Your doctor will ask you about your symptoms, and health and family history. This will involve a digital rectal exam (DRE) to check for any problems. 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.
Suspicion of Prostate Cancer
You will need more tests if your doctor thinks you have problems with your prostate or finds something abnormal during the DRE. The tests will help to find a specific cause of changes whether or not it's cancer. These may be:
- Blood tests—Certain substances are released into the blood as cancer grows. These markers, such as prostate-specific antigen (PSA) or certain other blood proteins, may be higher if you have cancer.
Imaging tests—These tests can help look for changes to the prostate and find tumors. Some tests use contrast material to highlight structures. This makes them easier to see. These tests are:
- Transrectal ultrasound
- MRI scan
Diagnosis of Prostate Cancer
Diagnosis of prostate cancer is confirmed with a biopsy. Samples are taken from the prostate gland to be tested in a lab.
A prostate biopsy is done with a core needle. A needle is placed into the prostate to remove tissue. The needle may be guided by imaging such as an MRI scan or ultrasound. This will improve accuracy. This test is mainly done during a transrectal ultrasound.
During the test, a pathologist will look for signs of cancer in the samples. There are many ways to find the type of prostate cancer based on what is seen.
In some cases, a biopsy may show abnormal changes in prostate cells. These cells are not cancerous, don't cause symptoms, or need to be treated. High grade prostatic intraepithelial neoplasia (HGPIN) raises the risk that prostate cancer may grow. Although it doesn't need to be treated, men with HGPIN are watched for any changes. Another biopsy may be needed to test different parts of the prostate to see if HGPIN or cancer is found.
Staging of Prostate Cancer
If prostate cancer is found, results from finished tests and new tests will help find out what stage it's in. The stage is based on how the tumor looks like during testing. It will help your doctors come up with ways to treat it. The stage of cancer is based on where the tumor is and how far it’s spread.
Tests that may help with cancer stage are:
- Blood tests to look for certain blood cells, proteins, indications of cancer, and abnormal cells. The tests can also see how your liver and kidneys are working.
- Imaging tests—To find how deep the cancer has spread in prostate tissue. It will also look for growths in the lymph nodes or nearby structures. They may also help to find cancer in other parts of the body. Some tests use contrast material to highlight structures. This makes them easier to see. These may be:
- Lymph node biopsy—Cancer cells can drain from the tumor site into nearby lymph nodes. From here, they can travel in 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—A lab will closely check the tissue that has cancer. This helps with finding the best way to treat the cancer. The lab will also look for problems in the genes that may make certain types that resist certain kinds of treatment.
Prostate cancer is staged from 1-4:
- Stage 1—Cancer is found only in the prostate gland.
- Stage 2—Cancer is still in the prostate gland, but is more advanced than Stage 1.
- Stage 3—Cancer has spread outside of the prostate gland and MAY be found in the nearby seminal vesicles.
- Stage 4—Cancer has spread outside of the seminal vesicles. The most common sites for prostate cancer that's spread are the lymph nodes, organs in the pelvis, and the bones.
Prostate cancer can be graded based on a Gleason score. The grade depends on how much the cancer cells look like normal prostate cells when tested in a lab. Gleason scores are graded from 1-5. Grade 1 cancer mainly looks normal, while grade 5 cancer mainly look abnormal. Most cancers are grade 3 or higher. As with staging, a Gleason score can help with planning treatment.