Prostate Cancer Screening and Diagnosis

Prostate cancer screening begins with you and your healthcare team deciding to screen, even if you have no symptoms. The choice to be screened for prostate cancer is personal and should be taken seriously. It begins with you having a conversation with your doctor about your risk for the disease, including your personal and family history, and a discussion about the benefits and risks of testing.

Generally, screening is recommended for men with no symptoms who are between the ages of 45 and 69. Some men who are at higher risk for prostate cancer — African American men, men known to carry the BRCA gene, and men with a father, brother or son who has had prostate cancer — should consider screening as early as age 40 to 45.

To detect and diagnose prostate cancer, our doctors perform thorough exams, which include talking about your medical history and questions about urinary symptoms, sexual health and your overall general health. We also perform a physical examination and a blood test, known as a PSA (prostate-specific antigen). The goal of prostate cancer screening is early detection, which improves the success of treatment and limits the impact on your quality of life.

Prostate cancer screening may be offered by your primary care physician, a urology specialist or other specialty care physician. The most common ways to screen for prostate cancer are a physical evaluation and checking your PSA levels:

• PSA is a blood test to measure this protein found in the prostate. When screening for prostate cancer, the first screening test we use is the PSA.
  • A low PSA score is a sign of a healthy prostate.
  • A rapid rise in scores may signal a problem (not necessarily cancer).
• Digital rectal exam is an optional physical test to digitally feel the prostate for problems. As specialized experts, we assess the size of the prostate as well as the presence, shape and other characteristics of any prostate nodules. Our rate of successful diagnosis exceeds that of general urologists.
• Biopsy tests may be used if the PSA and/or DRE tests results cause concern. A biopsy is when a tissue sample is removed from the prostate and reviewed under a microscope to detect any cancer cells for a diagnosis.

Advances in prostate cancer diagnosis

To be sure you receive the most accurate diagnosis, our nationally recognized prostate cancer experts use the latest and most advanced diagnostic technology, including micro-ultrasound guided biopsy. In fact, our prostate cancer experts are the first and only in the region to offer micro-ultrasound prostate-guided biopsy.

This new tool’s high-resolution images dramatically improve clarity over conventional transrectal ultrasound in detecting and staging prostate cancer. Its magnified images provide 300% improved clarity over conventional transrectal ultrasound, allowing a visualization depth of 70 microns – the width of a human hair. In addition, micro-ultrasound offers reduced cost, in-office examinations and accessibility when compared to MRI-targeted prostate biopsy. Overall, micro-ultrasound prostate-guided biopsy shortens the timespan from a patient receiving PSA results to a biopsy being performed.

Understanding your risk for prostate cancer

We use information from your PSA and prostate exam to approximate your risk of prostate cancer. Several noncancerous conditions can cause an enlarged prostate and/or elevated PSA levels. PSA levels can also vary from person to person and change with age. Your doctor will recommend additional testing, possibly with a urologist or a urology specialist at the cancer center, before he or she can make an accurate prostate cancer diagnosis.

To help you understand your prostate cancer risk and screening options, your doctor may refer you to the Burns & McDonald High-Risk Prostate Cancer Screening Program. The goal of the program is to personalize prostate cancer testing – based on your risk factors, general health and screening goals – and to closely monitor high-risk patients. This program provides vital tools to help with early detection of prostate cancer, when it is most treatable.

Our team of experts is here to help you understand your diagnosis regardless of whether your results are due to prostate cancer or a noncancerous cause.

Next steps

To ensure we accurately identify and diagnose prostate cancer based on your PSA and/or digital examination, we may take one or more of the following steps, including:

Additional lab work

PSA is just one test we use to estimate your risk of prostate cancer. Because infections, inflammation, injury or growth can also increase PSA levels, we may use additional testing to better determine the level of risk for prostate cancer in some men.

Precision imaging of the prostate

Multiparametric MRI of the prostate is an imaging test that accurately evaluates the presence of tumors in the prostate. We use this test to both rule out prostate cancer risk as well as identify potential tumors for biopsy. In addition to offering the highest quality MRI imaging (3T magnets), we provide a team of specialized radiologists who read a high volume of prostate MRI. These experts work together with your urologist to ensure you receive the most accurate assessment of your prostate cancer risk.

Micro-ultrasound of the prostate is a new imaging tool for prostate cancer diagnosis. We are the first and only program in the region with this technology. We have used ultrasound imaging for decades to guide prostate biopsies, but it has limited ability to actually see prostate cancer tumors. This new technology has a very high resolution that provides enhanced clarity (300% improved) allowing us to visualize findings as small as 70 micrometers (the width of a human hair). In addition, micro-ultrasound costs less, can be performed during in-office examinations and is more readily available than MRI-targeted prostate biopsy.

Overall, micro-ultrasound prostate-guided biopsy may shorten the timespan from you receiving your PSA results to having your biopsy performed.

Diagnosing prostate cancer

The only way to accurately diagnose prostate cancer is with a tissue sample or biopsy. We require a biopsy to determine if cancer is present. We can perform prostate biopsies in one of several ways:

Transrectal: A transrectal biopsy is the most common method to biopsy the prostate. This involves inserting an ultrasound probe into the rectum to visualize and guide the biopsy. During the procedure – which takes only minutes and is most often performed in the office – we numb the prostate with local anesthesia so we can take biopsy samples using a needle through the rectum into the prostate.

Transperineal: A transperineal biopsy is similar to a transrectal biopsy in that we use ultrasound to pass into the rectum and visualize the prostate. Rather, instead of passing the needle through the rectum, it passes through the skin of the perineum (skin between the rectum and scrotum) and into the prostate. We often perform this procedure in the operating room under anesthesia.

In addition to the 2 methods above, biopsies can also be guided or templated.

With template biopsies, we take 12 samples from the prostate that represent the most common regions where we find prostate cancer.

Fusion biopsies incorporate findings from either an MRI or the micro-ultrasound to guide the biopsy to areas of concern. With a fusion biopsy, we obtain samples from any areas of concern and also 12 representative samples from the remainder of the prostate.

Prostate cancer evaluation is not “1 size fits all” and we believe all patients are unique. Our team personalizes the evaluation to you – ensuring that the right tests and the right procedures are done to meet your individual needs.

If you are concerned about your risk of prostate cancer or have been told you need further evaluation for an abnormal prostate cancer screening test – we are here for you.