Men who have a high PSA level or an abnormal prostate exam are often referred for a prostate biopsy. However, most men would be better served by obtaining a customized prostate health evaluation that includes biomarker tests for prostate cancer and a thorough analysis of the man’s individual prostate cancer risk factors, including age, family history, and overall health. If further prostate cancer testing and prostate biopsy are needed, he may be referred for an advanced 3D prostate cancer biopsy that provides a detailed look at the entire prostate rather than just a few samples.
To learn more about our advanced 3D prostate biopsy, watch this video.
Continue reading our guide below to learn more about prostate health evaluations or jump directly to the section that interests you most:
The thought of prostate cancer can be scary. Prostate cancer is the second most common cancer in men and the second leading cause of cancer death in men. But the fact is that the majority of men will die with prostate cancer present, but they will not die because of prostate cancer.
Sound confusing? It can be and that’s why we believe every man needs—and deserves—a customized prostate health evaluation. This is especially true for men who have had a prostate specific antigen screening, also called a PSA test, and have received a result of 1.5 ng/ML or higher.
Whether you will develop prostate cancer and whether it should be treated—and the best way to treat prostate cancer—is a complicated decision. Often that decision is made based on two tests: a PSA test and a traditional prostate cancer biopsy that looks at 12 tiny samples of prostate tissue and has been shown to sample less than 1% of the prostate.
A prostate health evaluation is much more extensive and is customized to each man. A prostate health evaluation takes a comprehensive look at all of the factors that influence a man’s prostate health, including:
- Family history
- Weight and diet
- Activity and exercise levels
- Testosterone levels
- PSA history
In addition, a personal prostate health evaluation may include a new category of tests that measure the level of biomarkers for prostate cancer in a man’s blood, urine and tissue. These tests are essential if you have received a PSA test result of 1.5 or above. But they also are useful for men who have any of the prostate cancer risk factors listed above.
At Precision Prostate Cancer Care, we do not believe that men should wait until age 50 to think about their prostate health. Like any other health issue, the seeds of prostate cancer may be planted early in your life through lifestyle choices or genetics. We recommend most men consider a personalized prostate health evaluation and that they also consider regular PSA testing beginning before age 50.
Men who receive a high PSA test result or have a suspicious prostate exam are often referred for further evaluation by their primary care physician or urologist. The most common tests that have been used for decades and are still the most predominant prostate cancer tests all have significant limitations. However, some of these limitations can be overcome with our advanced 3D prostate biopsy and tests that measure prostate tissue samples for biomarkers for prostate cancer.
Commonly used prostate cancer diagnostic tests and their limitations include:
- Transrectal ultrasound (TRUS): This technique uses high-frequency sound waves that are directed toward the body and detected by a special probe when they bounce back — similar to the system used by bats to direct their flight. Ultrasound can be used to view the size, outline, structure, and pathological lesions of some internal organs. This diagnostic technique can identify the general prostate structure but cannot discriminate between benign (non-cancerous) and malignant (cancerous) tissue. TRUS is a good first-line test, but in general, when used alone, cannot detect prostate cancer any better than a digital rectal exam or PSA test. Because of these limitations, it is mainly used to aid in guiding needle biopsies and determining prostate cancer volume.
- Conventional 12 core-needle biopsy: During a traditional prostate biopsy, a urologist collects 12 cylindrical tissue samples from the prostate gland through a fine needle inserted through the rectum or perineum, guided by a trans-rectal ultrasound. The samples are later examined under a microscope for signs of cancer by a specialized physician known as a pathologist. While this type of biopsy can detect the presence of prostate cancer, the limited number of tissue samples can result in findings that over- or under-represent the extent of cancer. Similarly, the needles could miss prostate cancer that is occurring outside the sample area. The small amount of tissue analyzed can lead to inaccurate Gleason scores. In general, about 1% of the prostate tissue is examined by the conventional 12 core-needle prostate biopsy technique.
- Other imaging modalities to detect prostate cancer: Physicians also may use other imaging techniques to evaluate the prostate, including:
- Magnetic resonance imaging (MRI)
- X-ray computed tomography (CT scan)
- Positron emission tomography (PET)
- Single photon emission tomography (SPECT)
Unfortunately, these modalities don’t always provide reliable information regarding early cancer identification. However, when used in combination, they have demonstrated some success in the diagnosis of disease, but they sometimes fail to identify small localized prostate cancers.
Two new types of prostate cancer diagnostic testing have recently come on to the scene that significantly improve the detection and analysis of prostate cancer. These tests are:
- Prostate Cancer Markers (PCMs): These tests, also known as PC Markers, use urine, blood or prostate tissue removed in a biopsy. These tests were designed to help identify men who are at increased risk for harboring a high grade (greater than or equal to Gleason 4+3=7) prostate cancer. They also help assess the likelihood that the prostate cancer could grow rapidly or spread outside the prostate. These tests also can help assess the likelihood of prostate cancer if a standard core biopsy is negative but the man has elevated PSA levels, particularly if the PSA levels have continued to rise over time. These tests include the Prostate Health Index (phi), Select MDx, 4k, the Prolaris Test, the Decipher test, the Oncotype DX test, and the ConfirmMDX test. Click here to learn more about PC Markers.
