Prostate Tests, Diagnosis and Imaging Methods
Enlargement of the prostate and elevated levels of certain blood parameters, such as PSA, may be a normal part of the aging process, but they may also be an indicator that prostate cancer has begun to develop. If the prostate shows signs of enlargement or irregularity, the doctor may order various tests to determine whether the prostate is developing outside of what is expected. A physical examination may be performed, and blood tests and imaging techniques may be used to obtain definitive results. Examination of the prostate by ultrasound or other imaging tests, or a prostate biopsy, may be considered necessary.
Laboratory Tests in Prostate Diagnosis
What Is Total PSA?
The PSA test is known as the prostate-specific antigen (PSA) test. Prostate-specific antigen is a type of protein produced by both normal and cancerous cells of the prostate gland. The total PSA test directly measures the amount of PSA bound to other proteins. The results also indicate how quickly the PSA has risen over time.
What Is Free PSA?
The free PSA value refers to prostate-specific antigens in the blood that are not bound to other proteins. The PSA test result is used to determine whether a prostate biopsy is needed. The free PSA test measures only the PSA that circulates freely in the bloodstream and is not bound to a different protein. Comparing the results of the total and free prostate tests can help determine the risk of prostate cancer.
What Is Creatinine?
The main function of the kidneys is to filter and clean waste products from the blood. Creatinine is a normal waste product formed in the blood as a result of muscle use. The creatinine test measures the total amount of creatinine in the blood and urine. The creatinine value is a blood test that measures how well the kidneys are functioning. Creatinine levels may sometimes increase due to prostate enlargement.
What Is Urinalysis?
Urinalysis is a medical test in which a urine sample taken from the person is examined visually, chemically and microscopically. Various compounds passing through the urine can be detected using a single urine sample. The doctor commonly uses urinalysis to screen for or monitor certain health problems such as liver disease, kidney disease, prostate problems and diabetes.
What Is Urine Culture?
The urine culture test is a test used to examine microorganisms that cause infections in the urine. Culture is the medical term used for growing microorganisms in a laboratory environment. Through a culture performed on urine in a medical laboratory, infections in the urinary system and antibiotics to which they are sensitive can be identified.
Imaging and Measurement Methods in Prostate Diagnosis
What Is Urodynamics?
The urodynamic test is used to examine how well the lower urinary tract sections, including the bladder, sphincters (muscles that hold urine) and urethra, function in storing and emptying urine. During the urodynamic test, the bladder is filled and then pressure values are recorded from the bladder and abdomen during emptying. The quality of urinary tract function can be measured using these values.
What Is Uroflowmetry?
Uroflowmetry is used to measure the rate of urinary flow. With this test, urinary problems such as urinary obstruction and difficulty urinating can be examined. It is especially used to diagnose prostate enlargement, urethral (external urinary canal) strictures and bladder function disorders.
What Is USG?
USG, i.e. ultrasound, is an imaging test that uses sound waves to create a real-time image of the body's soft tissues. Ultrasound scans use high-frequency sound waves to create an image of a part of the body. A prostate ultrasound scan can show changes in the prostate, including abnormal prostate enlargements. Pelvic organs such as the bladder, prostate, rectum, ovaries, uterus and vagina are among the organs that can be visualized by ultrasound.
What Is Post-Void Residual Urine?
The amount of urine remaining in the bladder after urination is called post-void residual urine. The post-void residual urine test, that is, the test performed after urination, measures the amount of urine remaining in the bladder. Ideally, a person's bladder should be completely empty after urinating. However, sometimes some urine may remain in the bladder even after going to the toilet. A small amount of residual urine usually does not cause a problem, but large amounts of increased residual urine may be associated with a problem.
Advanced Imaging Methods Used in Prostate Diagnosis
What Is Multiparametric Prostate MRI (MP-MRI)?
