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.

Anatomy of the Prostate Gland

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Suspicion of prostate cancer

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:

  • Blood tests—Certain substances are released into the blood when a cancerous tumor develops. These markers, such as prostate-specific antigen (PSA), or other specific blood proteins, may be elevated in the presence of cancer.
  • Imaging tests—Changes to the prostate including abnormal growth can be found with these tests. Imaging tests may include:

Diagnosis of prostate cancer

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.

High grade prostatic intraepithelial neoplasia

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.

Staging of prostate cancer

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.

Staging tests

Tests that may help determine prostate cancer stage include:

  • Blood tests to look for abnormal numbers of certain blood cells, proteins, indications of cancer, and abnormal cells. The tests may also show changes in kidney or liver function.
  • Imaging tests—To help determine how deep the tumor is in prostate tissue, and evaluate lymph nodes and other nearby structures. They may also help to determine if there are any metastatic growths in other areas of the body. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may include:
  • Lymph node biopsy—Cancer cells can drain from the tumor site into nearby lymph nodes. From here, cancer cells can travel through the lymph fluid to the bloodstream and other areas of the body. Lymph nodes are normally checked if suspicious tissue is removed, or if they are swollen or felt during the physical exam.
  • Seminal vesicle biopsy—A small needle is used to get fluid that eventually becomes semen. The gland is next to the prostate.
  • Tissue evaluation—Cancer tissue from the biopsy will be closely examined to look for characteristics that can help with prognosis and treatment selection. Important characteristics include presence of genetic mutations. For example, some genetic mutations cause resistance to certain types of treatment.

Stages of prostate cancer

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:

  • Stage I—Cancer is found only in the prostate gland.
  • Stage II—Cancer is still contained within the prostate gland, but is more advanced than Stage I.
  • Stage III—Cancer has spread outside of the prostate gland and MAY be found in the nearby seminal vesicles.
  • Stage IV—Cancer has spread outside of the seminal vesicles. The most common sites for metastatic prostate cancer are the lymph nodes, organs in the pelvic cavity (rectum or bladder), and the bones.
Grading of Prostate Cancer

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.