Prostate Cancer Diagnosis

Prostate cancer is the most common cancer in American men. About one in seven men is diagnosed with prostate cancer at some point in his lifetime. Approximately 60 percent of prostate cancers are diagnosed in men age 65 or older.

Like some other types of cancer, the risk of developing prostate cancer is thought to be partly based on genetic factors. If your father or brother had prostate cancer, particularly at a young age, you may be at increased risk for the disease.

At NYU Langone’s Perlmutter Cancer Center, our philosophy for diagnosing prostate cancer is based on the latest research, which indicates that diagnosing some prostate cancers can cause more harm through unnecessary testing and treatment than leaving it undiagnosed and untreated. Some prostate cancers grow slowly, and, depending on your age and other individual health factors, may not need to be treated immediately, if ever.

Our urologists are at the forefront of investigating how advances in prostate imaging can guide decisions about who needs a prostate biopsy, and how to more effectively use imaging to diagnose only those prostate cancers that are potentially lethal. Our specialists employ image-guided detection that more accurately locates tumors than traditional “random” biopsy, which can miss tumors that need attention or detect small, slow-growing tumors that don’t warrant treatment.

Because some prostate cancers grow slowly, our prostate cancer specialists determine if testing and treatment are immediately necessary based on the latest research.

If screening tests reveal abnormal results, your urologist discusses the risks and benefits of additional testing with you based on your age, risk factors, and symptoms.

Prostate Cancer Risk Factors and Symptoms

Early prostate cancer causes no symptoms. Prostate cancer may arise many years before symptoms appear or a doctor can feel it during a basic screening test, known as a digital rectal exam.

Noticeable symptoms that may indicate prostate cancer include difficulty urinating or ejaculating, or pain or bleeding with ejaculation. If you are experiencing these symptoms, you should speak with your doctor, who may recommend certain tests.

At NYU Langone’s Smilow Comprehensive Prostate Cancer Center, your doctor first performs a physical exam, which includes a digital rectal examination, and gathers a detailed medical history.

Your doctor may then perform the following tests to check for the presence of prostate cancer and to assess whether the cancer is growing slowly or may require more immediate treatment.

PSA Test

In a prostate specific antigen, or PSA, test, a small amount of blood is drawn and sent to a laboratory for analysis. This is the same test that is used to screen for prostate cancer.

MRI Scan

If your doctor feels something clearly irregular in your prostate during the digital rectal exam, or if you have more than one PSA test result that indicates elevated levels of the protein in the blood, your doctor may recommend an MRI of the prostate. MRI uses magnets and computers to create two- and three- dimensional images of the body. This allows your doctor to view the prostate in detail and to check for areas that appear suspicious for cancer.

In the past decade, NYU Langone doctors have been recognized internationally for developing and improving techniques for MRI scanning of the prostate. Our radiologists use the latest technology to interpret images for this advanced method of MRI testing. If you have had an MRI scan of the prostate elsewhere, our doctors can reassess it. If they believe it’s necessary, they may order a second scan to better evaluate the likelihood that you have prostate cancer.

Our doctors are at the forefront of developing and improving techniques for MRI scanning of the prostate.

Our MRI techniques include measuring blood flow and the movement of water in the tissues of the prostate to identify regions that appear suspicious for cancer. Water molecules move differently within noncancerous cells than in cancerous tissue, helping doctors to identify tumors.

MRI can also help doctors identify cancerous tumors by the presence of abnormal blood vessels. This is because blood vessels that feed prostate cancer take up contrast material, an injected dye that rapidly helps makes cancer more visible on scans. This is known as early enhancement. The contrast material also leaves those abnormal blood vessels more quickly.

Our radiologists typically score any areas of suspicion on a scale, developed at NYU Langone, from 1 to 5. This suspicion score indicates how confident the radiologist is that there may be cancer in the area.

Our doctors developed the suspicion score scale to assess a radiologist’s confidence that the scanned area is cancerous.

An MRI typically takes 45 minutes to complete. Following the scan, your doctor assesses the results to decide whether a biopsy of the prostate is necessary. For instance, our doctors may recommend that some men who have normal MRI results and elevated and rising PSA levels or prominent family history undergo a biopsy, whereas older men with the same results may instead be monitored for any further elevation in PSA levels.

Prostate Biopsy

A biopsy—a series of tissue samples collected from the prostate—can allow your doctor to confirm a diagnosis of prostate cancer. Urologists may recommend biopsy if previous tests have shown abnormalities.

