Prostate Enlargement (BPH)
A prostate cancer diagnosis often raises immediate questions: What does my PSA mean? Do I need an MRI or biopsy? If cancer is found, how aggressive is it? What happens next?
Those answers depend on the individual. PSA results, prostate examination findings, MRI, biopsy pathology, family history, genetics, overall health, and other factors can all influence the evaluation and treatment plan.
At the Center for Advanced Urology, prostate cancer care in South Jersey and Philadelphia begins with a thorough assessment of the information available for each patient. Stuart Diamond, MD, FACS, is a board-certified urologist with more than 30 years of urologic experience and provides evaluation, diagnosis, advanced prostate imaging, biopsy services, and treatment planning.
The practice offers Promaxo MRI and Promaxo MRI-Guided Biopsy for appropriate patients. These technologies can provide additional information when imaging or tissue evaluation is needed.
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Understanding Prostate Cancer
Prostate cancer develops when abnormal cells in the prostate grow uncontrollably. The prostate is a gland below the bladder and in front of the rectum that contributes fluid to semen.
Prostate cancer does not behave the same way in every patient. Some cancers grow slowly and may never cause significant problems, while others can be more aggressive and spread beyond the prostate.
That variation is why no single PSA value, imaging finding, or symptom can fully define an individual's diagnosis.
When cancer is suspected or confirmed, physicians look at the available evidence to determine whether further testing is needed, how significant the cancer may be, and which management options are appropriate.
Why Prostate Cancer Evaluation Matters
Early prostate cancer often causes no noticeable symptoms. Some cancers are therefore identified during an evaluation prompted by an elevated PSA, an abnormal prostate examination, or other risk factors.
At the same time, prostate cancer screening has limitations. PSA is not specific to cancer, and an elevated result can also occur with benign prostate enlargement, inflammation, infection, and other conditions. Screening can also identify cancers that may never become clinically significant.
For these reasons, the decision to screen and the need for additional testing should be based on the individual patient rather than a single test result.
Who Is at Higher Risk?
Certain factors can increase the likelihood of developing prostate cancer. Having a risk factor does not mean cancer will develop, and the absence of known risk factors does not eliminate the possibility.
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Age
The risk of prostate cancer increases with age. Prostate cancer can occur in younger men, but advancing age is an important factor when determining screening and evaluation needs.
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Family History
A father, brother, or son with prostate cancer can increase an individual's risk. A family history of certain other cancers may also be relevant because some inherited genetic changes are associated with prostate cancer.
Tell your urologist about significant cancer diagnoses in your family.
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Genetic Factors
Inherited changes involving genes such as BRCA1 and BRCA2, as well as changes associated with Lynch syndrome, can be linked to increased prostate cancer risk.
Men with a strong family history or other high-risk features may benefit from genetic counseling or testing.
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Other Risk Factors
Your age, family history, previous testing, overall health, and other clinical information may all contribute to risk assessment.
Early prostate cancer frequently causes no symptoms.
When symptoms do occur, they may overlap with benign prostatic hyperplasia (BPH), urinary infection, or other prostate and urinary conditions.
Possible symptoms include:
- Difficulty starting urination
- A weak or interrupted urine stream
- Increased urinary frequency
- More frequent urination at night
- Blood in the urine or semen
- Pain or discomfort with ejaculation
- Erectile difficulties
- Persistent pain in the back, hips, or pelvis
These symptoms do not necessarily indicate cancer. An evaluation is needed to determine the underlying cause.
Screening is intended to identify possible prostate cancer before symptoms develop.
The decision to screen should account for factors such as age, family history, genetic risk, overall health, and personal preferences. Screening can help identify clinically important cancers earlier, but it can also lead to false-positive results, unnecessary biopsies, overdiagnosis, and treatment-related effects.
There is no single screening approach that fits every man.
PSA Testing
The prostate-specific antigen (PSA) test measures PSA in the blood. PSA is produced primarily by prostate tissue, but an elevated result does not automatically mean cancer is present.
PSA can rise because of prostate cancer, benign enlargement, inflammation, infection, and other factors. A PSA within a typical range also does not completely rule out cancer.
Your physician may consider:
- The current PSA level
- Previous PSA measurements
- PSA changes over time
- PSA density
- Prostate size
- Family history
- Physical examination findings
- Other risk factors
Digital Rectal Examination
A digital rectal examination allows the physician to assess the prostate for abnormalities that may require further evaluation.
