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While a PSA blood test may be ordered, the most accurate test for prostate cancer is a biopsy
The most accurate test for detecting prostate cancer is a prostate biopsy. This biopsy involves taking a tissue sample from the prostate and examining it under a microscope, which can help your doctor determine whether there is an uncontrolled growth of cells in the prostate gland.
During a prostate biopsy, your doctor inserts a thin needle into your prostate under image guidance using magnetic resonance imaging (MRI) and/or a transrectal ultrasound TRUS) to collect a tissue sample. The tissue is then examined in a lab to look for cancer cells. Your doctor may insert the biopsy needle through your rectum (transrectal biopsy) or the skin between the scrotum and anus (transperineal biopsy).
What other screening tests are used to detect prostate cancer?
Because a biopsy is an invasive procedure, your doctor may first use one or more of the following methods to screen for prostate cancer:
Medical history
When your doctor takes a detailed medical history, they may ask you about your symptoms, underlying health conditions (such as diabetes or high blood pressure) and whether you consume alcohol or tobacco in any form. Your doctor may also ask you whether any of your close family members such as a father, uncle or brother were diagnosed with prostate cancer at a young age (under 65 years). You may also be asked other questions such as whether you have experienced weight loss or a change in sex drive.
Digital rectal examination (DRE)
A thorough physical examination will also allow your doctor to assess your general health by looking for any signs of disease.
Your doctor may order a digital rectal examination (DRE). During a DRE, your doctor will insert a gloved, lubricated finger into your rectum and try to feel for any lumps, irregularities or hard areas on the prostate that could suggest cancer. This examination will also provide clues as to whether the cancer is in one or both sides of the prostate and whether it has spread to the nearby structures.
Prostate-specific antigen (PSA) blood test
Your doctor may order blood tests to look for blood counts or inflammatory markers (substances increased in the blood in response to an infection or inflammation). One blood test may measure the levels of a type of protein called PSA, which is made by both normal and cancerous cells in the prostate.
A PSA test does not indicate with 100% accuracy whether a person has prostate cancer. Thus, it is generally used to screen high-risk groups or as a preliminary test. Most people without prostate cancer have PSA levels less than 4 ng/mL (nanograms per milliliter). There is almost a 50% chance that a person has prostate cancer if their blood PSA levels are above 10 ng/mL. However, men with prostate cancer may have PSA levels less than 4 ng/mL. Moreover, higher PSA levels may be observed in noncancerous conditions such as benign prostatic hyperplasia (BPH).
Is a prostate biopsy painful?
Chances of feeling any significant pain during a prostate biopsy are generally low, because your doctor will numb the area with an anesthetic shot.
However, you may feel some pain after the procedure, especially when sitting. Pain may occur in the area between the anus and scrotum and can last for a day or two. Your doctor may prescribe pain medications and suggest that you take it easy for a few days after the procedure.
What are potential complications of a prostate biopsy?
While prostate biopsy is a fairly quick and simple procedure that takes about 10 minutes to complete, complications of the procedure may include:
- Pain lasting for a few days or a week
- Hematuria (blood in urine) lasting for a few days to many weeks
- Blood in stools lasting for a day or two
- Blood in the semen lasting for four to eight weeks
- Fever with chills (indicative of an infection and must be reported immediately to your doctor)
- Inability to pass urine or urinary retention (a rare but dangerous complication and one must seek urgent medical attention)