*This slide show represents a visual interpretation and is not intended to provide, nor substitute as, medical and/or clinical advice.

Diagnosing prostate cancer begins with a visit to your family doctor or urologist. They will ask about your medical history, family history of prostate cancer, symptoms, and do a physical exam.

Prostate cancer may have no physical symptoms. If there are symptoms, they may include problems with urinating, blood in the urine, or pain in the bones.¹

Your visit may include a digital rectal exam, or DRE where the doctor will gently examine your prostate for abnormalities.²

You may have a blood test to check your level of a protein that only the prostate makes. This protein is called prostate-specific antigen, or PSA.² If the level is high, it might mean cancer. Some conditions, such as an enlarged prostate, can also raise PSA levels.

Your doctor may talk to you about other blood or urine tests that help with diagnosis and screening of prostate cancer.²

If there is concern for cancer your doctor may recommend a prostate biopsy.² During the biopsy, your doctor samples your prostate with the help of an ultrasound. The samples are then sent to a lab to check for cancer cells.³

A biopsy is usually quick and safe. The pain is minimized with the help of local anesthetic. You may be asked to take antibiotics and do an enema before the procedure.¹

Prostate biopsies can be done using ultrasound guidance through your rectum or perineum which is the space between the scrotum and anus. This perineal method may be safer and more accurate.⁴ Your doctor may also do an MRI before the biopsy to perform an MRI-fusion biopsy.

Ask your doctor about all the options and see which is right for you.

It takes a few days to get the results of your prostate biopsy.

If the biopsy results show no cancer your doctor may order further tests.¹ These can include additional blood tests, a urine test called PCA-3, an MRI to look for abnormalities on the prostate,⁵ or a repeat biopsy.

If you have cancer on your biopsy, the report will show the overall percentage of cancer in the tissue and a Gleason score.^3,6 This score tells your doctor how abnormal the cancer cells are in the prostate. 

Gleason scores go from 6 to 10. A Gleason score of 6 is not very aggressive, 7 is moderate, and 8 through 10 are considered aggressive.^5,6

Your doctor will then take all the information and put you in a risk or grade group. The group you are in helps the doctor to discuss the best treatment options for your prostate cancer. 

For example, Low Risk or Grade Group 1 are not aggressive cancers so your doctor may recommend simply watching the cancer. If you are in the High Risk or Grade Group 5 then your doctor may recommend moving quicker with treatment.⁶

A biopsy may show an abnormality that is not cancer, but could lead to it. These abnormalities include a condition called atypical small acinar proliferation, or ASAP.¹

Other conditions are called, prostatic intraepithelial neoplasia, or PIN, and proliferative inflammatory atrophy, or PIA.¹ If you have one of these, your doctor may want to watch for cancer and do more tests later.

Genetic changes are responsible for some prostate cancers. For example, a mutation on the BRCA gene can cause prostate cancer as well as breast cancer. And a syndrome that runs in some families, called Lynch syndrome, can also cause prostate cancer.¹ Your doctor may suggest testing for these genetic mutations.

Imaging tests are used to show abnormalities in prostate cancer. For example, an MRI can show possible cancerous areas of the prostate and help decide if you need a biopsy. It can also show if cancer has spread.¹

If your Gleason score or grade group is high, your doctor may check if cancer has spread to your bones or other areas. A CT scan can show if it has spread to the lymph nodes or other organs. A bone scan can show if it is present in the bones.¹

Prostate cancer is common in men as they get older. When diagnosed early there are effective treatment options. Talk with your doctor about the tests you may need to diagnose prostate cancer or another condition as early as possible.

References

1. American Cancer Society. Tests to diagnose and stage prostate cancer. Available at https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html. Updated January 30, 2020. Accessed September 9, 2020.
2. American Society of Clinical Oncology. Cancer.Net. Prostate Cancer: Diagnosis. Available at https://www.cancer.net/cancer-types/prostate-cancer/diagnosis. Updated November 2019. Accessed September 9, 2020.
3. US Centers for Disease Control. How is Prostate Cancer Diagnosed? Available at https://www.cdc.gov/cancer/prostate/basic_info/diagnosis.htm. Updated August 18, 2020. Accessed September 9, 2020.
4. Stefanova V, Buckley R, Flax S, et al. Transperineal prostate biopsies using local anesthesia: Experience with 1287 patients. Prostate cancer detection rate, complications and patient tolerability. J Urol 2019;201:1121-1126.
5. Prostate Cancer Foundation. Diagnosis of Prostate Cancer. Available at https://www.pcf.org/about-prostate-cancer/diagnosis-staging-prostate-cancer/how-diagnosed/. Accessed September 9, 2020.
6. American Society of Clinical Oncology. Cancer.Net. Prostate Cancer: Stages and Grades. Updated November 2019.
   Available at https://www.cancer.net/cancer-types/prostate-cancer/stages-and-grades. Accessed September 9, 2020.