PSA tests to biopsies: What to know about prostate cancer

Prostate cancer is one of the most common cancers among men. According to the American Cancer Society, about 1 in 8 men will be diagnosed with prostate cancer in their lifetime.

In its early stages, prostate cancer often shows no symptoms, making screening especially important. However, the process between screening and a diagnosis can be unfamiliar.

To help understand what to expect, Dr. David Hatcher, a urologist with Sharp Rees-Stealy Medical Group and affiliated with Sharp Memorial Hospital, explains how prostate cancer is detected and what a biopsy is like. He also shares a newer option available at Sharp that lowers the risk of infection.

It starts with a blood test

A common way of checking for prostate cancer is through a prostate-specific antigen (PSA) blood test, which measures the amount of PSA. This is a protein made by the prostate gland, and a high amount can sometimes be a sign of prostate cancer.

According to the American Cancer Society, men at average risk should discuss PSA screening with their doctor at age 50. Men at higher risk, including Black men and those with a strong family history of prostate cancer, should start discussing screening with their doctor between the ages of 40 and 45, depending on their level of risk.

A high PSA does not necessarily mean you have cancer. “There’s no level above which we can say you have prostate cancer, and no level below which we can say you don’t,” says Dr. Hatcher.

A recent infection, a bike ride or sexual activity can all temporarily raise PSA. If your PSA comes back high, the next step is to repeat the test to confirm accuracy.

If PSA levels remain elevated with no clear explanation, it may be time to talk with a urologist. Next steps may include additional blood or urine tests, an MRI of the prostate or a biopsy.

“It’s a shared decision,” says Dr. Hatcher. “It depends on the patient’s age, health, medical history and preferences.”

For most men, he adds, there’s no need to panic. Prostate cancer is typically slow-growing, and diagnosis is rarely an emergency.

A biopsy option that lowers infection risk

There are multiple ways of performing a biopsy. The traditional method, a transrectal biopsy, reaches the prostate through the rectum. Sharp now also offers a transperineal biopsy, which reaches the prostate through the skin between the scrotum and anus.

The biggest difference between the two approaches comes down to the risk of infection. Going through the rectum can carry bacteria to the prostate, while the transperineal approach avoids the rectum entirely.

“It can be thought of as a cleaner approach,” says Dr. Hatcher.

A transrectal biopsy carries about a 2% risk of infection, even with preventive antibiotics. The transperineal approach lowers that to less than 1% and often requires no antibiotics at all.

Dr. Hatcher especially recommends the transperineal approach for men who’ve had an infection after a previous biopsy, those at higher risk of infection, or those who are immunocompromised.

“Here at Sharp, we want to have every tool in our arsenal,” says Dr. Hatcher. “There are a lot of men this really helps.”

What a biopsy is really like

Many men are nervous about having a biopsy, but the procedure is very quick — usually just 10 to 15 minutes. Patients may feel some pressure but generally tolerate it well. Depending on preferences, the biopsy can be done with local numbing, light sedation or general anesthesia.

Afterward, it’s normal to see some blood in the urine, stool or semen anywhere between a few hours and a few weeks. Most people return to their usual activities the very next day.

Patients should contact their doctor if they experience heavy continuous bleeding, difficulty urinating or signs of infection, such as a fever over 101°F.

If the biopsy finds cancer

If a biopsy detects cancer, a pathologist assigns what is called a Gleason score to show how aggressive it is. The Gleason score ranges from 6 to 10, with 6 being the least aggressive and 10 being the most.

Prostate cancer is a spectrum. Some cases are slow-growing, giving patients options between treatment and having the cancer monitored. Other cases call for a procedure, such as surgery or radiation therapy.

The bottom line

“Prostate cancer screening saves lives,” says Dr. Hatcher.

If you’re 50 or older, have a family history of prostate cancer, or are interested in learning more, talk with your doctor about whether a PSA test is right for you.

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