In the past, prostate biopsies consisted of a series of six samples spaced equally throughout the prostate gland. This increased the chances of identifying a cancer in men with an elevated PSA level. But NYU Langone urologists have more recently demonstrated that increasing the number of samples to 12, including samples taken from the far edges of the gland, could increase cancer detection and reduce the likelihood of a missed cancer.

Our doctors developed the national standard for 12-core prostate biopsy, which helps detect cancer and reduce the likelihood of missed cancer.

This is called a 12-core systematic biopsy, and it has become the national standard for the past 15 years. As the 12-core biopsy can also miss some cancers, many urologists began to increase sample numbers to up to 60, or to perform repeat biopsies, to identify missed cancers.

Image-Guided Biopsy

As urologists have become more aware that many early prostate cancers are slow growing and may never harm men, the goal of biopsy has changed. Now, urologists use biopsy to identify aggressive cancers while minimizing the likelihood of finding small, slow-growing cancers that are unlikely to harm a man.

In the past few years, researchers, including those at NYU Langone’s Smilow Comprehensive Prostate Cancer Center, have been working to identify the most effective strategy for prostate biopsy. This includes combining imaging techniques, such as MRI and ultrasound—which produces sound waves that create images of the prostate—to help target the most suspicious areas of the gland for biopsy, rather than selecting areas at random.

Our doctors are among the country’s most experienced at MRI-ultrasound fusion targeted biopsy, which combines MRI with ultrasound and requires fewer biopsy needles.

Doctors at the Smilow Comprehensive Prostate Cancer Center are among the country’s most experienced in using a state-of-the-art technology called MRI-ultrasound-fusion targeted biopsy, which combines MRI with ultrasound to create a three-dimensional “fusion” biopsy of the prostate. This allows doctors to align the biopsy needle with the suspicious regions found on MRI. As a result, fewer biopsy needles are needed to identify cancers that require treatment.

This reduces the likelihood that additional biopsies will be required at a later date. Image-guided biopsy also helps doctors identify harmful prostate cancers and to avoid detecting small, nonaggressive cancers that don’t require treatment.

NYU Langone doctors were among the earliest in the country to adopt MRI-ultrasound fusion targeted biopsy and have refined the technique over the years.

Transrectal Ultrasound–Guided Biopsy

A traditional prostate biopsy is known as a transrectal ultrasound–guided biopsy. A doctor first inserts an ultrasound probe into the rectum to visualize the prostate. The probe contains a hollow needle that can quickly pass in and out of the prostate to obtain several thin sections of prostate tissue, which are sent to a laboratory for analysis. Twelve samples, or cores, of the prostate are typically collected as part of a systematic biopsy.

Almost all prostate biopsies at Smilow Comprehensive Prostate Cancer Center are performed with local anesthesia, and men are able to return home about 30 minutes after the procedure. If an MRI identifies a lesion, which is a change in tissue, an MRI-ultrasound-fusion targeted biopsy is often combined with a transrectal ultrasound–guided biopsy to diagnose prostate cancer.

Our urologists have performed research that shows how to optimize a combination of MRI-ultrasound-fusion targeted biopsy and transrectal ultrasound-guided biopsy to decrease the detection of cancers that don’t require treatment.

After a transrectal biopsy, you may experience mild discomfort, bleeding from the rectum, or blood in urine or semen. These effects generally subside after a few days. To reduce the risk of infection after biopsy, your doctor prescribes an antibiotic taken by mouth the day before the procedure and another injected into a muscle immediately before the procedure.

Computerized Template Biopsy

A computerized template biopsy uses ultrasound imaging to create a three-dimensional map of the prostate. The template allows urologists to obtain more precise tissue samples, making it more accurate than a traditional biopsy.

Our doctors were among the first in the United States to use computerized template biopsy, which may predict the location of the prostate cancer more accurately than traditional biopsy.

NYU Langone doctors were among the first in the country to implement a computerized template biopsy and to lead national multicenter studies on its use. A study led by NYU Langone researchers demonstrated that this type of biopsy may more accurately predict where cancer is located in the prostate.


Doctors may order a PET/MRI scan if prostate cancer is suspected to have returned after treatments, such as surgery or chemotherapy. This combination of imaging tests can more accurately detect prostate cancer cells than a single test.

We are among very few medical centers nationwide to routinely perform PET/MRI scans.

Before the test, small amounts of a radioactive agent called Axumin® are injected into a vein in the arm. The agent travels through the bloodstream and makes prostate cancer cells more visible by the PET scan machine. Sometimes, a sodium fluoride tracer is injected into a vein in the arm. It helps detect prostate cancer that has spread to the bone.