Invasive Tests
Sometimes, initial testing and imaging scans are not sufficient to give a proper staging of your cancer. More invasive testing is then needed.
- Lymph Node Biopsy During Surgery
When a radical prostatectomy (the most common form of cancer-removing surgery for prostate cancer) is performed, the surgeon is able to remove lymph nodes that are near the prostate. These lymph nodes are some of the earliest places that cancer can spread.
If the surgeon is highly suspicious that your cancer may have spread (due to very high PSA levels or a high Gleason score), then he or she will remove the lymph nodes during the surgery and have them immediately examined by a pathologist for evidence of cancer. If no cancer is found, the surgery is then completed as planned. If cancer is found in the lymph nodes, however, then usually the surgery is stopped without removing the prostate. This is due to the fact that, if the cancer has already spread outside of the prostate, removal of the prostate adds little benefit to the patient.
- Lymph Node Biopsy Without Surgery
Men who choose not to have surgery to remove their prostate (because, for instance, they wish to use radiation therapy instead), in rare circumstances, still need to have their lymph nodes evaluated for the presence of cancer. Both of the following options are only occasionally used.
- Laparoscopic Biopsy
For this method, the surgeon does not make any long incisions in the abdomen. Instead, he places small holes in the abdomen through which long, thin instruments (including a tiny camera) are inserted. These instruments can then be manipulated by the surgeon to remove the lymph nodes surrounding the prostate. The lymph nodes are then sent for evaluation.
- Fine Needle Aspiration (FNA)
For this method, an interventional radiologist (who is trained specifically to perform procedures such as the FNA), inserts a long needle through the skin and into any enlarged lymph node near the prostate. A tiny sample of the lymph node is then taken out and sent for evaluation.
Source:
Trabulsi EJ, Merriam WG, Gomella LG. New imaging techniques in prostate cancer. Curr Urol Rep. 2006 May;7(3):175-80. Review.
- Laparoscopic Biopsy