MRI is a radiological examination method that does not involve radiation and best shows prostate anatomy and pathologies. MP-MRI is an imaging method performed by adding diffusion MRI and dynamic contrast use to a routine MRI scan. It is the most advanced examination method used especially in prostate cancer screening and for the most detailed visualization of benign prostate enlargement. It is especially important to perform it on 3 Tesla devices. In MP-MRI examinations, findings are reported using the PIRADS classification. PIRADS 3 and above refers to lesions that require verification by biopsy for cancer.
What Is TRUS?
Used as the abbreviation for TransRectal UltraSonography (TRUS), this examination is performed using special thin ultrasound probes inserted through the rectum. It does not require anesthesia. The prostate and seminal vesicles, along with their pathology, are examined and reported.
Biopsy Methods in Prostate Diagnosis
What Are Conventional Prostate Biopsies?
When prostate gland pathology is considered, the first blood test checked is PSA levels. If PSA values are high, a biopsy is performed due to suspicion of prostate cancer. If there is no mass that can be palpated on prostate examination, and no lesion with clearly defined borders can be identified on MP-MRI (Multiparametric Prostate MRI), a conventional prostate biopsy is performed. Prophylactic antibiotics are used before the biopsy, and the rectum is cleaned with an enema. A total of 12-14 quadrant biopsies are taken sequentially from the peripheral zone of the prostate gland, from the right and left sides, from the apex to the base. The obtained materials are sent to the pathology laboratory in special solutions.
What Is an MR Cognitive Fusion Biopsy?
After multiparametric prostate MRI is performed, the MRI examinations of patients with a lesion of PIRADS 3 or higher in the prostate gland are reviewed in detail before the prostate biopsy. The location of the lesion detected on MRI is identified on ultrasound, taking anatomical landmarks into consideration, and the biopsy is taken from this location. This biopsy procedure, performed transrectally with ultrasound guided by MRI information, is called an MR Cognitive Fusion Biopsy.
What Is an MR Fusion Biopsy?
In an MR fusion biopsy, a multiparametric prostate MRI is performed first. The images are then loaded onto a computer with special processing capabilities. This computer works simultaneously with the ultrasound device and matches the MR images with the ultrasound images. The biopsy is taken from the lesion area where the ultrasound image matching the MR image is located. It can be performed transrectally (through the rectum) or transperineally (outside the rectum). It is performed under general anesthesia. The obtained materials are sent to the pathology laboratory in special solutions for examination.
What Are Robotic Biopsies?
A special robot is used to take biopsies from suspicious prostate cancer areas seen on MRI scans. The MRI creates a model on a computer. This virtual computer model is then loaded into the robot. The aim is to increase the accuracy of prostate cancer diagnosis compared with traditional prostate biopsy techniques, because obtaining an accurate diagnosis is very important for choosing the appropriate treatment in men with prostate cancer. It is essential to distinguish cancers that may need to be surgically removed or treated with radiation from very slow-growing cancers. A robotically obtained biopsy provides an accurate tissue sample, eliminating errors in the results.
What Are Navigation-Guided Biopsies?
The navigation system does not change the imaging system or the biopsy routine in any way. A non-invasive navigation tool is used that produces an online 3D model of the prostate to help the doctor move around the prostate during the biopsy procedure. By mapping prostate cancer, overtreatment and undertreatment can be avoided and an adequate treatment can be selected.
Staging and Grading in Prostate Cancer
What Is Gallium 68 PSMA PET CT?
Gallium 68 PSMA PET CT can provide more detailed results in a patient diagnosed with prostate cancer than CT or other whole-body screening systems. When Gallium 68 PSMA is administered intravenously, the substance travels to tumor tissues and binds to PSMA receptors in cancerous tissue, enabling these cancer cells to be detected. This is a very successful and new therapeutic application. Gallium 68 PSMA is not a contrast agent and has no side effects.
The reliability of prostate diagnosis and the findings obtained is very important for a person's health. Especially in cases such as prostate cancer, the diagnostic methods applied can also play a major role in the treatment process. The results obtained must be checked by a physician who is an expert in the field. Especially with regular prostate checkups in men above a certain age, the early diagnosis process can be facilitated. You can make an appointment by contacting us for a prostate examination.
