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Diagnosis


The American Cancer Society's position regarding early detection is "Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. The American Cancer Society believes that men should not be tested without learning about what we know and donít know about the risks and possible benefits of testing and treatment. Starting at age 50 (45 if African American or brother or father suffered from condition before age 65), talk to your doctor about the pros and cons of testing so you can decide if testing is the right choice for you."

The only test that can fully confirm the diagnosis of prostate cancer is a Biopsy, the removal of small pieces of the prostate for microscopic examination. However, prior to a biopsy, less invasive testing can be conducted.

There are also several other tests that can be used to gather more information about the prostate and the urinary tract. Digital Rectal Examination (DRE) may allow a doctor to detect prostate abnormalities.

Cystoscopy shows the urinary tract from inside the bladder, using a thin, flexible camera tube inserted down the urethra. Transrectal ultrasonography creates a picture of the prostate using sound waves from a probe in the rectum.

Prostate imaging

Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) are the two main imaging methods used for prostate cancer detection. Urologists use transrectal ultrasound during prostate biopsy and can sometimes see a hypoechoic area (tissues or structures that reflect relatively less of the ultrasound waves directed at them). But Ultrasound has poor tissue resolution and thus, is generally not clinically used. Prostate MRI has better soft tissue resolution than ultrasound. MRI in those who are at low risk might help people choose active surveillance, in those who are at intermediate risk it may help with determining the stage of disease, while in those who are at high risk it might help find bone disease.

Prostate MRI is also used for surgical planning for men undergoing robotic prostatectomy. It has also shown to help surgeons decide whether to resect or spare the neurovascular bundle, determine return to urinary continence, and help assess surgical difficulty.


Biopsy

If cancer is suspected, a biopsy is offered expediently. During a biopsy, urologist or radiologist obtains tissue samples from the prostate via the rectum. A biopsy gun is inserted that removes special hollow-core needles in less than a second. Prostate Biopsies are routinely done on an outpatient basis and rarely require hospitalization. Fifty five percent of men report discomfort during prostate biopsy.