Prostate Cancer Diagnosis

Prostate Cancer Diagnosis


You have an elevated PSA and they’re worried about prostate cancer. What happens next? New tests are available which can help in the decision of whether to perform a tissue biopsy.

  • The prostate health index – PHI test – is a combination of three forms of the PSA protein. The results are used to provide a probability of cancer.
  • The 4k score is a blood test measuring four different prostate related proteins that provides a percent risk score of having an aggressive prostate cancer.
  • The prostate cancer gene 3 test -PCA 3 – is a gene based test carried out on urine: higher the level, the more likely the chance cancer is present.
  • The prostate can be evaluated further with the Uro/NAV MR/Ultrasound fusion biopsy system. Fusion biopsy is a more effective method for detecting and diagnosing high-risk and aggressive prostate cancers.

After the biopsy, additional tests may be performed to help assess the aggressiveness of the tumor and decide whether or not treatment is indicated. Different types of genetic testing may be performed to give information on the tumors growth rate, aggressiveness and risk of morbidity. These tests include Prolaris, Oncotype DX and ProstaVysion.

If your doctor has detected consistently elevated PSA (prostate-specific antigen) levels over a period of years or tests, a prostate biopsy is recommended. Before doing so, your doctor should have conducted a digital rectal exam (DRE) to feel for any abnormalities that could be caused by tumor growth. A transrectal ultrasound may have also been used to create an image of your prostate. A prostate cancer expert, proficient in diagnosis and treatment, should review the results of these tests.

When substantial evidence exists suggesting the possibility of cancer, a prostate biopsy is used to sample the prostate tissue. These tissue samples provide a clearer diagnosis and help doctors determine the grade, or Gleason Score, of your prostate cancer.

Prostate cancer staging is used to define the extent of the primary tumor and whether or not it has spread beyond the prostate gland. T stages are used as follows:

T1/Stage A: Microscopic, unilateral, non-palpable cancer tumor, only detected via imaging T2/Stage B: Cancer is felt during DRE, confined to one or both sides of prostate gland T3/Stage C: Cancer spread to tissue immediately outside the gland T4/Stage D: Cancer has advanced to other parts of body

Separately, Gleason Score is used to categorize the aggressiveness of the cancer, regardless of location. Degree of differentiation among the cancer cells drives Gleason Score.

Grade 1 – Uniform, small cells packed tightly together Grade 2 – Cells of varied shapes and sizes, loosely packed Grade 3 – Greater irregularity in cell size and shape, less distinction between the cells Grade 4 – Large cells, irregular fused together Grade 5 – Fused, irregular cells invading the surrounding connective tissue

Absolutely. Prostate cancer is considered a silent killer because it often appears, and even spreads, with no noticeable symptoms. Prostate cancer is very common, affecting one out of every six men. When diagnosed early, while localized in the prostate gland and before symptoms appear, prostate cancer is highly treatable.

Prostate cancer occurs most often in men over age 65, but the exact causes are not fully known. Certain risk factors can increase the likelihood of an earlier diagnosis. A father or brother with prostate cancer doubles your risk. African American men are 60% more likely to develop prostate cancer than Caucasian men. Obesity, at any age, also plays a significant role in prostate cancer risk, as does metabolic syndrome.

The earlier you consult with a prostate cancer expert like Dr. Samadi, the better. Prostate cancer treatment options are varied, making education your best weapon. Your individual prostate cancer status and risk factors must be considered in conjunction with treatment choice.

Prostate cancer treatments include: robotic prostate surgery, prostate cancer hormone therapy, radiation for prostate cancer, High Intensity Focused Ultrasound (HIFU), and CyberKnife®. Some men choose not to treat their prostate cancer, opting for a Watchful Waiting or Active Surveillance approach.

Robotic prostate surgery is the only definitive prostate cancer treatment that removes the cancerous prostate.

PSA Test

This simple blood test is used to monitor the level of prostate-specific antigen (PSA) produced by the prostate gland. PSA is considered elevated with sustained levels above a normal 4.0ng/ml. The PSA is not a definite prostate cancer test, but rather an effective early indicator of prostate cancer, infection, or enlargement.

Since the PSA is a simple blood test, it’s a good idea to get a baseline before the age of 50. With your individual PSA risk factors as a guide, you and your doctor can determine a follow-up screening schedule. The best time for annual PSA screening is between the ages of 55-69. Risk increases significantly after age 65, so diagnosis in this window allows for early, more effective treatment. Screening is still valuable after age 70, depending on overall health.

The PSA test cannot diagnose prostate cancer, but it is the most effective monitoring tool available today. Some experts believe the PSA causes unnecessary follow-up testing, concern, and treatment. Others, like Dr. Samadi, encourage annual screening to educate and arm men with the most thorough picture of their health. From that point, men should partner with a prostate cancer expert such as Dr. Samadi for individual counsel on screening and treatment.


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