A DRE can provide useful clinical information, but it does not replace PSA testing, imaging, biopsy, or other diagnostic methods when those are appropriate.
An elevated PSA does not automatically mean that you have prostate cancer.
Depending on the circumstances, your physician may recommend repeating the PSA, reviewing factors that could have affected the result, using additional risk-assessment tools, obtaining prostate imaging, or discussing biopsy.
The next step depends on the complete clinical picture rather than one PSA number.
Diagnosis typically involves several pieces of information rather than one test.
Reviewing Your History and Risk
Your physician may review:
- PSA results and previous PSA measurements
- Family history
- Genetic risk factors
- Urinary and sexual symptoms
- Previous biopsies or prostate procedures
- Medications and relevant medical conditions
- Physical examination findings
- Prostate size and other clinical information
This helps determine whether additional testing is warranted.
Prostate MRI
Prostate MRI can provide detailed images of the prostate and surrounding structures. It may help identify areas that appear suspicious for clinically significant prostate cancer and can contribute to biopsy planning.
MRI findings are commonly reported using the PI-RADS classification system, which ranges from 1 to 5 according to the level of suspicion.
MRI may be considered before biopsy when prostate cancer is suspected. When a suspicious lesion is identified, MRI information can help determine whether targeted sampling is appropriate and where that sampling should be directed.
MRI is an important diagnostic tool, but it does not establish a tissue diagnosis.
Prostate Biopsy
A prostate biopsy obtains small tissue samples for microscopic examination by a pathologist.
When clinical findings or imaging indicate that tissue confirmation is necessary, biopsy is used to determine whether cancer is present and to characterize the cancer identified.
Depending on the patient and clinical circumstances, biopsy may involve systematic sampling, targeted sampling, or a combination of approaches.
Center for Advanced Urology offers Promaxo MRI and Promaxo MRI-Guided Biopsy for appropriate patients as part of the prostate cancer diagnostic process.
Promaxo MRI
Promaxo MRI is a compact, point-of-care MRI platform designed for prostate imaging and MRI-guided procedures.
For an appropriate patient, prostate MRI may help identify a suspicious area, provide information about prostate anatomy, and contribute to decisions about additional evaluation or biopsy.
The role of MRI depends on the patient's PSA history, clinical findings, previous biopsy results, and other risk factors.
Promaxo MRI-Guided Biopsy
When tissue evaluation is indicated, MRI guidance can help the physician target a suspicious area identified during prostate evaluation.
Promaxo MRI-Guided Biopsy incorporates MRI information into the biopsy procedure so the physician can use the location of the area of concern while obtaining tissue samples.
MRI guidance does not guarantee that cancer will be detected. The biopsy samples specific areas of tissue, and the pathology report remains the basis for determining whether cancer is present in the sampled tissue.
A prostate biopsy pathology report provides information about whether cancer was identified and, when present, characteristics that help determine its significance.
If Cancer Is Not Found
A negative biopsy means cancer was not identified in the tissue samples obtained.
It does not necessarily mean that no cancer is present anywhere in the prostate. If PSA levels or other findings remain concerning, your physician may recommend continued monitoring, additional imaging, repeat biopsy, or other evaluation.
If Cancer Is Found
When prostate cancer is identified, the pathology report provides information about the characteristics of the tumor.
One important factor is tumor grade. The Gleason grading system evaluates how abnormal the cancer cells appear under a microscope, and the resulting Grade Group helps physicians assess how the cancer may behave.
Your physician will interpret the pathology findings together with PSA, imaging, examination findings, overall health, and other relevant factors.
The diagnosis is therefore about more than determining whether cancer is present. The goal is to understand its characteristics and overall significance.
A cancer diagnosis leads to a more detailed evaluation of the disease and a discussion of management options.
Understanding the Extent of Disease
Your physician may need additional information to determine whether the cancer appears confined to the prostate or whether there is evidence of spread beyond it.
The need for additional imaging or testing depends on the cancer's characteristics, risk category, and other clinical findings.
Discussing Treatment and Monitoring
Treatment depends on the type, grade, and extent of the cancer as well as the patient's overall health and preferences.
Depending on the diagnosis, management may include:
- Active surveillance
- Surgery
- Radiation therapy
- Hormone-based treatment
- Other systemic therapies
- Combination treatment
Not every prostate cancer requires immediate treatment.