Download a flyer about Prostate Cancer BioMarkers.
- Advanced 3D prostate biopsy: This advanced prostate biopsy gathers 40 to 100 prostate tissue samples in 5mm increments that are then used to produce a 3D model of the prostate gland and pinpoint the location and size of any and all prostate cancer tumors present. This type of biopsy has been shown to detect 98 percent of significant and insignificant cancers within the prostate, and shows exactly where the cancer lies. This allows the surgeon to be able to treat only the area or areas of cancer within the prostate for patients who meet eligibility criteria.
A traditional core needle biopsy takes 12 tissue samples from the prostate. In a 3D prostate biopsy, 40 to 100 prostate tissue samples are obtained every 5mm to create a map of the entire prostate. This provides the highest accuracy possible and allows physicians to know exactly how much cancer is present, where it is located, and the best treatment option for a patient’s degree of disease.
To see how a 3D prostate biopsy is performed, view this video.
A 3D prostate biopsy is performed by accessing the prostate through the skin under the scrotum (transperineally) guided by transrectal ultrasound (TRUS). A grid is placed over the skin and the location of each prostate tissue sample is meticulously recorded in 5mm increments. That information is then input into a computer software program (designed by us) to create a 3D model of the prostate showing the exact location and size of all prostate cancer tumors if present. The prostate tissue samples also can be used for prostate cancer biomarkers that measure the presence and levels of biomarkers for prostate cancer, which provides your physician with information that allows him to customize your prostate cancer treatment plan exactly to your type of cancer.
The 3D prostate biopsy helps provide a much more accurate prostate cancer diagnosis for patients than traditional biopsy, which misses up to a third of all prostate cancers and cannot accurately depict their exact position within the prostate. The 3D prostate biopsy has been shown to detect 98 percent of significant cancers within the prostate. The in-depth level of detail provided by a 3D prostate biopsy, which uses up to 100 tissue samples vs. the standard 12, shows the exact location and size of all prostate cancer tumors (if present) within the prostate gland.
Approximately 40% of the men who receive a 3D biopsy are given a result that is different than what their initial conventional core biopsies revealed. These men usually require some sort of intervention such as radical prostatectomy (prostate removal surgery) or whole gland prostate radiation. Another 40% of patients who receive a 3D prostate biopsy are candidates for targeted focal cryotherapy, which targets only the cancer cells in the prostate, sparing most normal prostate tissue and most surrounding nerves. This prostate cancer treatment is often called the male lumpectomy and has been compared to a breast cancer lumpectomy that removes just the portion of the breast that is cancerous.
Lastly, about 20% of patients who receive a 3D prostate biopsy can confidently be recommended for active surveillance. These patients include men who have a 3D prostate biopsy that is negative for cancer, or who have a very small low risk of prostate cancer that the patient and his health care practitioner have decided to watch rather than treat.
The superior accuracy of 3D prostate biopsy offers diagnosis as valid as “post-surgery, whole-mount pathologic specimen” and has demonstrated the highest assessment and accuracy for prostate cancer grading and staging. This provides you with:
- Confidence in making an educated decision to treat the disease with radiation, surgery or targeted focal cryotherapy vs. active surveillance, leading to increased peace of mind regardless of subsequent treatment.
- Avoiding unnecessary prostate cancer surgery and its associated side effects due to indeterminate biopsy results.
- More accurately targeted radiation therapy, if necessary, based on 3D biopsy results.
- Accurate 3D mapping information to perform Targeted Focal Cryotherapy Prostate Cancer Treatment, a targeted therapy that treats only the portion of the prostate affected by cancer.
There are many different situations in which a man may want or need an advanced 3D prostate biopsy. We recommend that all men obtain a customized prostate health evaluation to determine the appropriate next steps. PC markers—tests that measure biomarkers for prostate cancer in blood, urine, and tissue – may indicate that a prostate cancer biopsy is not needed.
Specific common situations that men typically seek a 3D prostate biopsy include:
- A man receives an elevated PSA test result but has had a single negative prostate biopsy or multiple negative standard prostate biopsies with a Gleason score of 3+3 or in some cases 3+4. (Learn more about Gleason scores.)
- A man receives a positive prostate biopsy result but does not feel confident in the treatment option recommended, or would like to have additional detailed information about his prostate cancer, including the number, location, size and stage of each prostate cancer tumor.
- A man’s PSA levels are increasing over time and/or he has had a positive PC markers test.
- A man has a higher-than-average risk of developing prostate cancer due to family history or other factors.
- A man has negative or low-risk results on a prostate MRI, and would like further evaluation.
Whatever your situation, if you feel you need more information about your cancer and your options, a 3D prostate biopsy can provide you with peace of mind by giving you and your doctor additional detailed and customized information.
If you are interested in obtaining a prostate health evaluation, advanced testing for biomarkers for prostate cancer, or a 3D prostate biopsy, you can schedule a free phone consultation to discuss your situation and needs with a clinical specialist at Precision Prostate Cancer Care. We also offer a multidisciplinary second opinion conference, which can aid in confirming an existing diagnosis to recommended treatment, or provide you with additional information to consider.
To learn more, schedule a free phone consultation or learn about how to become a patient.