Diagnosis of Prostate Cancer

Prostate Cancer Screening

Screening for prostate cancer consists of:

• Digital rectal examination - doctor inserts a lubricated gloved finger into the rectum to check for lumps on the prostate.
• Prostate-specific antigen (PSA) blood test - a blood sample is analyzed for levels of a protein produced by the prostate that, when elevated, can indicate the presence of cancer.
• New urinary (PCA3 and MDx Select) and blood (4K score and PHI test) biomarkers are also used at times to screen for prostate cancer in men considered to be at-risk for the diagnosis.

UCLA Urologists follow the American Urological Association’s guidelines for prostate cancer screening. Screening is not without controversy – the PSA test, for instance, is often elevated when there is no cancer, and may not be elevated when there is (though this is rare). In addition, PSA alone cannot distinguish life-threatening tumors from those that are so slow-growing that they would be unlikely to pose any problem before the patient dies of something else. Patients should discuss the pros and cons of screening with their physician.

Early Detection of Prostate Cancer

Early detection is key to achieving cure in men with prostate cancer. At UCLA, our ability to identify men at an early stage is enhanced by our cutting-edge prostate imaging program, which utilizes the most advanced MRI technology to find tumors that conventional approaches such as ultrasound can miss. We also use specialized testing to evaluate men at high risk for prostate cancer who have had prior negative prostate biopsies.

Diagnostic Pathway 

Men will typically be referred to a urologist if an abnormal PSA value is found. It is important to have the PSA lab repeated to ensure that PSA is truly elevated. For men with an abnormal PSA, there are now numerous additional tests to consider ordering before proceeding with a prostate needle biopsy. These include prostate Magnetic Resonance Imaging (MRI), blood test such as the 4K test or urinary test such as Select Mdx. 

By utilizing these additional tools, men who require a prostate needle biopsy can be further identified. The sequence of using these tests is often a personalized decision made between the patient and provider. However, at UCLA we most frequently use MRI as the next step in evaluating an elevated PSA. This allows us to identify discrete suspicious lesions in the prostate and potentially biopsy those areas directly if needed. 

Imaging: Prostate MRI

Magnetic resonance imaging (MRI) uses magnetic fields to create detailed pictures of the prostate. An MRI of the prostate is most frequently obtained to evaluate for prostate cancer. MRI is the best test to non-invasively identify suspicious lesions within the prostate which can help guide the location of a biopsy. Also due to the high resolution of MRI, in men diagnosed with prostate cancer, the cancer stage and relationship of the cancer to the nerve bundles can be determined. This is very important to help decide the appropriate treatment for patients and also to help guide surgical planning. 

Due to improvements in the MRI magnet, we no longer need to use an endorectal coil which was previously a source of discomfort for patients.

Imaging: PSMA PET Imaging for Prostate Cancer

Prostate-specific membrane antigen (PSMA) PET imaging is an innovative diagnostic tool used at UCLA to diagnose prostate cancer. This scan is approved by the U.S. Food and Drug Administration and it enables more precise detection of prostate cancer allowing for individualized and targeted care. This imaging technique locates cancer lesions found not only in the prostate but also in other parts of the body to which the tumors can migrate. PSMA PET is ideal for men who are initially diagnosed with prostate cancer or for men who were previously treated but have experienced cancer recurrence.