Staging tests

Determining the extent of prostate cancer is important in predicting the course of the disease and choosing the best treatment. The results from the digital rectal exam, PSA tests, and prostate biopsy give the urologist a good idea of whether the cancer is confined to the prostate or has spread outside the gland.

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In some cases, patients may undergo a bone scan to determine whether prostate cancer has spread to the bones. The bone scan involves an intravenous injection of a radioactive material, which settles in damaged bone. (Bone can be damaged by cancer as well as by arthritis and other bone diseases.) A special scanner is then used to detect the radioactivity. Areas of the body with increased radioactivity have bone damage, possibly because cancer has spread to the bone.

A test called the ProstaScint scan is also available to detect prostate cancer cells that have spread, in this case to the lymph nodes or soft organs. ProstaScint uses antibodies that attach to a protein, called prostate specific membrane antigen, on prostate cancer cells. These antibodies mark cancer cells with a radioactive isotope that is then picked up by a special scanner. The ProstaScint scan is not considered to be very accurate. It is usually used when PSA levels start to rise again after surgery or radiation therapy.

Computed tomography (CT) or magnetic resonance imaging (MRI) may be done to look for enlarged lymph nodes if the spread of cancer is suspected. In some cases, the urologist may recommend a laparoscopic biopsy, in which a surgeon uses a laparoscope (an instrument with a light and a camera) to view the lymph nodes near the prostate.