prostate cancer, according to the USPSTF.

Regardless of age or risk factors, men should get checked if they suddenly experience issues with urination, erectile dysfunction or unexplained pain.

The USPSTF suggests that, before deciding on a screening, men should seek expert advice about the benefits and harms of screening. Risks may include:

• False positives
• Complications and side effects from biopsies to confirm a diagnosis
• The possibility that a prostate cancer diagnosis wont extend lifespan or improve quality of life

Age
Consider a biopsy or additional testing

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What Is The Gleason Grade Or Gleason Score What Do The Numbers In The Gleason Score Mean For Example 3+4=7 Or 3+3=6

Pathologists grade prostate cancers using numbers from 1 to 5 based on how much the cells in the cancerous tissue look like normal prostate tissue under the microscope. This is called the Gleason system. Grades 1 and 2 are not often used for biopsies most biopsy samples are grade 3 or higher.

• If the cancerous tissue looks much like normal prostate tissue, a grade of 1 is assigned.
• If the cancer cells and their growth patterns look very abnormal, a grade of 5 is assigned.
• Grades 2 through 4 have features in between these extremes.

Since prostate cancers often have areas with different grades, a grade is assigned to the 2 areas that make up most of the cancer. These 2 grades are added to yield the Gleason score . The highest a Gleason score can be is 10.

The first number assigned is the grade that is most common in the tumor. For example, if the Gleason score is written as 3+4=7, it means most of the tumor is grade 3 and less is grade 4, and they are added for a Gleason score of 7. Other ways that this Gleason score may be listed in your report are Gleason 7/10, Gleason 7 , or combined Gleason grade of 7.

If a tumor is all the same grade , then the Gleason score is reported as 3+3=6.

The higher the Gleason score, the more likely it is that your cancer will grow and spread quickly.

What Is Screening For Prostate Cancer

Some men get a PSA test to screen for prostate cancer. Talk to your doctor, learn what is involved, and decide if a PSA test is right for you.

Cancer screeningexternal icon means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.

If you are thinking about being screened, learn about the possible benefits and harms of screening, diagnosis, and treatment, and talk to your doctor about your personal risk factors.

There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.

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What Are Additional Tests For Detecting Prostate Problems

If the DRE or the PSA blood test indicates a problem may exist, the health care provider may order additional tests, including urinalysis, urodynamic tests, cystoscopy, abdominal ultrasound, transrectal ultrasound with prostate biopsy, and imaging studies such as magnetic resonance imaging or computerized tomography scan.

The Test Is Often Not Needed

Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:

• An enlarged prostate gland.
• Recent sexual activity.
• A recent, long bike ride.

Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.

Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.

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How Are Researchers Trying To Improve The Psa Test

Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. And other potential biomarkers of prostate cancer are being investigated. None of these tests has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include

Selected References

Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. New England Journal of Medicine 2004 350:22392246.

The Role Of Psa In Staging

Prostate cancer causes cells to become malignant and multiply uncontrollably. This can lead to overproduction of PSA, and higher levels of PSA in the bloodstream.

However, some men who have prostate cancer do not exhibit elevated PSA levels. And certain noncancerous conditions, like a prostate infection or benign enlargement, can also cause high PSA levels.

PSA levels are just one factor used in determining the stage of prostate cancer. Another diagnostic tool is called the Gleason scale. This rates the extent of abnormality in your prostate cells after biopsy.

At a certain point in prostate cancers late-stage progression, Gleason and PSA become less useful. When a tumor is large enough, doctors no longer need these numbers to predict its growth or malignancy.

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What Is The First Test For Detecting Prostate Problems

The first test for detecting prostate problems is a blood test to measure prostate-specific antigen , a protein made only by the prostate gland. This test is often included in routine physical exams for men older than age 50. Because African American men have higher rates of getting, and dying from, prostate cancer than men of other racial or ethnic groups in the United States, medical organizations recommend a PSA blood test be given starting at age 40 for African American men. Medical organizations also recommend a PSA blood test be given starting at age 40 for men with a family history of prostate cancer. Some medical organizations even recommend a PSA blood test be given to all men starting at age 40.

If urination problems are present or if a PSA blood test indicates a problem, additional tests may be ordered. These tests may require a patient to change his diet or fluid intake or to stop taking medications. If the tests involve inserting instruments into the urethra or rectum, antibiotics may be given before and after the test to prevent infection.

Diagnosis Of Prostate Cancer

Check out this factsheet for a summary of the video.

Diagnosis is the process of finding out the cause of a health problem. Diagnosing prostate cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist called a urologist or order tests to check for prostate cancer or other health problems. A urologist is a doctor who specializes in treating conditions of the genital and urinary tracts, including the prostate.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as prostate cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of prostate cancer.

