Prostate Cancer: Tests After Diagnosis

What tests might I have after being diagnosed?

After a diagnosis of prostate cancer, you will likely have more tests. These tests help your healthcare providers learn more about the cancer and your overall health. For instance, scans can show if the prostate cancer has spread to other parts of the body. The test results help your healthcare providers decide the best ways to treat the cancer. If you have any questions about these or other tests, be sure to talk with your healthcare team.

The tests you may have can include:

• Bone scan

• CT scan

• MRI scan

• PET scan

• Lymph node biopsy

Bone scan

Prostate cancer tends to spread to the bones. This test shows whether it has done so. A small amount of a radioactive substance is put into your blood through a vein. It travels through your blood vessels and collects in bones where there is damage. The damage may be from cancer or other conditions, like arthritis. 

The scan takes about 30 minutes. It looks at your whole skeleton. If abnormal areas are found, you may need other tests, like bone X-rays, a CT scan, an MRI scan, a PET scan, or even a biopsy to see what's causing the damage.

CT scan

A CT scan is a series of X-rays that are put together by a computer. CT scans make 3-D images that are much more detailed than regular X-rays. The test helps to find out if prostate cancer has spread into lymph nodes or other organs.

During the test, you lie on a narrow table. The table slides through the center of the donut-shaped CT scanner.

A CT scan is painless. You may be asked to hold your breath a few times during the scan. You may be asked to drink a contrast dye before the scan. Or a dye might be put into your blood through an IV. The dye helps to show certain tissues and organs better on the images.

MRI scan

An MRI scanner uses large magnets and a computer to make images of your insides. It's used to look at the prostate and nearby organs and tissues. An MRI makes very detailed images.

For this test, you lie on a narrow table as it passes through a long, tube-like scanner. A technician may put a probe into your rectum to get even better images. It can cause some discomfort. If needed, medicines can be used to make you sleepy while this is done. Sometimes a contrast dye is put into your blood through a vein for an MRI scan. It helps the details show up better on the scans.

When the scanner is working, it can make very loud clicking and whirring noises. You may be given earplugs or headphones to help block the sound. The scanner is a small space. If you're uncomfortable in small spaces, you may be given a sedative to take before the test. Some hospitals and clinics have open MRI scanners. These are less confining, but the images aren't always as clear. A 2-way intercom will let you hear and talk to the technician during the test.

PET scan

During a PET scan, a small, safe amount of a radioactive substance (known as a tracer) is injected into the blood, which can then be found with a special camera. PET scans use tracers that collect mainly in cancer cells so they can locate where the cancer is. Sometimes a PET scan is combined with a CT scan (PET-CT) so that even more detail can be seen. Newer types of tracers are used in tests called PSMA PET scans. The tracers attach to prostate-specific membrane antigen (PSMA). This is a protein found on prostate cancer cells. This test is useful if it's not clear if or where prostate cancer has spread. These tests may not be available in all imaging centers.

Lymph node biopsy

A biopsy is the removal of small pieces of tissue to test. The small pieces of tissue are looked at with a microscope. A lymph node biopsy is done to see if cancer cells have spread to the lymph nodes. These are small collections of immune cells located all around the body. Prostate cancer may spread to nearby lymph nodes.

Lymph node biopsies are not that common in prostate cancer. But a biopsy may be done if tests show that you may have cancer in your lymph nodes or other parts of your body. Or a biopsy may be done if scans show swollen lymph nodes, which may mean there's cancer in them. Treatment for prostate cancer is different if it has spread to lymph nodes or other parts of your body.

One or more lymph nodes can be removed in these ways:

• The biopsy may be done at the same time as other surgery for prostate cancer. 

• The biopsy may be done as laparoscopic surgery. A few very small cuts (incisions) are made in the lower belly (abdomen). This way is rarely used for prostate cancer.

• A fine-needle aspiration may be done. A CT scan is used to find the lymph node(s). Then a local anesthetic is given to numb the area around the lymph node(s). A long, hollow needle is put through the skin, into the lower abdomen, and into the lymph node. A small sample is taken out through the needle.

A pathologist looks at the tissue with a microscope and checks it for cancer cells. A pathologist is a healthcare provider who has special training in examining cells and tissues.

Working with your healthcare provider

Your healthcare provider will talk with you about which tests are needed. Make sure to get ready for the tests as instructed. Ask questions and talk about any concerns you have.