Prostate Cancer Diagnosis
The Perlmutter Cancer Center offers a variety of tools for diagnosing prostate cancer, including:
- blood tests for PSA
- ultrasound (including transrectal ultrasound) and other imaging techniques (including CT and MRI scanning)
- endorectal MRI and magnetic resonance spectroscopy
- biopsy of tissue suspected to be cancerous, guided by imaging techniques
NYU has a radiologist who is specially trained to read images of the genitourinary tract. If your doctor recommends a biopsy (removal of a small amount of tissue and examination for cancer cells), the tissue will be analyzed by NYU's expert pathologists, including a pathologist with special training diagnosing genitourinary disorders.
Comfortable, More Accurate Biopsies
Perlmutter Cancer Center physicians have led the way in optimizing the biopsy of prostate tissue to increase the ability to detect cancer while making the procedure more comfortable for the patient. Patients who have a prostate biopsy receive a local anesthetic first. Ultrasound imaging is then used to guide the biopsy procedure, in which the surgeon samples the prostate laterally (from the side) in addition to the standard central positions. This approach has increased the ability to detect prostate cancer by 20 percent.
Prostatic Epithelial Neoplasia (PIN)
The Perlmutter Cancer Center has defined the standard of care for performing biopsies in men with PIN, about 25 percent of whom develop prostate cancer. Instead of performing prostate biopsies every 6 to 12 months, which was the standard of care until recently, Perlmutter Cancer Center physicians have demonstrated that these men only need a biopsy every 3 years. The National Comprehensive Cancer Network based their recommendations for such delayed interval biopsies on our research when establishing national standards of prostate cancer care.
Magnetic Resonance Spectroscopy
NYU is one of only a few centers in the country assessing a novel approach called endorectal MRI with magnetic resonance spectroscopic imaging (MRSI) to diagnose prostate cancer in patients in whom other technologies are not accurate enough. Our radiologists perform this procedure routinely in patients who need it. MRSI differs from other approaches because it detects minute biochemical differences between normal and cancerous prostate tissues. This approach may be most useful for guiding biopsies in men with high PSA levels who have had multiple negative biopsies of the prostate performed using conventional approaches. MRSI is also useful for staging prostate cancer (determining how advanced it is) in men with the greatest risk of having cancer outside the prostate.
The Perlmutter Cancer Center is one of the nation's leading centers evaluating complex PSA, participating in a national multicenter study of this potentially useful marker for prostate cancer. Complex PSA – the fraction of PSA bound to other proteins – is a more reliable indicator of prostate cancer than free PSA, which is less stable. Complex PSA is just as sensitive as free PSA for signaling the presence of prostate cancer, but is more specific, meaning it is less likely to produce false-positive test results.
Prostate Tissue and Serum Banks
The NYU Prostate Tissue Bank was established in 2000 as part of the National Cancer Institute-supported Cooperative Prostate Cancer Tissue Resource (CPCTR). In conjunction with three other universities, the CPCTR has developed into a nationally recognized tissue resource for prostate cancer investigators. NYU's Prostate Tissue Bank is the only center in New York City participating in the CPCTR. In addition, the NYU Urologic Oncology Serum/Urine/Tissue Bank collects bladder, prostate, and kidney tissues and/or blood and urine samples, as well as clinical information, from a large group of patients from whom tissue is removed for diagnostic or therapeutic purposes. These banks are valuable resources for researchers seeking to find genetic and protein differences between cancerous and normal prostate tissues. Such studies may further improve the diagnosis of this disease.