Your doctor will ask you about your symptoms, and medical and family history. This will include a thorough digital rectal exam (DRE) to detect any abnormalities. A DRE is a brief exam of the prostate. The doctor inserts a lubricated, gloved finger into the rectum. The doctor can feel the prostate through the rectal wall to check for lumps or enlargement.
Additional tests may be done if certain symptoms are present or the doctor feels something suspicious during DRE. The tests will help to find specific cause of changes whether or not it is cancer. Tests may include:
Diagnosis of prostate cancer is confirmed with a biopsy. Tissue samples are taken from the prostate gland. After removal, the samples are examined under a microscope. This is the only way to confirm a diagnosis.
A prostate biopsy is done with a core needle. A needle is inserted into the prostate and removes samples of prostate tissue. The biopsy needle may be guided by imaging, such as an MRI scan or ultrasound, to improve accuracy. The biopsy is usually done during a transrectal ultrasound.
During the test, a pathologist will look for signs of cancer in the samples. There are different methods for categorizing the cells based on what is seen.
Sometimes, a biopsy may reveal abnormal changes in prostate cells. These cells are not cancerous, do not cause symptoms, or need treatment. High grade prostatic intraepithelial neoplasia (HGPIN) increases the risk of prostate cancer development. Although treatment is not needed, men with HGPIN are followed closely by their doctor for progression. Another biopsy may be needed to test different parts of the prostate for the presence of HGPIN or cancer cells.
If prostate cancer is confirmed, results from completed tests and new tests will help determine the stage of cancer. Staging is used to determine characteristics of the tumor that will help develop the prognosis and treatment plan. Factors that play a role in staging include how far the original tumor has spread, whether lymph nodes are involved, if cancer has spread to other tissue, and microscopic cellular details.
Tests that may help determine prostate cancer stage include:
Prostate cancer staging take several factors into consideration. These include how much can be felt during a DRE exam, needle biopsy results, where the cancer is located, and what can be seen on imaging tests.
Prostate cancer is staged from I-IV:
Prostate cancer can be graded based on a Gleason score. The grade depends on how much the cancer cells look like normal prostate cells under a microscope. Gleason scores are graded from 1-5. Grade 1 cancer cells mainly look normal, while grade 5 cancer cells mainly look abnormal. Most cancers are grade 3 or higher. As with staging, a Gleason score can help with prognosis and the development of a treatment plan.
General information about prostate cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq. Updated July 7, 2016. Accessed April 13, 2017.
How is prostate cancer diagnosed? Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/prostate-cancer/diagnosis. Accessed April 13, 2017.
Prostate cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/genitourinary-disorders/genitourinary-cancer/prostate-cancer. Updated November 2013. Accessed April 12, 2017.
Prostate cancer staging and imaging. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T905769/Prostate-cancer-...ging-and-imaging. Updated March 12, 2016. Accessed April 13, 2017.
Stages of prostate cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq. Updated July 7, 2016. Accessed April 13, 2017.
Tests for prostate cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html. Updated March 11, 2016. Accessed April 13, 2017.
Understanding your pathology report: Prostatic intraepithelial neoplasia (PIN) and intraductal carcinoma. American Cancer Society website. Available at: https://www.cancer.org/treatment/understanding-your-diagnosis/tests/understanding-your-pathology-report/prostate-pathology/high-grade-prostatic-intraepithelial-neoplasia.html. Updated March 7, 2017. Accessed April 13, 2017.
7/17/2017 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T905769/Prostate-cancer-...ging-and-imaging: Coakley FV, Oto A, Alexancer LF, et al. ACR Appropriateness Criteria for prostate cancer-pretreatment detection, surveillance, and staging. Available at: https://acsearch.acr.org/docs/69371/Narrative. Updated 2016.
Last reviewed September 2017 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.