Diagnosis
If you have symptoms of prostate cancer, your doctor will conduct a physical exam and take your medical history to determine what might be causing them. If your doctor thinks prostate cancer might be present, he may order the following tests to diagnose and stage the disease:
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Digital Rectal Exam (DRE)
This simple test is commonly used to screen for prostate cancer in older men and is usually performed during routine physical exams. Your doctor inserts a gloved, lubricated finger into the rectum to check for enlargement of the prostate or any other abnormalities.
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Prostate-specific antigen (PSA) test
Doctors use this test to screen for prostate cancer in men without symptoms and to help diagnose the disease when symptoms are present. PSA is a protein produced by the prostate that is found in the semen and blood. This test measures the amount of PSA in the blood. Higher-than-normal amounts of PSA may be caused by cancer or other conditions such as BPH and prostatitis. High PSA levels may also mean the cancer has spread outside of the prostate to other parts of the body.
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Transrectal Ultrasound (TRUS)
Your doctor will insert an ultrasound probe into your rectum. This device emits high-energy sound waves that bounce off of tissues to make images of the prostate. Doctors commonly perform this procedure to guide biopsy needles or treatments such as internal radiation and cryotherapy to the cancerous section of the prostate.
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Core Needle Biopsy
If symptoms or results of screening exams suggest prostate cancer, your doctor will perform a biopsy. A biopsy is the only way to be certain of a cancer diagnosis. To biopsy your prostate, your doctor will most likely perform a core needle biopsy, using a transrectal ultrasound to guide the needle. Your doctor will remove a small sample of prostate tissue and send it to a lab to be analyzed.
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Bone scan
A bone scan uses a radioactive substance to identify cancerous tissues in the bones. A bone scan provides a picture of all of the bones in the body, and allows doctors to find small areas of cancer not seen on plain X-rays. The radioactive substance collects in these areas and illuminates them on the skeletal X-ray. Your doctor may order a bone scan because prostate cancer often spreads to the bones first.
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Computed tomography (CT) scan
A computed tomography (CT) scan uses X-rays to produce an image of your body. A special dye may be injected into your veins and you may be asked to drink a special fluid in order to make the internal organs stand out. A CT scan can show if prostate cancer has invaded nearby lymph nodes or tissues in the pelvis, but is not very useful for looking at the prostate itself.
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Positron Emission Tomography/Computed Tomography (PET/CT) scan
A CT scan produces detailed cross-sectional images of the body and allows doctors to study specific areas, while a PET scan uses radioactive tracers to detect suspicious masses. An integrated PET/CT scan combines images from a PET scan and a CT scan to produce a more thorough image than either test alone. Both scans are performed at the same time using only one machine. Prostate PET/CT scans can detect cancer earlier than a CT or MRI scan alone.
Recently, new radioactive tracer drugs, which are used to home in on the targeted tissue, have been found for the detection of prostate cancer. These new innovations in PET/CT technology include:
Prostate-Specific Membrane Antigen (PSMA) PET/CT Scan (Gallium [68 Ga] PSMA-11 or 18F-DCFPyl PSMA PET/CT): PSMA is used as a target for imaging and therapy in radionuclides in prostate cancer. The tracer drug is injected into the patient and taken in by the prostate cancer cells. Energy is emitted and picked up by the PET/CT scanner, which then creates a detailed image. This scan is used in both the primary staging and recurrence of prostate cancer. A PSMA-targeted radiation treatment (177Lu-PSMA-617) is approved by the FDA for metastatic prostate cancer.
Other types of PET/CT scans that exist and are commonly used are the Sodium Fluoride PET/CT Scan (NaF-PET/CT) for bone metastases, F-fluciclovine PET/CT Scan (Axumin), and C11 Chloline PET/Ct Scan and the C11 Acetate PET/CT Scan.
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Magnetic resonance imaging (MRI) scan
Magnetic resonance imaging (MRI) uses radio waves and a strong magnet to create clear and detailed images of body parts. Radio waves are absorbed by the body and then released in a certain pattern, which is translated by a computer in order to show “slices” of the body. An MRI can produce detailed pictures of the prostate, and can show if it has spread to the seminal vesicles or other nearby structures.
