The most indicative test for prostate cancer is:
A. A thorough digital rectal examination
B. Magnetic resonance imaging (MRI)
C. Excretory urography
D. Prostate-specific antigen
Correct Answer: D. Prostate-specific antigen
An elevated prostate-specific antigen level indicates prostate cancer, but it can be falsely elevated if done after the prostate gland is manipulated. Elevated Prostate Specific Antigen (PSA) levels (usually greater than 4 ng/ml) in the blood is how 80% of prostate cancers initially present even though elevated PSA levels alone correctly identify prostate cancer only about 25% to 30% of the time. We recommend at least 2 abnormal PSA levels or the presence of a palpable nodule on DRE to justify a biopsy and further investigation.
Option A: A digital rectal examination should be done as part of the yearly screening, and then the antigen test is done if the digital exam suggests cancer. Digital rectal examination (DRE) may detect prostate abnormalities, asymmetry, and suspiciously hard nodules but is not considered a definitive test for prostate cancer by itself. An abnormal DRE initially uncovers about 20% of all prostate cancers.
Option B: MRI is used in staging the cancer. Prostate MRI has much better soft tissue resolution than ultrasound and can identify areas in the gland that are truly “suspicious” with a high degree of accuracy and reliability (positive predictive value greater than 90%). Prostate MRI is also used for surgical planning in men considering radical prostatectomy and for improved biopsies, instead of saturation biopsies, when cancer is strongly suspected despite a negative initial TRUS-guided biopsy.
Option C: An intravenous pyelogram (PIE-uh-low-gram), also called an excretory urogram, is an X-ray exam of the urinary tract. An intravenous pyelogram lets the doctor view the kidneys, the bladder, and the tubes that carry urine from the kidneys to the bladder (ureters).
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