Prostate Cancer Testing, Testing, 1,2,3
Screening examinations for prostate cancer have come a long way from their early days of diagnostic testing, which weren't long ago. Would it surprise you to learn that screening for prostate cancer using a prostate-specific antigen test (commonly known as a PSA test) and digital rectal examination has only been a widespread practice in the United States since the late 1980s? It's true. While PSA and digital rectal examination (DRE) are the two most essential and standard screening tests for the detection of prostate cancer, there are additional exam types that have been more recently added to a urologist’s or screening physician's toolkit – ensuring we deliver timely and accurate diagnoses to men and their loved ones looking for answers.
As mentioned, a PSA test and DRE are men's first diagnostic investigation courses. Sometimes, and depending on age, these examinations are administered during an annual physical. In other cases, a man may be experiencing symptoms potentially associated with prostate cancer, so his physician may order these tests to find out what exactly is happening.
Traditionally, if a PSA test or DRE results are abnormal, then the individual may need a prostate biopsy. Transrectal Ultrasound-Guided Needle Prostate Biopsy (TRUS/PNbx) is physicians' most frequently used prostate biopsy technique. To perform the biopsy, an ultrasound probe is first gently guided into the rectum. The prostate gland is examined in different dimensions, and the suspicious areas are identified. A biopsy needle is passed through the ultrasound probe into various locations of the prostate. The biopsy needle obtains multiple samples. Generally, 6 to 18 samples are taken from the outer edges of the prostate and suspicious areas found on the DRE or an ultrasound exam. In some cases, the prostate biopsy will be clear, and no prostate cancer will be present.
As prostate health experts, we always want to be thorough in our approach to investigating suspected prostate cancer in every patient. However, we don't want to test our patients unnecessarily and are happy to avoid invasive tests when they aren't necessary or when other options can be employed first. In these areas, prostate cancer screening has made significant leaps and bounds when it comes to bridging the gap between suspicious rectal examination or PSA findings.
Fortunately, today, before moving on to a prostate biopsy, there are additional tests that can be performed to determine whether the prostate biopsy is essential:
"Liquid Biopsy" Test: This is a urine test to check for prostate cancer DNA in the urine. The man's urologist usually orders this test. The liquid biopsy test is a home kit given directly to the patient to complete at home. The patient will urinate into the container and send it via mail to the laboratory for examination.
Prostate MRI: This imaging study looks for abnormal findings within the prostate gland. The MRI will produce one of three results: benign, intermediate, or highly likely for the presence of prostate cancer. The MRI is usually ordered by the patient's urologist or primary physician.
Prostate 4K Score: This blood test determines the likelihood of prostate cancer in patients with abnormal PSA results. The man's urologist usually orders this test.
If any of the above tests result in abnormal findings, then a prostate biopsy to confirm the presence of cancer will usually be performed.
In the unfortunate event that a man is diagnosed with prostate cancer, other tests are available that can help him, and his healthcare team makes the best treatment choices. For example, molecular testing can help the patient and his physician determine the degree of prostate cancer's aggressiveness, the chance of spreading, and the need for treatment. Based on the results, it may be suggested that some prostate cancers may be consistently observed, while others should be immediately treated.
While many men believe ignorance is bliss when it comes to their prostate health, I can assure you that this can’t be further from the truth. We are more equipped today than ever before when it comes to the diagnosis and treatment of prostate cancer. Yes, the mere thought of prostate cancer can generate a healthy amount of fear in us all, but with continued advancements in diagnostic tests and minimally-invasive treatments, we can feel confident in taking a step forward into this brave new world of medicine.
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