To diagnose advanced cancer, your health care provider looks for cancer outside the prostate. Blood and imaging tests may show where the cancer has spread. Your health care provider will want to know how much cancer there is and how it is affecting you. That way they can offer treatment that is best for you.
Advanced cancer may be found before, at the same time, or later than the main tumor. Most men diagnosed with advanced prostate cancer have had biopsy and treatment in the past. When a new tumor is found in someone who has been treated for cancer in the past, it is usually cancer that has spread. Rarely, a bone marrow test, spinal tap or fluid test may also show cancer cells.
If you need a prostate biopsy
Men diagnosed with advanced prostate cancer from the beginning may start with a prostate biopsy. This is a tissue sample taken from your prostate. The biopsy removes small pieces of prostate tissue to look for cancer.
Prostate biopsy is best done with ultrasound and a probe. Before the biopsy, you will have an enema to clean out your bowels and take an antibiotic. During the biopsy, you lie on your side and the probe goes into the rectum.
First, your health care provider takes a picture of the prostate using ultrasound. The prostate gland size, shape and any abnormalities are noted. Shadows are a common abnormality. Shadows might be prostate cancer. But not all shadows are cancer. And not all cancers can be seen.
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The prostate gland is then numbed through the probe. Then 10 or more samples of prostate tissue about 3/4 inch long and 1/16 inch wide are removed. The number depends on the size of the prostate gland, PSA test results, and past biopsies.
The biopsy takes 10 to 20 minutes. A pathologist (a doctor who identifies diseases by looking at them under a microscope) looks at the prostate tissue to see if cancer is there. If cancer is seen, the pathologist will also "grade" the tumor.
After a biopsy, you may have blood in your ejaculate and urine. This stops within a few days for urine and a few weeks for semen. About 1 or 2 in 100 men have high fever after biopsy. You will need to take antibiotics for at least 48 hours after the biopsy.