If you were told you have prostate cancer, who gave you the news? Your doctor, right? But that doesn’t mean he or she made the ultimate diagnosis.

In fact, your doctor may have suspected you have prostate cancer (PCa) based on your PSA blood test, a DRE (digital rectal exam in which an abnormality was felt), and a multiparametric MRI (mpMRI) that registered telltale signs of clinically significant PCa. But no matter how much suspicion there is, only a needle biopsy can obtain physical proof of PCa, and there’s only one person who evaluates your tissue samples and make the final call. It’s not your doctor or the radiologist who did the mpMRI. It’s a specialist called a pathologist.

The word pathology comes from two ancient Greek words: pathos (suffering or experiencing) and logia (study), so in medieval times the two words were combined into pathologia, meaning the study of diseases from which we suffer.

Becoming a pathologist requires many years of training. According to the University of Medicine and Health Sciences, a person must first become a doctor by completing medical school (4 years), then doing a residency in Pathology (3-4 years), followed by passing the exams required for licensing and board certification. Then, to specialize in prostate pathology, they must complete a genitourinary fellowship (typically 1 year). Finally, experience matters, along with continuing education. The more years in practice, the better the pathologist. Two respected U.S. authorities who have earned their stripes in prostate pathology are Jonathan Epstein (Johns Hopkins) and David Bostwick (Bostwick Laboratories).

Thus, it is the pathologist who says whether or not you have PCa. If your doctor states, “You have prostate cancer,” it’s not just his or her professional opinion—it’s because a pathologist looked at your actual cells and saw cancer.

Importance of a second opinion

Every grassroots PCa patient organization gives the same advice: when you get your pathology report, get a second opinion. Why? Because diagnosing the amount and aggressiveness of a PCa tumor is a matter of informed judgment. As UCLA Health points out, “Prostate cancer is a complex disease and there are a variety of treatment options. Patients are often given conflicting recommendations about management.” You want the most reliable information in order to make the best treatment decision. It’s reasonable to expect greater room for error from less experienced pathologists, and since you won’t know in advance who will be reading your slides, you don’t know how authoritative they are. Therefore, patients are encouraged to submit their slides to an institution like Johns Hopkins, Bostwick Labs, etc.

Today’s pathologists also have a new resource in their corner to boost the accuracy of their diagnosis: Artificial Intelligence programs. These rapidly growing diagnostic tools are “trained” on hundreds or even thousands of slides with cancer cells flagged and labeled by authoritative pathologists, so the program can rapidly recognize cancerous areas and how aggressive they appear. Thus, less experienced pathologists can benefit from the “brains” of those with greater experience—but the human makes the final call.

Can mpMRI diagnose prostate cancer?

The short answer is, not yet. Many patients wonder if imaging alone can determine if PCa is present, and how dangerous it is. Based on PI-RADS risk level, mpMRI provides important clues as to whether the tumor is insignificant (does not require immediate treatment) or significant (requires immediate treatment). In fact, studies like the recent 2023 paper from Sweden now show that mpMRI combined with PI-RADS scoring can determine if a biopsy is necessary. If there is insignificant disease, no biopsy is necessary because a future repeat PSA and mpMRI can keep an eye on tumor activity.

However, the bottom line remains: If PSA and mpMRI together suggest clinically significant PCa, a biopsy is required because only a pathologist can determine whether or not you have PCa.

While that may be an unwelcome thought, rest assured that a real time, in-bore MRI targeted biopsy greatly minimizes the number of needles, and therefore the risk of side effects. The procedure is safe, with greatly reduced risks vs. conventional 12-14 needle TRUS biopsy (with its history of inaccuracy).

Thus, it’s the pathologist who says, “You have prostate cancer.” However, thanks to the further analytics provided by our 3T mpMRI, the Sperling Prostate Center says, “We can help you match the best treatment for your disease.” Contact us for more information about our state-of-the-art MRI detection, in-bore targeted biopsy for the most accurate diagnosis, and MRI-guided focal treatments for qualified patients.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.