Tests
The gold standard for diagnosing prostate cancer is the prostate biopsy, collecting small samples of prostate tissue and identifying abnormal cells under the microscope. If cancer is found, the doctor will use the sample and imaging tests, such as an ultrasound, to determine the cancer’s stage (how far it has spread into the body) and grade (how abnormal the cells appear). The more abnormal they are, the more likely it is that the cancer will be aggressive.
The total PSA (total prostate specific antigen) blood test and digital rectal exam (DRE) are the primary tools used to help determine the need for a prostate biopsy. The DRE is a physical examination. To perform the DRE test, the doctor inserts a gloved, lubricated finger into the rectum and feels the prostate gland with his finger.
Laboratory Testing
Laboratory testing is used to screen asymptomatic and symptomatic men for cancer, rule out other diseases and conditions that may be causing or exacerbating a patient’s symptoms, monitor the effectiveness of treatment for cancer, and monitor for recurrence.
Testing may include:
PSA (total prostate specific antigen) – to help screen for and monitor prostate cancer. PSA is a good, but not perfect tool. Increased levels of PSA have been associated with an increased risk of prostate cancer, but are also found with BPH, prostatitis (inflammation of the prostate), infection, and a variety of other temporary conditions. About two-thirds of men with an abnormal PSA level do not have prostate cancer, and about 20% of those with prostate cancer will have normal PSA concentrations. When evaluating the results, the doctor must consider both the concentration of PSA in the blood and the volume of the patient’s prostate. (Discussion of variations of the PSA test, such as free PSA and cPSA, are included on the PSA test page).
Urinalysis – to screen for kidney disorders
Urine Culture – to look for signs of a UTI
Blood Urea Nitrogen (BUN) and Creatinine – blood tests to evaluate kidney function
Non-laboratory tests may include:
Ultrasound – A transrectal ultrasound (TRUS) may be used to help measure the size of the prostate and to help guide needle placement during a prostate biopsy
CT (computed tomography) – to help evaluate the extent of the cancer
MRI (magnetic resonance imaging) – to help evaluate the extent of the cancer
Radionuclide bone scintigraphy – occasionally used to detect cancer that has spread to bone
PET (positronic emission tomography) – occasionally used to help stage metastatic cancer (cancer that has spread beyond the prostate)
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