One in eight men will be diagnosed with prostate cancer. The American Cancer Society reports that prostate cancer is the second leading cause of cancer death in American men, second only to lung cancer. The sooner it is found, the better the chances for a positive outcome. That’s why early diagnosis is critical for treating this condition.

Identifying possible prostate cancer in men typically involves an exam with a physician. Also, a blood test for measuring the prostate specific antigen (PSA) level in the blood may be used to show if prostate cancer may be present. 

When an exam or a PSA test indicates the possibility of prostate cancer, a doctor may order additional lab work or an imaging test to evaluate risk. If there is confirmed risk, a procedure known as a biopsy is used to extract small pieces of prostate to be studied by a pathologist

Diagnosing prostate cancer through biopsy

The biopsy is the gold standard for diagnosing prostate cancer. Traditionally, a surgeon performs the prostate biopsy through the rectum and into the prostate using imaging (ultrasound) as a guide. This approach is still commonly used but can lead to infection for the patient and presents challenges for the surgeon when reaching certain areas of the prostate.

A newer way of performing biopsy is through a transperineal approach. Using this approach, a surgeon places a needle across the skin between the testicles and anus known as the perineum to access the prostate. For the patient, this can lower the risk of infection. For the surgeon, it allows for better access to challenging areas of the prostate. 

Both biopsy procedures are typically performed using guidance from an MRI obtained prior to the procedure that identifies the high-risk areas. At the Minimally Invasive Urology Institute at The Miriam Hospital, image guidance and transperineal biopsy are used frequently to allow for safer and more accurate biopsies for patients. 

Detecting cancer through PET imaging

In addition to a new biopsy approach, a new imaging test is now available through Lifespan Medical Imaging at Rhode Island Hospital. 

Once a patient has been diagnosed with prostate cancer, the physician must also determine if disease has spread to other areas in the body. This is based on various factors (PSA levels, Gleason score, and T staging). If a patient is found to be at high risk for metastatic disease or has already undergone prostate cancer treatment but demonstrates elevated serum prostate antigen levels during a follow up visit, he would qualify for a type of scan known as PSMA PET imaging – prostate-specific membrane antigen positron emission testing. 

PSMA PET imaging allows for more precise detection of prostate cancer in the body for better treatment planning and targeted care. This exam uses a new imaging agent that is far superior to earlier agents to detect prostate cancer that may have spread to other parts of the body. For more information on PSMA PET imaging and other imaging studies, visit our website.

Treating prostate cancer

A new therapy called Xofigo is now available to treat prostate cancer that does not respond to medical or surgical treatments that lower testosterone and has spread to the bone with symptoms, but not to other parts of the body. Xofigo is a one-minute injection that is administered every four weeks for a total of six injections. 

In clinical studies, Xofigo helped extend life by more than 30 percent in men with a certain type of prostate cancer, known as metastatic castration-resistant prostate cancer. Results from a clinical trial with Xofigo in addition to the drug that men were already taking showed that patients treated with Xofigo lived significantly longer than men who were given placebo that did not have an active drug.

Experts in prostate cancer near you

We encourage men to talk with their doctor to see if screening is right for them. Detecting prostate cancer early is key as it is most treatable. Every man is different in his risk factors and what tests may be helpful to rule out dangerous forms of prostate cancer.

For more information on prostate cancer diagnosis and treatment or to learn more about our expert team, visit our Minimally Invasive Urology Institute website. 

Elias Hyams, MD

Elias S. Hyams, MD

Dr. Elias Hyams is a board-certified urologist at the Minimally Invasive Urology Institute of The Miriam Hospital.