Your providers will tailor a screening and treatment plan specifically for you. Here is an example of a common screening and treatment path for prostate cancer. If you have been diagnosed with prostate cancer or are suspected to be at risk for prostate cancer you can expect to follow most of these steps.
- Blood test and prostate exam - Many men have an annual blood test with their primary care provider called a PSA test that stands for “prostate specific antigen” as well as a prostate examination.
- Urology evaluation - If the PSA test or prostate exam are concerning, patients are often referred to a urologist for further evaluation. The urologist will discuss your specific risks for prostate cancer and make a decision with you regarding the next step in diagnosis.
- Prostate biopsy - If you and your urologist feel that the risk of prostate cancer is significant then the next step is to undergo a prostate biopsy. This procedure is performed by placing an ultrasound probe in the rectum to visualize the prostate, and a needle is used to sample the prostate in multiple areas. While not a completely pleasant experience, most men find the idea of the procedure to be much worse than the actual biopsy. The biopsy is critical as this is the only way we can diagnose prostate cancer. The biopsy also allows us to determine how aggressive the prostate cancer is.
- Prostate MRI and MRI-directed biopsy - Traditionally the first step in evaluation of a patient with an elevated PSA was to perform a biopsy. In recent years, MRI technology has improved and we can now use this study to further evaluate a patients risk for cancer and help us “target” any abnormal areas of the prostate in what is called an “MRI Fusion Biopsy.” If you are evaluated at Dartmouth-Hitchcock for an elevated PSA your provider will discuss with you the benefits and limitations of prostate MRI during your initial consultation.
- Treatment plan - If you are diagnosed with prostate cancer, do not panic. Prostate cancer is a very common disease and in this day and age, it is almost always caught early and there are many treatment options available. After diagnosis you will likely undergo a “staging” process. This often involves a prostate MRI or CT scan and a bone scan. These studies are used to determine if the cancer is confined to the prostate or if it has spread outside of the prostate. This information determines which treatment is best.
- Localized Cancer - Many cancers confined to the prostate may not need immediate treatment but those that do are treated with either surgical removal of the prostate or radiation therapy to the prostate. Most patients diagnosed with prostate cancer will meet with both a cancer surgeon and a radiation oncologist to discuss the differences between treatments.
- Metastatic Cancer - If the prostate cancer is suspected to have moved out of the prostate into other parts of the body, you will be referred to a medical oncologist. Metastatic cancer requires treatment to the whole body with chemotherapy, hormonal therapy or immunotherapy.