While a prostate biopsy is typically necessary to diagnose prostate cancer, alternative tests may be available.

A prostate biopsy is a standard diagnostic tool for identifying prostate cancer. Doctors typically recommend a prostate biopsy if other tests indicate but do not confirm prostate cancer. However, there are several instances in which a person will undergo prostate cancer screening but not require a biopsy.

In this article, we explain three of these alternatives and their benefits.

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If a person does not have identifiable risk factors for prostate cancer and initial screening tests do not discover any prostate abnormalities, then a biopsy will not be necessary.

Screening procedures can help in the early detection of many forms of cancer. Early detection can greatly increase a person’s outlook. Many tests can indicate cancer but not confirm it. In these instances, doctors will typically order a biopsy to accurately diagnose any prostate abnormalities.

Before recommending a prostate biopsy, doctors may first carry out a medical history assessment, prostate-specific antigen (PSA) tests, a rectal exam, and imaging procedures.

They may recommend a biopsy if:

However, several reliable alternatives to a biopsy can help a person assess their risk for prostate cancer, decide on further screening, and test for prostate cancer without causing excess worry.

Learn more about PSA levels and what they mean here.

Three of the possible alternatives to a prostate biopsy. Each technique has strengths, weaknesses, and a variable ability to detect a type of prostate cancer. The most effective MRI methods combine several of these imaging techniques.

Prostate cancer enzyme tests

PSA levels can indicate the presence of prostate cancer. Conducting these tests can determine if a person requires further screening, including biopsies.

Typically doctors will measure a person’s total PSA levels. This measurement includes all forms of PSA in a person’s system. If these tests return abnormal results, doctors may recommend more specific enzyme tests before recommending a biopsy.

These tests do not completely replace the need for a biopsy, but they can help identify who should have one. As a result, it may help doctors reduce the number of people who have biopsies.

Watchful waiting

Doctors often recommend a prostate biopsy due to a high PSA score. However, other factors can elevate a person’s PSA score, including infection, prostate inflammation, and advanced age.

Waiting and testing PSA levels again can be helpful. If a PSA score remains high but has not changed since the last test, a person may not have prostate cancer.

Often a doctor will recommend a watchful waiting event after a prostate biopsy has confirmed cancer. Prostate cancer can be slow-growing, and in some instances, a person with prostate cancer may never require treatment. In these cases, doctors may recommend watchful waiting.

MRI scan

An MRI scan uses a magnetic field and radiofrequency pulses to produce a clear prostate image. They are less invasive and still give an accurate guide to prostate cancer risk.

Doctors use a variety of MRI techniques to look for prostate cancer, including:

  • Diffusion weighted imaging: This examines how the prostate absorbs water.
  • Contrast imaging: The doctor observes blood flow in and around the prostate with the help of a dye.
  • Spectroscopic imaging: This aims to distinguish prostate cancer from other causes of prostate enlargement, such as infection.

Read more about MRI scans and what to expect.

During a biopsy, a doctor uses an ultrasound machine to look at the prostate. They insert a small device into the rectum to perform the ultrasound.

Using a small, hollow needle, the doctor removes a tissue sample from the prostate. They send this to a laboratory where a pathologist views the sample under a microscope to check for abnormal cell growth.

The biopsy may involve the collection of several samples of prostate tissue during the procedure.

Learn more about the prostate biopsy procedure here.

A prostate biopsy is a standard procedure. The benefits of choosing this option include:

  • getting accurate information about how aggressive the cancer is
  • confirming a diagnosis of suspected prostate cancer
  • enabling prompt treatment of prostate cancer

If diagnosis and treatment remove prostate cancer before it spreads to distant organs (localized cancer), the 5-year survival rate is almost 100%.

This means that a person with localized prostate cancer is almost as likely to survive for 5 years beyond diagnosis as a person who does not have prostate cancer.

The disadvantages of a prostate biopsy include:

  • Discomfort: Most people receive pain medication to reduce discomfort during the procedure. However, it is common to experience bleeding and pain in the days following a prostate biopsy.
  • Inaccurate or incomplete results: Prostate biopsies miss about 20% of cancers. They can also produce false-positive results. This means some people may need to have multiple biopsies.
  • Risk of hospitalization: This might occur due to infection and other prostate issues.

Prostate cancer can be a frightening diagnosis, but the disease is also highly treatable and often progresses slowly.

People often do not need every test for prostate cancer, and not all prostate cancers require treatment. People should consult their doctors to determine the best preventive checks for them.