What tests help confirm a prostate cancer diagnosis? Expert Dr. Daniel Sentana explains how testing methods, such as the PSA test, digital exams, imaging, and biopsies, work together to shape a prostate cancer diagnosis.
Dr. Daniel Sentana Lledo is a genitourinary medical oncologist in the Lank Center for Genitourinary at Dana-Farber Cancer Institute. Learn more about Dr. Sentana Lledo.
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Transcript
Katherine Banwell:
What testing should be done following a diagnosis?
Dr. Daniel Sentana Lledo:
Yes, diagnosis of prostate cancer is actually something that is difficult on its own, and that’s because while we’ve had a screening test for a long time, it’s not the most predictive of it. And what I mean by that is we’ve relied historically on two things to diagnose prostate cancer. First thing was digital rectal examinations, and that’s something that a physician would do or a healthcare provider would do in a clinic, but at the end of the day, it relies on an individual picking up something on an exam. And we know that not all prostate cancer grows where you can feel it with your finger.
The other part of this is we’ve had now for many decades the prostate-specific antigen or PSA test, which is very, very revolutionary, and still today very important in prostate cancer. But again, people can have high PSAs and not have prostate cancer, and people can have low PSAs and get diagnosed with prostate cancer. So, many times both an abnormal digital rectal exam or an abnormal PSA is not enough to say you have prostate cancer.
Nowadays, we rely on two additional pieces of information which are very important. The first one is imaging. So, we’re lucky in most places to be able to access very sophisticated and very advanced techniques in imaging. I would say the most important one for localized disease is having access to MRI because that can give us a whole vision of the gland, and if there are any suspicious lesions, that could be prostate cancer.
For people that have more advanced disease, as we will talk about, I’m sure, there’s newer technologies like PET scans, which are specifically looking at prostate cancer, wherever it may be in the body. And so, imaging is very important in diagnosis.
And obviously, the gold standard to this day is you need a biopsy. And most of the time, for people that have prostate cancer inside the prostate, so localized disease, that is going to be a prostate biopsy. I would say historically, this was done going after 12 quadrants in the prostate, still done these days. However, with the addition of newer imaging techniques, we now have the ability to make what I call targeted biopsies. So, you use the images that you have, usually MRI, this is a suspicious place, I’m going to especially make sure I biopsy that spot. And so, biopsy of the prostate is essential.
If someone we think has advanced prostate cancer, so cancer that has spread from the prostate, then the biopsy usually for us is more helpful if you go after the place where the cancer you think has spread. So, yes, I would say while we may start with an abnormal PSA or an abnormal exam finding, really you need a combination of imaging and biopsying to nail the diagnosis.