Prostate biopsies are conducted to determine if the prostate tissues are cancerous. Abnormalities detected during a digital rectal exam and a high PSA level often warrant a prostate biopsy. This procedure consists of introducing a fine needle into the prostate through the rectum to extract tissue samples. The samples are then sent to a laboratory to be tested and analyzed under a microscope. A biopsy is frequently performed at the same time as a transrectal ultrasound and the procedure usually lasts around 10 minutes. A local anesthetic can be used to reduce discomfort from the procedure.
A biopsy is the most efficient method to detect cancer and grade it according to how aggressive and advanced it is.
A biopsy can detect cancer early and increase the chances of stalling the spread to other organs and tissues.
A biopsy may cause side effects. Some side effects include:
- Bleeding (if severe or persistent, consult your doctor right away)
- Mild pain or discomfort
- Risk of infection
- Urine retention (inability to pee despite having a full bladder)
It might take up to two weeks to get the results of a biopsy.
If cancer is present, the pathologist will grade it according to the Gleason scale that will determine the level of advancement and aggressiveness of the tumour.
In a case when the biopsy is negative or no cancer is found but the urologist suspects you have cancer, a second biopsy may be ordered or another type of biopsy may follow. Otherwise, regular prostate checkups, including the PSA test, digital rectal exam (DRE), and magnetic resonance imaging (MRI), may be the preferred route.1
If the results from the biopsy reveal the presence of cancer, additional exams may be required to determine if the cancer cells have begun to spread to other parts of the body. These exams are generally done when there are serious signs of the disease such as a lump in the prostate, extensive induration and elevated PSA levels.
Complete Blood Work
The complete blood count (CBC) test uses a blood sample to evaluate an individual’s overall health by measuring the number and quality of red blood cells, white blood cells, and platelets. The CBC test is also used to check for an infection and anemia as these conditions can affect cancer treatment.
Chemistry tests measure the concentration of various chemical substances in the blood. These chemicals show how well the organs are functioning and can be used to detect damaged tissues or abnormalities. Among them, high levels of urea nitrogen and creatinine can mean that the kidneys are either working abnormally or inefficiently. In this case, it is possible that the prostate is blocking urine flow and impairing kidney function. Alkaline phosphatase (ALP) and calcium may indicate the presence of bone metastases as your cancer spreads to the bone.
The bone scan is an imaging technique used to detect the presence of cancerous cells in the bone. A small amount of radioactive material (tracer) is injected into the bloodstream and after a few hours the scan is performed. The presence of cancer is indicated if the tracer is absorbed by the bones.
Computed Tomography (CT) Scan
A computed tomography (CT) scan is also known as a computerized axial tomography (CAT) scan. This scan is a computerized x-ray that takes three-dimensional images of the internal organs in the body. Prostate cancer often spreads to the pelvic lymph nodes and a urologist may be particularly interested in measuring the dimensions of the prostate and knowing where exactly the cancer has spread. Before undergoing the CT scan, a non-radioactive colorant is injected to help see the internal organs clearly. A camera within the machine then takes images of the entire body, this procedure lasts about 20 minutes.
Once complete, the software will place the pictures together to form a three-dimensional image of the prostate, surrounding tissues and other organs. Enlarged lymph nodes could be an indication that the cancer has spread and it may affect the course of treatment.
Magnetic Resonance Imaging (MRI)
An MRI is more defined than a CT scan and uses magnetic forces and radio-frequencies to take a 3D picture of the internal organs. An MRI allows doctors to see if there is spread to other soft tissues surrounding the prostate and it can also be used to plan your treatment, evaluate the efficiency of a treatment, or follow the cancer’s progression.
Pelvic Lymph Node Dissection
This is a surgical procedure where pelvic lymph nodes are extracted or dissected to verify if the cancer has spread. This test is performed under general anesthesia through an incision in the abdomen or with a laparoscope.