Challenges of diagnosing prostate cancer
Diagnosing prostate cancer is always a great concern and a wide topic to talk about among doctors and health professionals. The most accurate way to diagnose and stage prostate cancer is a biopsy, but there are many side effects, including recurrent bleeding, chronic pain in the urinary tract, and severe urinary tract infections. Thus, instead of recommending biopsies to every patient, doctors are encouraged to decrease unnecessary biopsies and use other diagnostic tools. They only recommend biopsies when they are strictly necessary, and they are usually performed to confirm a highly likely diagnosis and stage cancer.
PSA testing was included as a diagnostic tool as a means to reduce unnecessary biopsies, and many other biomarkers have followed ever since. They are a reliable clinical tool, but they fail to discriminate between aggressive and indolent forms of prostate cancer. Thus, to evaluate patients appropriately, PSA levels should be assessed every year, and records should be made to compare current PSA levels to a baseline that is individual for every patient.
In some cases, PSA levels and rectal examinations are suspicious but not alarming. In these patients, doctors usually perform other exams, including ultrasound, MRI, and other imaging techniques. There are other tests that combine PSA levels with other biomarkers (4Kscore test), and special ultrasound exams made to detect abnormal blood flow that is suggestive of prostate cancer.
They are all non-invasive diagnostic tools that should be performed before considering a prostate biopsy. Still, biopsies are performed in patients who are highly suggestive of prostate cancer in order to stage the disease and decide what comes next.