Ensure patients understand goals of diagnostic testing
Typically, testing for prostate cancer (PCa) will follow the steps in the timeline as noted below, but can differ slightly based on individual patient circumstances.
Prostate-specific antigen is a protein secreted by both normal and malignant cells in the prostate gland. A test to measure PSA can monitor tumor growth and response to treatment and can help detect biochemical recurrence of disease.1
High PSA does not always indicate cancer and can be caused by other conditions such as underlying infection, prostate growth, or inflammation.1
For your patients with aPC, explain the importance of routine PSA blood tests. Digital rectal exams (DREs) may also be performed. If these indicate biochemical recurrence, further imaging and scans may be needed.2,3
| PSA by age1 | Upper limit ng/mL |
|---|---|
| 40-49 | ≤2.5 |
| 50-59 | ≤3.5 |
| 60-69 | ≤4.5 |
| 70-79* | ≤6.5 |
*Routine screening should be discontinued in men with a life expectancy of 10 years or less based on comorbidities or by the age of 75.
If a patient’s PSA is above normal for their age, further testing such as imaging, blood tests, or biopsies should be considered to determine the cause. See the accompanying table for PSA upper limit values by age.1
*Routine screening should be discontinued in men with a life expectancy of 10 years or less based on comorbidities or by the age of 75.
Prostate Imaging Reporting and Data System (PI-RADS) is a structured reporting scheme for prostate MRI that can help evaluate the likelihood of clinically significant prostate cancer using a score range of 1 to 5.4
Learn more about PI-RADS scoring and what the scores may mean for probability of significant cancer.
| Prevalence of prostate cancer detection based on PI-RADS score5,6 | |||
|---|---|---|---|
| Score | Clinical significance | Any Prostate Cancer (% (95% CI)) | Clinically Significant Prostate Cancer (% (95% CI)) |
| PI-RADS 1 or 2 | Clinically significant cancer is highly unlikely or unlikely to be present | 15% (95% CI: 8% to 22%) | 7% (95% CI: 4% to 11%) |
| PI-RADS 3 | The presence of clinically significant cancer is equivocal | 25% (95% CI: 22% to 29%) | 11% (95% CI: 8% to 14%) |
| PI-RADS 4 | Clinically significant cancer is likely to be present | 58% (95% CI: 53% to 63%) | 37% (95% CI: 33% to 40%) |
| PI-RADS 5 | Clinically significant cancer is highly likely to be present | 85% (95% CI: 80% to 90%) | 70% (95% CI: 62% to 79%) |
| Prevalence of prostate cancer detection based on PI-RADS score5,6 | |
|---|---|
| Score | PI-RADS 1 or 2 |
| Clinical significance | Clinically significant cancer is highly unlikely or unlikely to be present |
| Any Prostate Cancer (% (95% CI)) | 15% (95% CI: 8% to 22%) |
| Clinically Significant Prostate Cancer (% (95% CI)) | 7% (95% CI: 4% to 11%) |
| Prevalence of prostate cancer detection based on PI-RADS score5,6 | |
|---|---|
| Score | PI-RADS 3 |
| Clinical significance | The presence of clinically significant cancer is equivocal |
| Any Prostate Cancer (% (95% CI)) | 25% (95% CI: 22% to 29%) |
| Clinically Significant Prostate Cancer (% (95% CI)) | 11% (95% CI: 8% to 14%) |
| Prevalence of prostate cancer detection based on PI-RADS score5,6 | |
|---|---|
| Score | PI-RADS 4 |
| Clinical significance | Clinically significant cancer is likely to be present |
| Any Prostate Cancer (% (95% CI)) | 58% (95% CI: 53% to 63%) |
| Clinically Significant Prostate Cancer (% (95% CI)) | 37% (95% CI: 33% to 40%) |
| Prevalence of prostate cancer detection based on PI-RADS score5,6 | |
|---|---|
| Score | PI-RADS 5 |
| Clinical significance | Clinically significant cancer is highly likely to be present |
| Any Prostate Cancer (% (95% CI)) | 85% (95% CI: 80% to 90%) |
| Clinically Significant Prostate Cancer (% (95% CI)) | 70% (95% CI: 62% to 79%) |
CI, confidence interval.
Transrectal ultrasound (TRUS)-guided, transperineal, and fusion biopsies are techniques that can be used for better diagnosis of the tumor.
TRUS-guided biopsy uses an ultrasound probe inserted through the rectum to sample tissues from the prostate.
A transperineal biopsy places needles through the perineum with an ultrasound probe in the rectum. This type of biopsy can have a lower risk of infection since the biopsy needles are not contaminated with feces.
A fusion biopsy is another test that can be performed. This is done by using a prior MRI image and overlaying it with real-time ultrasound images during a biopsy. This allows you to better determine which specific area to collect samples from.
CT is typically not the first imaging test used to diagnose prostate cancer, as the prostate gland itself does not show up well on CT images. CT scans can be useful when assessing the spread of cancer to other parts of the body, as it can show metastases to areas such as lymph nodes and bones.
PET is commonly used in advanced prostate cancer to identify and characterize metastatic disease, including its extent and location. PET is a sensitive imaging option that is able to identify abnormal function in prostate cells that indicate cancer.
PET uses the help of radiopharmaceutical agents to better detect cancer, such as:
Tumor biomarker testing can help assess aggressiveness of cancer beyond the grade and stage of disease. Some examples of these tests include Decipher® Prostate Biopsy, Opko 4K®, Oncotype DX Prostate®, Prolaris®, and ArteraAI Prostate Test®.
