Thanks to new blood and urine biomarkers and improvements in MRI imaging, diagnosing prostate cancer has become easier and more accurate than ever before.

For most men, however, detecting prostate cancer still begins with a digital rectal exam and a PSA blood test. If you are a man over 45, don’t let anyone talk you out of getting an annual digital rectal exam and a PSA test. Yes, it’s true. Both of these tests are “old school” and imprecise, but they remain the front line of defense against prostate cancer. These two tests are usually performed during a routine physical or because a man is experiencing urinary symptoms such as:

  • Waking up in the middle of the night to pee (Nocturia)
  • Urinary frequency (having to pee more often than normal)
  • Urinary urgency (must pee NOW!)
  • Low flow (weak urine stream)
  • Painful urination (Dysuria)
  • Difficulty peeing or emptying your bladder
  • Itching/burning during urination

These symptoms can be caused by advanced prostate cancer and four non-threatening conditions:

  1. Prostatitis (prostate inflammation/infection)
  2. Enlarged Prostate (BPH)
  3. Pelvic Floor Dysfunction (urinary sphincter)
  4. Urinary strictures (scar tissue in the urethra)

It’s a doctor’s job to figure out which condition (or conditions) is causing a man’s elevated PSA numbers or any of the symptoms above.

Ten years ago, if a man had a higher than normal PSA number (with or without any of the symptoms described above), he was an automatic candidate for a prostate biopsy. This type of needle biopsy involves shooting 10-20 needles through the wall of the rectum, into the prostate, to take tissue samples from the prostate.

If this procedure sounds demoralizing, it feels worse. Even when the local anesthetic works correctly, a prostate biopsy feels like what it is: a bunch of needles being shot through your rectum and into your prostate — not a holiday.

I’ve had three of these biopsies. During the last one, the surgeon botched the local anesthetic, so it felt like a knife fight was going on in my backside. A week after that biopsy, I developed sepsis (a systemic blood infection), which almost killed me. The ER doctor said I was 6-12 hours away from complete organ failure.

So it’s easy to understand why avoiding a prostate biopsy is a good idea — unless other tests indicate a biopsy is needed.

Thanks to dozens of blood and urine biomarker tests, doctors have a new arsenal of tools that pick up where PSA testing leaves off. An abnormally high PSA number tells you that something is wrong, but it doesn’t tell you what. It could be cancer or an infection or an enlarged prostate or something else.  

A blood test like the 4KscoreTest identifies biomarkers for advanced prostate cancer, and urine tests like PCA3 or SelectMDx can accurately identify men who should have a prostate biopsy because of an increased risk of finding cancer during a biopsy.

Multi-parametric MRI combines four different types of imaging (anatomic, metabolic, diffusion weighted, and dynamic contrast enhanced) to deliver a more accurate picture of the prostate — and any areas that contain cancer.

When used before a prostate biopsy, multi-parametric MRI can accurately identify suspicious areas of the prostate for a “targeted biopsy,” which is 70-75 percent more likely to detect cancer than a standard biopsy, if cancer is present. In other words, a multi-parametric MRI does a much better job of finding prostate cancer.

Both blood/urine biomarkers and multi-parametric MRI give doctors better tools to locate prostate cancer (if it is there) or rule it out (if it’s not).

In the next blog, we’ll look at how to pair the right type of treatment with the kind of prostate cancer a man has.    


Mark B. Saunders is a writer, editor, publisher, public speaker, and 11-year cancer survivor. As an active surveillance prostate cancer patient, Mark did not receive traditional treatment like surgery or some form of radiation. Instead, he dramatically overhauled his lifestyle and his cancer went away and hasn’t come back since.

As a prostate cancer survivor, Mark has dedicated his life to sharing what he has learned about health and wellness. A journey that he calls, Inside out, round-about, and back again.

Mark is the co-author of Prostate Cancer: A New Approach to Treatment and Healing and Do You Have Prostate Cancer: A Compact Guide to Diagnosis and Health 

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