How Is Prostate Cancer Diagnosed?
Reviewed by: HU Medical Review Board | Last reviewed: October 2017 | Last updated: February 2022
Screening and early detection of prostate cancer
Screening involves checking for a condition when the individual screened may not currently have symptoms for the condition. Screening, in many instances, is used to detect for the presence of a specific condition early, when, if discovered, treatment can be more effective and decrease the chance of serious health complications or even death.1
Perhaps one of the more troubling characteristics of prostate cancer is that common signs and symptoms of the condition typically do not appear until the cancer has grown substantially, or has progressed beyond the prostate. The most effective ways to catch prostate cancer early on are to visit your doctor regularly to discuss your risk of developing prostate cancer, as well as to determine what screening options may be appropriate for you. These screening tests may include prostate-specific antigen (PSA) test or a digital rectal exam (DRE). If your doctor suspects that you may have prostate cancer, they may recommend that you receive a prostate biopsy or have imaging tests done such as MRI, CT, or ultrasound images.2
History and physical exam
If you or your doctor have concerns that you may have prostate cancer, or think you should be screened for prostate cancer, the first step in the process is investigating your personal history and performing a physical exam. Even if your doctor does not mention prostate cancer or prostate cancer screening during an appointment, you can initiate the conversation yourself. Regardless of whether or not you’re examined at a regular well visit or if you make a separate appointment to address your concerns, the history and physical exam portion of the process will be the same. Your doctor will talk with you about any symptoms you might be experiencing, risk factors you may possess, and perform a digital rectal exam (DRE).
Diagnostic tests and procedures
There are a variety of different diagnostic tests and imaging techniques and procedures that can be used to determine if an individual has prostate cancer and how far their prostate cancer may have spread, if at all. Your doctor will help you determine which, if any, of these options you may need, and how to prepare for them. Not all diagnostic measures can provide a completely clear idea of what an individual’s cancer may look like, so oftentimes, many of these are used in combination with one another. Common diagnostic tests and procedures include transrectal ultrasound (TURP), prostate biopsy (also called core needle biopsy with ultrasound guidance), and pelvic lymph node biopsy.
If you have a confirmed case of prostate cancer and your doctor is concerned that it may have spread beyond the prostate, they may order imaging tests of other areas of the body. These imaging tests may also be used to determine the effectiveness of treatment or to determine if a cancer has recurred. Common tests for cancer spread include bone scans, CT scans, PET-CT scans, and MRI. This is not an exhaustive list of all diagnostic tests and procedures. Your doctor will help you determine which options are right for you, and what the tests are specifically looking for.3
Understanding your test results
If you undergo a prostate biopsy, a pathologist will study the prostate tissue collected from each sample removed. These samples are referred to as cores and there are approximately 10-12 cores removed during each biopsy. The pathologist creates a report based on what they see in each core. Each core is studied under a microscope to see if there are cancer cells. If prostate cancer is found, it will be assigned a Gleason score based on the individual Gleason grade of cancer cells found in each core. Other non-cancerous or pre-cancerous findings may be reported on your pathology report as well. Your doctor will help you understand your pathology report and explain any other concerns that are present.4
Staging and TNM system
During diagnosis your prostate cancer may be assigned a stage. These stages are determined by a variety of information, including imaging results, prostate biopsy reports, PSA levels, and more. Prostate cancer is generally assigned a stage from I to IV (1 to 4), with I being less advanced and IV being more advanced. In order to determine your stage, you will be assigned into different TNM categories. TNM categories were created by the American Joint Committee on Cancer (AJCC). These categories classify your case of prostate cancer based on the extent of the primary tumor found (T category), whether or not your cancer has spread to local lymph nodes (N category), and whether or not your cancer has spread to different parts of your body, also known as metastasis (M category). These categories and stages will help determine how your cancer may behave and what treatment options might be right for you.5,6