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At the University of Chicago Medicine, we offer the latest techniques for detecting and evaluating prostate cancer. An elevated prostate-specific antigen (PSA) test and/or abnormalities of the prostate identified during a digital rectal exam (DRE) typically are the first indication of the possibility of prostate cancer. Neither of these tests, however, provides a definitive diagnosis of the disease.
If prostate cancer is suspected, our specialists may suggest additional blood or urine tests to estimate the risk of having prostate cancer; advanced imaging; or proceeding with a biopsy. If cancer is diagnosed, it might be localized (contained within the prostate gland), locally advanced (spread beyond the gland, but not invading other organs or vital structures) or metastatic (spread to bones, lymph nodes or other parts of the body). Appropriate management options, of which there are usually multiple, depend on many specifics regarding the man, his overall health, and the cancer.
A prostate biopsy is the only test that can confirm whether or not a patient has prostate cancer.
Conventional prostate biopsy is typically performed on an outpatient basis under local anesthetic. The procedure is slightly uncomfortable and is usually completed in less than 10 minutes.
During the procedure, the urologist inserts a thin needle through the rectum into the prostate gland. Guided by ultrasound, the doctor then removes small tissue samples. A pathologist with special expertise in prostate cancer examines the tissue under a microscope.
If cancer cells are found, they are graded using the Gleason score to assign a number from 6 to 10 (and also assigned a Gleason grade group of 1 through 5, which is a more contemporary system that mirrors the Gleason 6 – 10 grading but thought to be easier to understand). Lower numbers mean a slow growing cancer; higher numbers indicate the cancer cells may be more aggressive.
We often recommend MRIs of the prostate in various clinical situations to obtain further information to guide decision-making. When needed, MRI-guided biopsies of suspected tumors in the prostate offer a targeted, minimally invasive, and more accurate diagnosis for prostate cancer. MRI-guided prostate biopsy and MRI/ultrasound fusion biopsy (described below) have a lower risk for false negative results than conventional prostate biopsy and more commonly identify clinically meaningful cancers.
MRI/ultrasound fusion biopsy blends the detection capabilities of magnetic resonance imaging with the real-time imaging of ultrasound to guide physicians directly to suspicious lesions during the prostate biopsy.
During this procedure, the prostate MRI is taken initially and radiologists identify areas in the prostate that could be potentially cancerous. If a biopsy is deemed necessary, specialists fuse MRI images to live ultrasound images, which guide the urologist in navigating directly to the lesions. The tissue samples from these exact locations will be examined to determine diagnosis and treatment. Read more about MRI-guided prostate biopsy and MRI/ultrasound fusion biopsy.
If the biopsy shows you have prostate cancer, your physician may recommend imaging tests to determine the location and size as well as the stage (whether the cancer has spread to other parts of the body) of the tumor.
At UChicago Medicine, our radiologists specialize in endorectal prostate MRI using state-of-the art 3 Tesla MRI scanners, which give unsurpassed images of the prostate.
Other diagnostic imaging tests, such as CT, bone and PET scans may also be necessary to fully assess and stage prostate cancer.
Researchers at UChicago Medicine continually work on developing new image and image-guided technologies for prostate cancer.
Learn More About PSA Tests
Scott Eggener, MD, believes the PSA test remains valuable for potentially saving lives, but he and other UChicago Medicine urologists take a sensible approach. “Every man who has a life expectancy estimated to be greater than 10 years should at least have the conversation with their physician about the pros and cons of checking their PSA levels,” Eggener said.