Imaging tests for early prostate cancer

When you need them—and when you don’t

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It is normal to want to do everything you can to treat prostate cancer. But it’s not always a good idea to get all the tests that are available. You may not need them. And the risks from the tests may be greater than the benefits.

This fact sheet explains why cancer experts usually do not recommend certain imaging tests if you are diagnosed with early-stage prostate cancer. You can use this information to talk about your options with your doctor and choose what’s best for you.

How is prostate cancer usually found?

Prostate cancer is cancer in the male prostate gland. It usually grows slowly and does not have symptoms until it has spread. Most men are diagnosed in the early stages when their doctor does a rectal exam or a PSA blood test. PSA is a protein made in the prostate. High levels of PSA may indicate cancer in the prostate.

If one of these tests shows that you might have prostate cancer, you will be given more tests. These tests help your doctor find out if you actually have cancer and what stage your cancer is.

What are the stages of prostate cancer?

Prostate cancer is divided into stages one to four (I, II, III, and IV). Cancer stages tell how far the cancer has spread.

Stages I and II are considered early-stage prostate cancer. The cancer has not spread outside the prostate. However, stage II cancer may be more likely to spread over time than stage I cancer. In stages III and IV, the cancer has already spread to other parts of the body.

What tests are used to stage prostate cancer?

The easiest and least risky way to find out the stage of prostate cancer is to take tissue samples from the prostate and do tests on the cancer cells. This is called a Gleason test.

If the Gleason test shows that you have early-stage prostate cancer, you usually do not need more testing. The cancer is not likely to have spread.

You do not need all imaging tests to stage prostate cancer.

Imaging tests take pictures inside the body. Specific imaging tests, such as a CT, PET, or bone scan, can help show how far cancer has spread. You may like the idea of having an imaging test to reassure your­self that your cancer has not spread. But if you have early-stage prostate cancer, it is highly unlikely that your cancer has spread to other organs. Your doctor should only use imaging tests if your Gleason score and PSA level suggest that the cancer has spread.

Imaging tests have risks.

The greatest risk from imaging tests is that they expose you to radiation. The effects of radiation add up over your lifetime. Having many tests that use radiation can increase your risk of cancer.

Imaging tests can also show a “false positive.” This means a test shows something that looks unusual, but after more testing turns out not to be a problem. False positives can lead to stress, more tests, and treatments you don’t need.

Imaging tests cost a lot.

Imaging tests are costly. They can add thousands of dollars to your treatment costs. If you do not need them, why spend the money?

When should you have an imaging test?

If your Gleason score is 7 or above and your PSA level is above 10 nanograms/mL, your cancer may have spread. In these cases, your doctor should order a CT, PET, or bone scan to find out whether the cancer has spread outside the prostate gland. If your doctor does not recommend one, ask why.

This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2012 Consumer Reports. Developed in cooperation with the American Society of Clinical Oncology. To learn more about the sources used in this report and terms and conditions of use, visit ConsumerHealthChoices.org/about-us/.

09/2012