What is the best test for prostate cancer

You usually have a number of tests to check for prostate cancer. This includes:

• a digital rectal examination
• a PSA blood test
• taking a sample of your prostate gland called a biopsy
• scans

Tests your GP might do

Most people start by seeing their GP. They can do some tests to help them decide whether you need a referral to a specialist. The tests your GP might arrange include:

• an examination of your prostate gland (digital rectal examination)
• a prostate specific antigen (PSA) blood test

Examination of your prostate gland

Your doctor checks your prostate gland for abnormal signs such as lumps or hard areas. This is also called digital rectal examination (DRE).

To examine your prostate, the doctor puts a gloved finger into your back passage (rectum).

PSA blood test

The PSA test measures the amount of prostate specific antigen (PSA) in your blood. PSA it’s a protein made by both normal and cancerous prostate cells.

It’s normal for all men to have some PSA in their blood. But a PSA level higher than what would be expected for someone of your age can be a sign of prostate cancer.

Tests your specialist might do

Depending on the results of your tests, your GP might refer you to a specialist. You usually see a urologist. This is a doctor who specialises in treating problems of the urinary tract such as the prostate, bladder and kidneys.

Your specialist usually does more tests. These include:

• an MRI scan (MRI)
• biopsy
• CT scan
• bone scan

MRI scan

The first scan your specialist does is an MRI scan. This is usually a multiparametric MRI scan (mpMRI). Some people may have a type of MRI scan called biparametric MRI instead.

MRI stands for magnetic resonance imaging. It uses magnetism and radio waves to take pictures of the inside of the body. A mpMRI scan produces a more detailed picture of your prostate gland than a standard MRI scan.

A mpMRI scan helps your doctor:

• check for any abnormality
• decide whether you need a biopsy
• guide where to take the biopsy from
• look at whether a suspected prostate cancer has started to grow outside the prostate
• look at the local lymph nodes
  
   and bones around your pelvis to make sure they are normal

Your doctor might not do a mpMRI if you're unwell or not likely to be able to have a biopsy or future treatment. 

It is important to know that an MRI alone can’t tell for sure whether you have prostate cancer or not. But the results help your doctor decide whether you need further tests.

Understanding your MRI results

A doctor who specialises in imaging scans gives the MRI scan a score based on the results. This score helps your doctor decide on the next step and whether you need to have a biopsy. This is where your doctor takes a sample of your prostate gland.

This score is called the Likert or PI-RAD system. It estimates the risk that an area seen on the MRI scan may be a cancer or not. The score is from 1 to 5.

An accurate diagnosis is critical for planning the best treatment approach for prostate cancer. Here, pathologist Victor Reuter (left) discusses a patient’s case with surgeon Karim Touijer.

We understand that a diagnosis of prostate cancer can cause a lot of anxiety and uncertainty. Our experts will use the latest technology to give you the most accurate diagnosis possible. We want you to feel confident about your next step, whether it’s active surveillance for your disease or starting treatment.

Our advanced detection tests find signs of the disease and whether it has spread outside the prostate. We also can help you understand your risk for prostate cancer.

The two common screening tests for prostate cancer are the prostate-specific antigen (PSA) test and the digital rectal exam (DRE). Screening with one or both tests will not give you a definite diagnosis of prostate cancer. For that, we’ll do:

• A comprehensive examination
• A prostate biopsy
• An evaluation of risk factors, such as your family history of the disease
• Diagnostic imaging studies

New Diagnostic Tests

A biomarker is a biological molecule found in our bodies that can tell us if something is normal or not. Biomarkers have become part of the molecular tests we use to diagnose prostate cancer. New biomarkers let us precisely find prostate cancer, guide treatment decisions, monitor response to treatment, and track the cancer’s growth.

Our researchers and doctors are working to develop and evaluate the use of biomarkers. They are studying the use of advanced molecular testing and molecular imaging to find prostate cancer.

These are some of the new diagnostic tests available:

• The 4Kscore Test is a follow-up blood test given after an abnormal PSA test or DRE. It scores your risk for having aggressive prostate cancer. The information from this test can help you avoid an unnecessary prostate biopsy. A biopsy is when we remove tissue samples from the prostate using thin needles and examine them for signs of cancer.
• The Prostate Health Index (PHI) is a new combination of 3 blood tests. The PHI score gives information about the chances of finding cancer with a biopsy after an elevated PSA level.
• A urine test can find PCA3, a gene that is specific to prostate cancer. It’s found in more than 90% of prostate cancer tissue but is not in normal tissue. This test can help us decide if someone who had a negative prostate biopsy should have another prostate biopsy.
• ConfirmMDx is a test done on prostate biopsy samples that did not show cancer. It can help us decide whether to repeat a biopsy.
• Several genetic tests are used on prostate biopsy tissues, including Prolaris and Oncotype DX GPS. These tests can give you and your doctor more information by measuring how aggressive the cancer is.