The following tests are usually used to rule out or diagnose prostate cancer. Many of the same tests used to diagnose cancer are used to find out the stage . Your doctor may also order other tests to check your general health and to help plan your treatment.

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Getting A Prostate Biopsy

For some men, getting a prostate biopsy might be the best option, especially if the initial PSA level is high. A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. This test is the only way to know for sure if a man has prostate cancer. If prostate cancer is found on a biopsy, this test can also help tell how likely it is that the cancer will grow and spread quickly.

For more details on the prostate biopsy and how it is done, see Tests to Diagnose and Stage Prostate Cancer.

For more information about the possible results of a prostate biopsy, see the Prostate Pathology section of our website.

Determining Whether Prostate Cancer Is Aggressive

If a biopsy sample is found to contain cancer, the pathologist analyzing the specimen takes a deeper look at the cancer cells to determine how aggressive the disease is likely to be.

If the cancer cells appear significantly abnormal and dissimilar from healthy cells under a microscope, the cancer is considered more aggressive and expected to advance quickly. Conversely, cancer cells that look relatively similar to healthy cells indicate that its less aggressive and may not spread as fast.

Prostate cancers are assigned a Gleason score depending on how abnormal the cells look.

Gleason score: Gleason scores range from 2 to 10, going from least to most aggressive prostate cancers.

There are different types of cancer cells in a prostate tumor, so the final Gleason score is determined by adding the scores of the two main areas of the tumor.

First, the primary part of the tumor is assigned a number between 1 and 5. Lower numbers indicate that the cells appear relatively similar to healthy cells, while higher numbers show that the cells are abnormal-looking. Then, another number between 1 and 5 is assigned to describe the second most prevalent area of the tumor.

Finally, the two numbers assigned to the different parts of the prostate tumor are added. So, if most of the tumor is given a 4, and some of the tumor is more aggressive and given a 5, the final Gleason score would be 9.

There are many biomarker tests, including:

• Oncotype DX® Genomic Prostate Score
• Prolaris
• ProMark®

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Can The Gleason Score On My Biopsy Really Tell What The Cancer Grade Is In The Entire Prostate

Because prostate biopsies are tissue samples from different areas of the prostate, the Gleason score on biopsy usually reflects your cancers true grade. However, in about 1 out of 5 cases the biopsy grade is lower than the true grade because the biopsy misses a higher grade area of the cancer. It can work the other way, too, with the true grade of the tumor being lower than what is seen on the biopsy.

Prostate Health Index Testing

The Prostate Health Index test is a diagnostic blood test that combines free and total PSA and the pro-PSA isoform . The PHI test is intended to reduce the number of unnecessary prostate biopsies in PSA-tested men. In prospective multicenter studies, the PHI test has outperformed free and total PSA for detection of prostate cancer and has improved prediction of clinically significant prostate cancer in men with a PSA of 2 or 4 ng/mL to 10 ng/mL.

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What Tests Screen For Prostate Cancer

Two tests are commonly used to screen for prostate cancer:

• A prostate-specific antigen test, also called a PSA blood test. PSA is a protein made by your prostate. A high level of PSA in your blood may mean you have prostate cancer, but it’s not proof of cancer. That’s because many other things may cause high PSA levels, including:
• Having an enlarged prostate

Problems controlling your bowel movements

What Are Some Common Prostate Problems

The most common prostate problem in men younger than age 50 is inflammation, called prostatitis. Prostate enlargement, or benign prostatic hyperplasia , is another common problem. Because the prostate continues to grow as a man ages, BPH is the most common prostate problem for men older than age 50. Older men are at risk for prostate cancer as well, but it is much less common than BPH.

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How Prostate Cancer Is Diagnosed

There are many tests used for diagnosing prostate cancer. Not all tests described here are commonly used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

Screening Indications And Controversies

Digital rectal examination and prostate-specific antigen measurement are the two components necessary for a modern screening program.

The indications for screening are controversial. Advocates of screening believe that early detection is crucial to finding organ-confined disease and to reducing the likelihood of mortality. When symptoms develop or when DRE results become positive, most cases have already advanced beyond organ-confined disease. Those who do not advocate screening note that screening can detect cancers that are not biologically significant , and subject patients to the risks of unnecessary intervention.

The American Cancer Society recommends that asymptomatic men with at least a 10-year life expectancy should be given an opportunity to make an informed decision with their health care provider after receiving information on the uncertainties, risks, and benefits of screening PSA evaluation. The recommended age at which men should receive this information varies by prostate cancer risk, as follows :

• Age 50 for those at average risk of developing prostate cancer
• Age 45 for those at high risk, including African Americans and men with a first-degree relative diagnosed with prostate cancer before age 65
• Age 40 for those at higher risk

Men who decide to be screened should be tested with a PSA test. A DRE may also be done as a part of screening. If screening does not detect cancer, the time between subsequent screenings depends on the PSA results, as follows :

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