���ѵ���

It’s important to assess your risk of prostate cancer with your doctor and discuss whether prostate cancer screening is appropriate. If the screening returns abnormal results, doctors at NYU Langone’s Perlmutter Cancer Center may recommend further diagnostic testing.

Some of the common diagnostic tests we conduct include prostate-specific antigen (PSA) tests, MRIs, and prostate biopsies.

Prostate-Specific Antigen Test

In a PSA test, a small amount of blood is drawn and sent to a laboratory for analysis. A PSA test, along with a digital rectal exam, is typically part of a prostate cancer screening. If the result of either test is abnormal, further diagnostic testing may be recommended.

MRI

If PSA levels are elevated or an irregularity is found during a digital rectal exam, doctors may recommend an MRI scan of the prostate. MRIs use magnets and computers to create 2D and 3D images. These allow doctors to view the prostate in detail to check for potentially cancerous regions.

Since 2010, NYU Langone doctors have been recognized internationally for developing and improving techniques for MRI scanning of the prostate. Our radiologists use the latest technology and techniques to interpret images.

For instance, we measure blood flow and movement of water in prostate tissues, because water molecules move differently in cancerous tissue. We also look for abnormal blood vessels using what’s called early contrast enhancement. Blood vessels that feed prostate cancer absorb contrast material, an injected dye that rapidly helps make cancer more visible on scans. The contrast material also leaves abnormal blood vessels more quickly.

After the MRI scan, our radiologists analyze the image to decide whether a prostate biopsy is necessary and, if so, where to target.

Prostate Biopsy

A prostate biopsy is a series of tissue samples collected to confirm a prostate cancer diagnosis. Biopsies are recommended if previous tests showed abnormalities. There are several types of prostate biopsies, and the type that’s best for each patient depends on other test results.

A prostate biopsy with ultrasound, the most traditional type, is also known as a transrectal ultrasound–guided biopsy. It uses an ultrasound device to help doctors visualize the prostate.

During a transrectal ultrasound–guided biopsy, doctors insert an ultrasound probe into the rectum. The ultrasound device creates echoes that become a computerized image of the prostate on a video screen. This allows the doctor to assess the shape, size, and abnormal areas of the prostate. The ultrasound probe also contains a hollow needle, which is used to collect roughly a dozen samples.

The procedure takes about 30 minutes, and patients can return home afterward. Potential side effects include mild discomfort, bleeding from the rectum, or blood in the urine or semen. These effects generally subside after a few days.

One of the greatest risks of a transrectal biopsy is severe infection, known as sepsis, which occurs in 1 to 2 in 100 patients. Another concern is that certain areas of the prostate may not be as thoroughly sampled. This can lead to missing clinically significant prostate cancer.

Both potential issues may be avoided with a different approach: a transperineal prostate biopsy. During this procedure, the doctor passes the biopsy needle through the perineal skin and into the prostate instead of through the rectum. By taking this route, the risk of sepsis is roughly 1 in 500.

Another variation, prostate biopsies with ultrasound, can be a valuable tool in diagnosing prostate cancer, but may miss aggressive cancers in areas of the prostate that are not sampled.

Because of this, NYU Langone doctors typically perform MRI–ultrasound prostate fusion biopsies, which pair MRI scans with ultrasound imaging for a clearer picture of the prostate. Using both techniques, our doctors can more accurately target abnormalities during treatment.

A computerized template biopsy, another option, uses ultrasound imaging to create a 3D map of the prostate. The template allows urologists to obtain more-precise tissue samples, making it more accurate than a traditional biopsy.

NYU Langone doctors were among the first in the country to implement a computerized template biopsy and to lead national multicenter studies on its use. A study led by NYU Langone researchers demonstrated that this type of biopsy may more accurately predict where the location of cancer in the prostate.

To reduce the risk of infection after any biopsy, our doctors prescribe antibiotics, one taken by mouth the day before the procedure and another injected into a muscle immediately before the procedure.

To develop an effective treatment plan, doctors need to know if the cancer has spread to other areas of the body. Our doctors use tests and imaging to make this assessment.

Decipher Testing

Decipher, a brand name of a type of genetic test, analyzes the activity of 22 genes, which may help predict the risk that prostate cancer will spread. The test categorizes tumors as low, intermediate, or high risk. Low-risk tumors often only require monitoring, but high-risk tumors may need more immediate and extensive treatment.

In a study partially funded by the National Cancer Institute, the Decipher test was found to be better at identifying aggressive prostate cancer than conventional tests, including the Gleason score and the PSA test. Some participants were categorized as lower risk on traditional tests, but found to be at higher risk on the Decipher test.

Only treating doctors can order a Decipher test for their patients. Such tests can help them better assess how quickly prostate cancer may spread—and how to best treat it.

Prostate-Specific Membrane Antigen PET/MRI or PET/CT Scan

If doctors suspect cancer has spread, they may order a prostate-specific membrane antigen PET/MRI or PET/CT scan—a CT scan that uses a series of X-ray images and computer software to create 3D, cross-sectional images. CT scans are typically better at detecting cancer in the bone and the lymph nodes than MRI scans.

For the PET/MRI or PET/CT scan, doctors use a radioactive tracer drug that attaches to receptors, which are proteins known as prostate-specific membrane antigens (PSMAs) that sit on the surface of prostate cancer cells. If such proteins are present, patients may be candidates for radionuclide therapy if they have not responded to other systemic therapies.

Staging or grading prostate cancer can help determine the right diagnosis and treatment. Doctors assign the cancer a numerical stage from 1 to 4 based on its location and growth.

To determine a prostate cancer’s aggressiveness, a pathologist reviews the biopsy sample and assigns the cancer what’s known as a Gleason score. This indicates how likely it is to spread. Grade groups may also be used in place of Gleason scores.

After they get initial Gleason scores from pathology, NYU Langone doctors also review them to ensure agreement before they are finalized.

Knowing the stage and grade of their prostate cancer helps patients better understand the status of their cancer, outlook, and treatment options.