Diagnosing Advanced Prostate Cancer: A Step-by-Step Guide
- Protein-Specific Antigen (PSA) screening is a simple blood test and is the first step in detecting potential prostate cancer. A primary care physician often initiates the PSA test. If your PSA is elevated, you will typically be referred to a urologist for further workup. Your urologist will usually order additional testing if they suspect prostate cancer.
- An imaging test, like an MRI and a biopsy, are often the next steps following abnormal PSA results. Patients will be given a Gleason score from the biopsy to determine how aggressive the cancer may be.
- A full-body PET scan helps determine whether the cancer is localized to the prostate or has spread or metastasized to other body parts like lymph nodes, bones, or lungs, which is often the case in more aggressive cancer.
- Dr. Neha Maithel, medical oncologist at UT Cancer Center, says about “5 to 7% of patients present with metastatic prostate cancer,” which requires more intensive, systemic treatment strategies.
Step 1: PSA Screening
The diagnostic journey often begins in a primary care setting, where a simple blood test can raise the first alarm.
Read MoreStep 2: Imaging and Biopsy
When PSA levels are elevated, doctors move to more targeted diagnostics: imaging and biopsy.
“Most of the time, patients get a prostate biopsy after getting an MRI,” says Dr. Maithel.
“Once they get a prostate biopsy, a pathologist looks at that biopsy specimen under the microscope to see what their Gleason score is.”
The Gleason score is a critical tool for assessing the cancer’s aggressiveness. It ranges from 6 (least aggressive) to 10 (most aggressive), based on how abnormal the cancer cells appear and how they’re arranged.
This score helps oncologists determine whether the cancer is likely to grow slowly or spread quickly — information that directly influences treatment planning.
Step 3: PET Scan — Tracking the Spread
Once the Gleason score is established, doctors need to know whether the cancer is confined to the prostate or has spread beyond the prostate, also called metastasis.
“From there, we will most likely order a full-body PET scan to see the extent of the disease spread,” Dr. Maithel explains.
PET scans provide a detailed map of cancer activity throughout the body, helping clinicians identify whether the disease has reached distant organs or tissues.
Step 4: Understanding Metastatic Disease
While most prostate cancers are caught early, a small but significant percentage of patients are diagnosed after the disease has already spread.
“About five to seven percent of prostate cancer patients present with metastatic disease,” Dr. Maithel notes. “Metastatic disease means that the cancer has left the prostate gland itself and has spread to other areas — specifically, the prostate cancer likes to go to lymph nodes, bones, or the lungs.”
This stage of disease requires a more aggressive and systemic treatment approach, which may include hormone therapy, chemotherapy, or targeted therapies.
Diagnosing advanced prostate cancer is not a single test — it’s a layered process that combines bloodwork, imaging, pathology, and full-body scans. Each step provides critical insight into how the cancer behaves and where it’s headed, allowing doctors to tailor treatment with precision and urgency.
Questions To Ask Your Doctor
- What does my PSA level suggest, and should I consider further imaging or a biopsy?
- Can you explain my Gleason score and what it means for how aggressive my cancer is?
- If my cancer has spread, how does that affect my treatment options?
- What are the next steps in managing advanced prostate cancer, and how do we tailor treatment to my specific case?
Content independently created by SurvivorNet with support from Novartis Pharmaceuticals Corp.
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