Prostate Cancer Testing

Imaging tests take pictures of the inside of your body. These tests are used to detect and treat prostate cancer.

Common imaging tests:

• X-rays use low-dose radiation to take one picture at a time.
• Ultrasounds use high-energy sound waves to make pictures.
• Computed tomography (CT) scans use x-rays to take pictures from many angles to create real-looking images.
• Magnetic resonance imaging (MRI) scans use radio waves and strong magnets to make detailed pictures.
• Positron emission tomography (PET) scans use a radioactive drug called a tracer to find disease and take real-looking pictures.

A CT scan of your abdomen and/or your pelvis may be one of the tests used to look for cancer that has spread to other areas (metastasized).

• CT scans are good at seeing lymph nodes and the area around the prostate.
• Before the CT scan, you may be given contrast. Contrast material is used to improve the pictures inside the body.
• Contrast might not be used if you have a serious allergy or if your kidneys aren’t working well.

• An MRI may cause your body to feel a bit warm.
• A contrast material may be used to make the pictures clearer.
• A special type of MRI scan, called a multi-parametric MRI scan (mpMRI), might be done before a biopsy to learn more about your prostate cancer.
• An mpMRI might help detect certain types of tumors. It also might be better at determining risk group for active surveillance.
• An MRI might be used to look for prostate cancer that has metastasized to nearby lymph nodes in your pelvis.

• Cancer cells show up as bright spots on PET scans.
• Usually a PET scan is combined with CT (PET/CT) or MRI (PET/MRI)
• A PET/CT or PET/MRI may be used to look for small tumors (metastases) in soft tissue and in bone.

• A TRUS is a transrectal ultrasound. In this procedure, a probe is inserted into the rectum where high energy sound waves are bounced off internal tissue to form an image called a sonogram.
• A TRUS is used to look for tumors in the prostate and nearby areas.
• A TRUS is also used to guide biopsies.

A bone scan is an imaging test that can show if cancer has spread to your bones.

• This test may be used if you have bone pain, are at high risk for bone metastases, or if there are changes in certain test results. Bone scans might be used to monitor treatment.
• A bone scan uses radiotracer to make pictures of the inside of bones.
• Before the pictures are taken, the tracer will be injected into your vein. It can take a few hours for the tracer to enter your bones. For the scan, you will need to lie very still on a table. A special camera will take pictures of the tracer in your bones as it moves over your body.
• Areas of bone damage use more radiotracer than healthy bone and show up as bright spots on the pictures. Bone damage can be caused by cancer, cancer treatment, or other health problems.

Blood tests check for signs of disease, how well organs are working, and treatment results. One common blood test is a complete blood count (CBC).

• A blood chemistry test is another common type of blood test. This test measures the levels of different chemicals in the blood.
• A prostate specific-antigen (PSA) test will be used after treatment to detect for recurrence of prostate cancer.

A biopsy, or tissue sample, is needed to confirm (diagnose) prostate cancer. Prostate cancer treatment often begins after biopsy.

• A biopsy looks for cancerous cells. Your doctor will order a biopsy to learn more about your cancer and share the results with you.
• A pathologist is an expert who will test the biopsy and write a report called a pathology report.
• A core biopsy or core needle biopsy is the most common type of prostate biopsy. Core samples will be taken from different parts of your prostate.

Your health care provider might refer you for genetic testing to learn more about your cancer. A genetic counselor will speak to you about the results. Genetic tests can help plan treatment.

There are 2 types of genetic tests used in prostate cancer:

• Germline testing
• Tumor testing

Germline testing is done using blood or saliva (spitting into a cup). The goal is to look for germline mutations.

• Germline mutations are passed down from parent to child. They are inherited.
• Some germline mutations for prostate cancer include BRCA1, BRCA 2, ATM, CHEK2, PALB2, MLH1, MSH2, MSH6, and PMS2 (Lynch syndrome).
• Some of the germline mutations like BRCA1 or BRCA2 are related to other cancers such as breast, ovarian, pancreatic, colorectal and melanoma skin cancer.
• You can pass these genes on to your children. Also, family members might carry these mutations.
• If germline mutation is suspected, you should be recommended for genetic counseling and follow-up germline testing.
• Germline testing is recommended for those with prostate cancer and any of the following:
  • A family history of prostate cancer.
  • High-risk, very high–risk, regional, or metastatic prostate cancer regardless of family history.
  • Ashkenazi Jewish ancestry.
  • Intraductal cancer shown on biopsy.

A sample from a biopsy of your tumor will be tested to look for biomarkers or proteins to choose the best treatment for you.

• Tumor testing can be considered for patients with regional or metastatic prostate cancer. Regional cancer has spread to nearby lymph nodes. Metastatic cancer has spread to distant parts of the body.
• Tumor testing is sometimes called gene profiling or molecular testing.

• Tests are used to plan treatments and to check how well treatments are working.
• Blood, imaging, and tissue tests check for signs of disease.
• A biopsy is used to confirm (diagnose) prostate cancer.
  Your health care provider might refer you for genetic testing to learn more about your cancer.
• Imaging testing may be used to see if the cancer has spread beyond the prostate.

IMPORTANT:

This information is provided for educational purposes only to support patients in understanding and discussing appropriate treatment options with their doctors. Included is information from treatment guidelines for doctors and other sources. However, this information should not be considered as patient treatment guidelines or recommendations, but as educational materials only. Patients should discuss treatments identified herein with their doctors to understand the risks and benefits of each based on their personal diagnosis. Treatment decisions should only be made between the patient and his doctor.