If your doctor suspects advanced prostate cancer, you may need a variety of tests and screening exams in addition to a prostate-specific antigen (PSA) test. These tests and exams will help you and your doctor learn more about where the cancer is located and how it’s behaving in your body.

The process of determining what stage a person’s cancer is in is called staging. The higher the stage number, the more the cancer has progressed. Very early signs of cancer, with cancer cells confined to one small area of your prostate and not growing aggressively, indicate the disease is in stage 1. Stage 4, the most advanced stage, means the cancer has spread to organs and areas beyond your prostate, like your bladder, rectum, bones, or lymph nodes.

Your doctor will recommend tests and exams that will help them find out exactly where the cancer has spread and how much is in your body. This information is then used to determine what your treatment will be and what the success rate is for different treatments at your stage. You may also have tests and screenings during the course of your treatment to see how the treatment is working.

Read on to learn about these tests and screenings to see what you can expect and how they help your doctor get more information.

Bone scan

When prostate cancer spreads, it often goes to the bones. This test helps doctors confirm if and where the cancer has spread in your bones.

Before the scan, you’ll be injected with a low-level radioactive substance that will go to the areas affected by the cancer. The scan uses a special camera to pick up the radiation and take a picture of your bones.

CT scan

The computerized tomography (CT) scan is often used to monitor the spread of cancer in the body. It uses X-rays to create a detailed picture of the inside of your body and its soft tissues.

This test might be the doctor’s first clue that cancer has spread to your lymph nodes or to other organs. You may have a CT scan scheduled regularly as a way for your doctor to see if treatment is slowing the growth and spread of the disease.

MRI scan

A magnetic resonance imaging (MRI) scan also creates a picture of the soft tissues in your body, but it’s more detailed than a CT scan. MRI scans use magnets and radio waves instead of X-rays to create the image.

For prostate cancer, an MRI scan can give a clear picture of the prostate and its surrounding tissues to see exactly where the cancer has spread. The doctor may use a special probe that’s inserted inside your rectum to get the most accurate scan. If you’re uncomfortable, medication can be given to sedate you during the process.

PET scan

A positron emission tomography (PET) scan is often used to find returning cancer, meaning cancer that has come back to areas after being treated.

You’ll be injected with a special liquid that will stick to cancer cells and make them visible in the PET scan. The imaging test allows doctors to see the tracer liquid clearly and pinpoint cancer.

Lymph node biopsy

A biopsy might be needed to confirm if your cancer has spread to your lymph nodes and how far. This biopsy can be done as its own procedure or during another surgical procedure.

If the biopsy is done separately, you’ll be given some local numbing medicine. Your doctor will insert a needle into the lymph node and remove some of the tissue to be tested. For prostate cancer, the sample is usually taken from a lymph node in the groin area.

If you’ve scheduled surgery to remove your prostate, the doctor may also remove a lymph node or two to biopsy while you’re already under anesthesia.

Bone biopsy

If your doctor wasn’t able to get an accurate picture of your cancer using the bone scan, they may want to do a bone biopsy to be sure the cancer hasn’t spread. Doctors will often recommend a biopsy to confirm cancer after imaging tests show abnormal results.

During this procedure, you’re given some numbing medication at the area where the sample will be drawn. A needle is inserted into the skin to reach the bone. A small amount of bone marrow is removed and examined under a microscope to look for cancer cells.

The takeaway

The tests and scans your doctor recommends will help them get more information about your cancer. Not every person needs every test. Sometimes doctors can get what they need from one test without having to do more, and other times they need to do more testing to absolutely sure.