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Prostate Cancer Diagnosis

Ayetkin Oto, MD, at MRI workstation

An early and accurate diagnosis of prostate cancer is not only vital for treatment planning but also increases the chance of a cure. 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 will perform one or more of the following tests to confirm the diagnosis and to determine if the cancer is 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).

Prostate Biopsy

A prostate biopsy is the only test that can confirm whether or not a patient has prostate cancer.

Conventional Prostate Biopsy

Conventional prostate biopsy is performed on an outpatient basis under local anesthetic. The procedure is only slightly uncomfortable for the patient and is usually completed in less than 10 minutes.

During the procedure, the urologist inserts a thin needle through the rectum wall into the prostate gland. Guided by ultrasound, the doctor then removes approximately 12 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 based on how closely they resemble normal cells in the prostate gland. The pathologist uses the Gleason grading system to assign a number from 6 to 10. Lower numbers mean a slow growing cancer; higher numbers indicate the cancer cells are more aggressive and may spread.

MRI-Guided Prostate Biopsy

We recommend MRI-guided biopsies of suspected tumors in the prostate for certain patients, as this targeted biopsy offers a minimally invasive, highly accurate diagnosis for prostate cancer. MRI-guided prostate biopsy and MRI/ultrasound fusion biopsy (described below) require fewer tissue samples and have a lower risk for false negative results than conventional prostate biopsy.

Factors considered in determining if a patient is an appropriate candidate for MRI-Guided prostate biopsy include:

  • Elevated prostate-specific antigen (PSA) and negative biopsy results
  • PSA elevation after treatment
  • The location, size and/or stage of a prostate cancer diagnosis needing further analysis
  • Low-risk prostate cancer requiring monitoring (active surveillance)
  • Patients under consideration for MRI-guided focal laser ablation (focal therapy)

The University of Chicago Medicine is one of only a few hospitals in the U.S. that offers MRI-guided prostate biopsy.

MRI/Ultrasound Fusion Biopsy

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.

Prostate MRI

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 those exact locations will be examined to determine diagnosis and treatment.
»Read more about MRI-guided prostate biopsy and MRI/ultrasound fusion biopsy

Diagnostic Imaging

If the biopsy shows that 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 the University of Chicago Medicine, our radiologists specialize in endorectal prostate MRI using state-of-the art 3 Tesla MRI scanners, which give unsurpassed images of the prostate. Dedicated prostate imaging experts interpret the images using prostate-specific MRI workstations and software.

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. »Read more about prostate MRI research.

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