For selected lower-risk cancers, active surveillance may be appropriate. This involves structured follow-up that can include PSA testing, examinations, MRI, repeat biopsy, or other evaluations as needed.
Cancers with a higher risk of progression may require more active treatment.
There is no single treatment that is appropriate for every prostate cancer patient.
Your physician may discuss:
- The cancer's Grade Group
- PSA level and other risk information
- Whether the cancer appears confined to the prostate
- Imaging findings
- Overall health
- Urinary and sexual function
- Other medical conditions
- Life expectancy
- Personal priorities and treatment preferences
The potential benefits, risks, side effects, and follow-up requirements of each option should be considered before a treatment decision is made.
Prostate Cancer Care in South Jersey & Philadelphia
Center for Advanced Urology provides urologic evaluation and treatment through two South Jersey offices.
Salem
MOORESTOWN
Patients throughout South Jersey and the greater Philadelphia area can contact the practice to discuss prostate cancer screening,
diagnostic evaluation, MRI, biopsy, or treatment planning.
Our Clinics
The Center for Advanced Urology provides prostate evaluation and treatment at two clinic locations, each serving the communities listed below.
Moorestown
Salem
Why Choose Center for Advanced Urology?
Prostate cancer care requires more than a PSA test or a single imaging result. Diagnosis and treatment planning depend on how screening results, risk factors, imaging, pathology, and the patient's individual circumstances fit together.
At the Center for Advanced Urology, Stuart Diamond, MD, FACS, provides physician-guided urologic care backed by more than 30 years of experience. Dr. Diamond is a board-certified urologist and Fellow of the American College of Surgeons with experience evaluating prostate and men's health concerns.
Our practice uses advanced diagnostic technology when it is clinically appropriate, including Promaxo MRI and Promaxo MRI-Guided Biopsy.
We approach each patient individually rather than treating every elevated PSA, abnormal examination, or suspicious MRI result the same way. The recommended next step depends on the available evidence and the patient's specific circumstances.
Prostate Cancer FAQs
Early prostate cancer often causes no symptoms. When symptoms occur, they may include urinary changes, blood in the urine or semen, erectile difficulties, or persistent pain in the pelvis, hips, or back. These symptoms can also have other causes.
No. PSA can increase because of prostate cancer, benign prostate enlargement, inflammation, infection, and other conditions. Your physician must interpret the result in the context of your other risk factors and clinical findings.
There is no single PSA value that can diagnose or completely rule out prostate cancer. The result must be considered alongside factors such as PSA trends, prostate size, family history, examination findings, and other clinical information.
MRI may be recommended before biopsy when prostate cancer is suspected. It can help identify suspicious areas and provide information that may influence whether targeted biopsy is appropriate.
No. MRI can identify areas that appear suspicious, but it cannot establish a tissue diagnosis. A biopsy may be needed to confirm cancer.
PI-RADS is a standardized system used to report prostate MRI findings. Scores range from 1 to 5 and describe the level of suspicion for clinically significant prostate cancer. The score does not by itself diagnose cancer.
No. The need for biopsy depends on the patient's PSA, examination findings, MRI results, previous biopsy history, risk factors, and other clinical information.
A negative biopsy means cancer was not identified in the tissue samples obtained. If other findings remain concerning, your urologist may recommend monitoring, additional imaging, repeat biopsy, or another form of evaluation.
No. Some lower-risk prostate cancers may be managed with active surveillance rather than immediate treatment. Other cancers may require more active intervention depending on their grade, extent, and overall risk.
Depending on the cancer and the patient's circumstances, management may include active surveillance, surgery, radiation therapy, hormone-based treatment, systemic therapy, or combinations of these approaches.
A urologic evaluation may be appropriate if you have an elevated or changing PSA, an abnormal prostate examination, significant risk factors, concerning symptoms, or an abnormal prostate MRI. A urologist can determine whether additional testing is warranted.
Contact Us
Discuss Your Prostate Cancer Care
Whether you are considering prostate cancer screening, have an elevated PSA, need evaluation after an abnormal prostate examination, or have already received a cancer diagnosis, the next step depends on your individual findings.
Center for Advanced Urology provides individualized prostate cancer evaluation, including advanced prostate imaging and MRI-guided biopsy services when appropriate. Stuart Diamond, MD, FACS, can review your clinical information, explain the diagnostic process, and discuss appropriate next steps.
Call Center for Advanced Urology at (856) 339-4466 to schedule an evaluation.
