If you have prostate cancer symptoms, the most effective means of detecting prostate cancer is through a screening, which involves a digital rectal exam and a PSA test, which checks the amount of prostate-specific antigen in patients’ blood.

PSA (Prostate-Specific Antigen) Test

The blood test, which is believed to detect a significant majority of prostate cancers and has the highest validity of a cancer screening to date, looks for increased levels of the prostate-specific antigen, a protein secreted by the prostate into the bloodstream. Elevated levels of the antigen may indicate the presence of prostate cancer. If cancer is suspected, a prostate biopsy will be performed. By removing a tissue sample from the tumor and examining it through a prostate biopsy, doctors can confirm or rule out a diagnosis of cancer and determine whether the disease has spread to other organs.

PCA3 (Prostate Cancer Gene 3) Test

Cleveland Clinic urologists are now offering a new innovative screening test for prostate cancer called PCA3. Compared to a traditional PSA blood test (which is not specific for cancer), PCA3 is a prostate cancer-specific marker. In clinical trials, it has been shown to provide improved sensitivity and specificity for detection of prostate cancer.

For men with an elevated PSA and prior negative biopsy, PCA3 may assist in the decision of whether or not to have additional biopsies. PCA3 is also being tested in a clinical trial in patients undergoing radical prostatectomy to test its predictive value for pathologic outcomes. PCA3 is measured in urine following a digital rectal exam (DRE).

Prostate MRI (Magnetic Resonance Imaging) Test

The Imaging Institutes’s Section of Abdominal Imaging performs and interprets prostate MR at Cleveland Clinic’s Main Campus. Prostate MR is advanced imaging technology that provides accurate, clear images of the prostate, which helps physicians accurately diagnose prostate cancer and determine the most effective treatment plan for patient.

This procedure allows radiologists to assess patients with biopsy-proven or suspected prostate cancer.

Advantages of Prostate MR

• Identifies suspicious areas to direct transrectal ultrasound (TRUS) guided-biopsy in patients with concerning rises in PSA but no documented prostate cancer.
• Assesses patients with biopsy-proven prostate cancer for possibility of multifocal disease before considering focal therapy.
• Assesses patients with biopsy-proven prostate cancer for extension outside the prostate.
• Assesses patients with suspected or biopsy-proven prostate cancer for pelvic extension into the lymph nodes, rectum or bladder.
• Assesses patients for recurrence after prostate cancer therapy (cryotherapy or prostatectomy.)

Contraindications of Prostate MR

• Recent biopsy of the prostate (within eight weeks) can mask prostate cancer on a MR. Whenever possible patients should not undergo prostate MR after a recent biopsy.
• In general, MR exams are contraindicated in almost all patients with pacemakers, defibrillations and implanted ferromagnetic metallic foreign bodies. The presence of other implanted medical devises is evaluated on a case-by-case basis.
• Patients with moderate to severe chronic kidney disease (GFR less than 30 ml/min/1.73m2) are not recommended to have contrast-enhanced MRI exams. However, limited, non-contrast enhanced studies can be performed on these patients.

Related Information

• Angela Townsend from The Plain Dealer features an interview with Eric Klein, MD, Chairman of the Glickman Urological and Kidney Institute, about the PCA3 test and prostate cancer screening in her article, Cleveland Clinic uses new prostate cancer screening test.
• Dr. Klein was recently interviewed about the new PCA3 test by WKYC's Monica Robins and Eric Mansfield in the Focus program, New tool to diagnose prostate cancer.