What to Know About Testing for Advanced Prostate Cancer

For prostate cancers caught early, your doctor may take a “watchful waiting” approach—that’s because stage 1 (and sometimes stage 2) prostate cancers often cause no symptoms or health problems, per the ACS. But for prostate cancers that keep progressing, treatment is usually recommended. Prostate cancer is considered “advanced” when it spreads to areas beyond the prostate or comes back after you’ve been treated, according to the American Urological Association (AUA).

When prostate cancer spreads only to nearby tissue, it’s called stage 3, or “locally advanced,” while cancer that has spread further in the body is considered stage 4. Unfortunately, stage 4 prostate cancer can’t be cured, according to the AUA. That said, there are treatments that can help control it and help you live longer with fewer symptoms.

When cancer cells from the prostate enter the blood stream, they can take root in other parts of the body and form new tumors, according to the AUA. “If a prostate cancer has spread, it most commonly goes to lymph nodes or the bone,” says Justin R. Gregg, M.D., a urologist at the MD Anderson Cancer Center in Houston. More rarely, it can spread to other places, such as the liver, lungs, or brain, per the AUA.

Usually—around 90% of the time, per the American Society of Clinical Oncology (ASCO)—prostate cancers are diagnosed when the cancer is still in the prostate or has only spread to nearby areas. If this is the case, your doctor will monitor your cancer to see if it changes over time, including whether it’s progressing into “advanced” territory. To do this, doctors use different tests—and the results can help inform the best treatment. These tests can also be used to monitor your cancer if you were first diagnosed at an advanced stage.

So how exactly does diagnosis of prostate cancer happen? “Diagnosis would be done by an appointment with a urologist, or if it is advanced, a medical oncologist,” explains Dr. Gregg. “It is typically diagnosed through a combination of laboratory testing, biopsy, and imaging.” Based on where your cancer has spread, you may receive different types of diagnostic and monitoring tests, explains Ashley Ross, M.D., a urologist at Northwestern Memorial Hospital in Chicago.

One of the most common tests related to prostate cancer is a blood test called the prostate-specific antigen (PSA) test. “PSA is a marker that both normal prostate tissue and prostate cancer makes,” says Dr. Gregg. “If it is elevated, this may be indicative of the presence of prostate cancer—especially if very elevated.” Your doctor may also use the PSA test to help determine whether your prostate cancer treatment is working, he says. “However, in cases of advanced prostate cancer, other data points such as symptoms and imaging findings become increasingly important.”

When it comes to imaging, one common test your doctor may use to learn more about your prostate cancer—including its stage—is magnetic resonance imaging (MRI), according to the ACS. These scans use radio waves and magnets to help your doctor get clear pictures of your prostate and nearby areas, says Dr. Ross. That said, it may not be your doctor’s first choice for imaging cancer that has spread to other areas in the body beyond the pelvis, he says.

A computed tomography (CT) scan is a test used to get images of your cancer from different angles. CT combines X-rays and computer calculations to create images. This test may be used for advanced cancers that have spread to areas such as the lymph nodes, explains Dr. Ross. CT scans are safe tests with low risks—that said, sometimes you’ll be injected with a contrast dye for your CT scan, and some people have mild reactions to the dye, including a rash or itching that can last up to an hour, per the ACS.

When cancer has spread to the bone, the nuclear medicine technology of bone scans can be used to detect and monitor it. Your provider will inject a small amount of a radioactive agent called a tracer into your body, and it will find its way to areas of bone where growth is abnormal, says Dr. Ross. Rest assured, these tests are safe because they use such small amounts of the tracer agents, per the ACS. A camera then takes images to identify areas of cancer in the bones. You may need an MRI or CT scan to confirm findings.

“PET imaging is a type of nuclear medicine imaging where you are given a tracer that’s specific to your cancer, and they can see where the tracer goes,” explains Dr. Ross. PET (positron emission tomography) scans can be more specific and sensitive than other types of imaging, he says, and recently, they have become more useful for detecting the spread of prostate cancer. That’s because scientists have developed new tracers that are better at finding prostate cancer cells throughout the body—plus, even more new PET scan options are being developed to help get even better information.

Prostate cancer researchers are actively working to find new and improved ways to use technology to detect and monitor advanced forms of this cancer, according to ACS. And the tools we have are improving all the time, becoming more specific and accurate. The future is in nuclear medicine, including the new and improved PET scan options being studied, says Dr. Ross. Work closely with your doctor—they can guide you through which imaging tests may be appropriate for your specific cancer.