However, there are several other tests that can provide critical information that may be helpful in specific cases. Most patients will not need and probably should not get these tests at the time of initial diagnosis, but we are providing this information so that people can be fully informed:
The prostatic acid phosphatase test is an old test that was available before the PSA test existed. The single greatest value of this test is that it can sometimes be used to assess risk of metastatic disease in patients with an elevated PSA but a negative bone scan.
The bone scan is a test that is used to clearly visualize metastatic prostate cancer in the pelvis, the spine, and other bones. It is only in patients at clear risk for metastatic disease.
CT and MRI scans can be used to identify the presence of metastatic disease not only in bone but also in soft tissues such as the liver.
A special type of MRI, known as an endorectal coil MRI, can be used to visualize the prostate itself in considerable detail. This may be valuable in helping to decide whether the cancer has extended outside the prostate before making decisions about the relative value of surgery or radiotherapy as treatment for specific patients.
Color Döppler ultrasound is a tool that has been used by some centers in attempts to identify the precise whereabouts of cancer in the prostate. The value of this form of imaging is still controversial.
A test known as the ProstaScint test can, sometimes, be used to identify the precise location of early extraprostatic metastases (before thay can be visualized by bone scans or CT scans). However, the accuracy of this test is limited, and although the test showed early promise, that promise has never been broadly confirmed in clinical practice.