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What Is the Best Test to Diagnose Prostate Cancer?

Prostate cancer is the out-of-control growth of cells in the prostate. Several tests can be used to diagnose prostate cancer, which include the PSA blood test, prostate health index (PHI) blood test, prostate cancer urine test, biopsy, MRI, and transrectal ultrasound (TRUS).
Prostate cancer is the out-of-control growth of cells in the prostate. Several tests can be used to diagnose prostate cancer, which include the PSA blood test, prostate health index (PHI) blood test, prostate cancer urine test, biopsy, MRI, and transrectal ultrasound (TRUS).

The prostate is a gland in men that helps produce fluid that goes into semen. The prostate is located in front of the rectum and just below the bladder. Prostate cancer occurs when cells in the prostate grow out of control. 

Prostate cancer is diagnosed with a patient history and physical examination, which will include a digital rectal examination in which a doctor inserts a gloved finger into the rectum to examine the prostate to check for:

  • The size, firmness, and texture of the prostate
  • Hard areas, lumps, or growths that spread beyond the prostate
  • Pain that occurs when touching or pressing on the prostate

Other tests to diagnose prostate cancer include: 

  • Blood test to check prostate-specific antigen (PSA) levels
    • The PSA test is generally considered the “gold standard” test for prostate cancer, and has been used for more than 30 years
  • Prostate health index (PHI) blood test 
    • Food and Drug Administration (FDA) approved for use in men who have a PSA score between 4 and 10
    • PHI is a more accurate test than the PSA test that measures the risk for having prostate cancer 
  • Prostate cancer urine test
    • More accurate than a PSA test
    • When cancer is present, the PCA3 is positive 80% of the time 
    • Used to detect the gene PCA3 in urine and help the doctor better assess the patient’s prostate cancer risk
  • Biopsy of the prostate if prostate 
  • Imaging test of the prostate gland

What Are Symptoms of Prostate Cancer?

Early-stage prostate cancer may not cause any symptoms. When symptoms of prostate cancer occur, they may include: 

  • Problems urinating
    • Slow or weak urinary stream 
    • Frequent urge to urinate, especially at night
  • Blood in the urine or semen
  • Erectile dysfunction, or ED (difficulty getting or maintaining an erection)
  • Pain in the hips, back (spine), chest (ribs), or other areas if cancer has spread to bones
  • Weakness or numbness in the legs or feet
  • Loss of bladder or bowel control from cancer pressing on the spinal cord

What Causes Prostate Cancer?

The cause of prostate cancer is unknown but inherited or acquired genetic changes are believed to be factors in developing the disease. 

Risk factors for developing prostate cancer include: 

  • Age: risk increases in men after age 50, and about 60% of cases are diagnosed in men over age 65
  • Family history
  • Gene changes
  • Race/ethnicity: more common in African-American men and in Caribbean men of African ancestry than in men of other races
  • Geography: most common in North America, northwestern Europe, Australia, and the Caribbean islands
  • Other factors that may increase the risk of developing prostate cancer — these links are less clear and have not been conclusively proven -- include: 

What Is the Treatment for Prostate Cancer?

Treatment for prostate cancer depends on whether cancer is in part or all of the prostate, if it has spread (metastasized) to other parts of the body, and the age and overall health of the patient, and may include one or more of the following:

  • Watchful waiting (active surveillance)
  • Surgery: removal of the whole prostate and some nearby tissue
  • Radiation therapy
    • External beam radiation
    • Brachytherapy (internal radiation)
  • Cryotherapy (also called cryosurgery or cryoablation)
    • Uses very cold temperatures to freeze and kill prostate cancer cells and most of the prostate
  • Hormone therapy
    • Androgen deprivation therapy (ADT) uses surgery or medicines to lower the levels of androgens made in the testicles
    • Orchiectomy (surgical castration)
    • Luteinizing hormone-releasing hormone (LHRH) agonists (also called LHRH analogs or GnRH agonists) are drugs that lower the amount of testosterone made by the testicles (also called medical castration)
    • LHRH antagonists
      • Degarelix (Firmagon) 
      • Relugolix (Orgovyx) 
  • Chemotherapy 
  • Immunotherapy 
    • Cancer vaccine (doesn’t stop prostate cancer from growing, but may help men live several months longer): Sipuleucel-T (Provenge) 
    • Immune checkpoint inhibitors
    • PD-1 inhibitor: pembrolizumab (Keytruda) 
  • Targeted therapy 
    • PARP (poly (ADP)-ribose polymerase) inhibitors
      • Rucaparib (Rubraca) 
      • Olaparib (Lynparza) 
  • Treatments for prostate cancer spread to bones
    • Bisphosphonates: zoledronic acid (Zometa) 
    • Denosumab (Xgeva) 
    • Corticosteroids
    • External radiation therapy
    • Radiopharmaceuticals
      • Strontium-89 (Metastron)
      • Samarium-153 (Quadramet)
      • Radium-223 (Xofigo)
  • Surgery
    • Kyphoplasty: surgery to stabilize a painful collapsed bone in a spine weakened by prostate cancer
  • Pain medicines

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References
https://www.cancer.org/cancer/prostate-cancer.html

https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/prostate-cancer-advancements-in-screenings