You may know that prostate cancer is one of the most common cancer types in men. The good news is that there are many treatment and management options, even if the cancer is caught at a later stage.

What you may not know: There are several options when it comes to prostate cancer screening . After considering multiple factors, your doctor may recommend the prostate-specific antigen (PSA) test, and/or one of the newer screening tests that are now available.

Johns Hopkins urologist Christian Pavlovich, M.D., explains what you should know.

PSA Test: The Current Prostate Screening Standard

Before recommending when you should be screened for prostate cancer, your doctor will consider many factors, such as your:

• Age
• Family history, particularly whether any of your family members have had prostate cancer
• Race, as African-American men have a higher risk of developing prostate cancer

If your doctor determines you should undergo screening, he or she will most likely recommend a PSA test. For more than 30 years, the PSA test has been the gold standard in prostate cancer screening. This simple blood test measures how much prostate-specific antigen (PSA) is in your blood, and elevated levels indicate prostate disease, and sometimes prostate cancer.

If you have an abnormal PSA score, your doctor may recommend other newer tests that give a better sense of your prostate cancer risk. These may include blood, urine, or imaging tests.

New Prostate Cancer Blood Test

The prostate health index (PHI) measures PSA and two other related molecules to provide a more accurate estimate of your risk for having prostate cancer. It’s approved by the FDA for men who have PSA scores between 4 and 10. The PHI and another similar test called 4K can also provide an estimate of the risk of aggressive prostate cancer.

What are the benefits of the PHI and 4K tests?

• Fewer unnecessary biopsies: Some men who have elevated PSA scores are unsure about whether to gen a prostate biopsy. These tools can be used to better determine whether your risk is high enough to warrant a biopsy.
• More accurate: These tests are better at detecting prostate cancer and more aggressive types of prostate cancer than a PSA alone. This information can guide doctors to a more targeted treatment plan for you.

If you score low on the PHI or 4K tests, your doctor may recommend monitoring you over time to see if your levels rise enough to cause concern.

New Prostate Cancer Urine Tests

PCA3: The PCA3 urine test detects the PCA3 marker in your urine and can also help your doctor better assess your prostate cancer risk. PCA3 is a prostate-specific noncoding RNA that is only expressed in the prostate. If the gene is “overexpressed” (meaning there are too many copies of it), then there’s a greater chance you have prostate cancer.

ExoDx: This test looks identified markers related to prostate cancer in exosomes, which are extracellular vesicles that contain genetic information from their parent cells. An elevated ExoDx indicates a higher risk of aggressive prostate cancer.

MPS: This is test is quite new and data on it are forthcoming, but early results are promising. By incorporating several markers of prostate cancer into one urinary assay, MPS results should help guide a decision to biopsy or not in men with elevated PSA.

None of these tests are definitive. But data suggest that when cancer is present, these tests will be positive most of the time. Any one of these can help your doctor determine whether a biopsy is necessary.

Prostate Biopsy and Imaging Developments 

To definitively confirm a prostate cancer diagnosis, you’ll need to have a biopsy, which is when doctors remove a tissue sample from the prostate. Advancements here, too, are ensuring more accuracy and greater safety, so there is less risk of misdiagnosis and fewer biopsy complications.

In a prostate biopsy, doctors have traditionally taken eight to 16 needle biopsies systematically around the prostate with little targeting. It provides a good, but incomplete, picture of whether you have prostate cancer. While traditionally performed transrectally, infection and rectal bleeding could occur. Urologists at the Brady and at many other institutions are now offering transperineal prostate biopsies, which confer far less infectious and no rectal bleeding risk at all.

Improvements in imaging have also come along to help determine both need for biopsy and helped improve biopsy accuracy. Prostate MRI is being used before biopsy to look for areas in the prostate that are suspicious for cancer. Transrectal prostate Microultrasound is a newer technology that is competing with MRI for identifying prostate cancer. These technologies are increasingly being used in men with elevated PSA in the setting of the newer biomarkers discussed above to determine need for biopsy and to help target the biopsy to abnormal areas. Modern technology can fuse MRI images with real time conventional ultrasound or microultrasound to help guide the biopsies to areas of specific concern.