Diagnosis of Prostate Cancer

Michael Jubinville, MPH

Your doctor will ask you about your symptoms and past health. A physical exam will be done which will include a brief exam of the prostate. This is done with a digital rectal exam (DRE). The doctor inserts a lubricated, gloved finger into the rectum. The prostate can be felt through the wall of the rectum.

Anatomy of the Prostate Gland

Suspicion of Prostate Cancer

More tests may be needed if the prostate feels abnormal or you have certain symptoms. The tests will show if cancer is present. Tests may include:

Blood tests —Cancer releases certain markers in the blood as it grows. Markers, such as prostate-specific antigen (PSA), may be higher if you have cancer.
Imaging tests —Can show increased size or shape of prostate and tumors. Common tests are:
- Transrectal ultrasound
- MRI scan

Diagnosis of Prostate Cancer

A biopsy may be done if early tests suggest prostate cancer. A biopsy is the removal of cells for testing. The tests will show if cancer cells are present.

High-grade Prostatic Intraepithelial Neoplasia (HGPIN)

A biopsy may show abnormal changes in prostate cells. These cells are not cancer. They don't cause symptoms, or need to be treated. However they do raise the risk that prostate cancer may grow. Men with HGPIN are watched for any changes. Another biopsy may be needed to test different parts of the prostate.

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.

Once cancer is found, the next step is to determine how aggressive the cancer is. This is called grade of the cancer cells. A sample of cancer cells will be looked at by a specialist. A higher grade means the cancer is more aggressive cancer. This also means it is more likely to spread quickly.

The most common scale used is called a Gleason score. Gleason scoring combines two numbers and can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer). Most Gleason scores used to assess prostate biopsy samples range from 6 to 10. A score of 6 is a low-grade prostate cancer. A score of 7 is a medium-grade prostate cancer. Scores from 8 to 10 is a high-grade cancer.

Genomic testing is also being used. It looks at genes to better understand risk of a cancer.

Staging Tests

Tests that may help with cancer stage are:

Blood tests to look for proteins, signs of cancer, and other 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 the 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:
- Pelvic MRI scan
- Abdominal and pelvic CT scan
- X-ray
- Bone scan
- PET scan
Lymph node biopsy—Cancer cells can drain from the tumor site into nearby lymph nodes. The cells can then travel to the bloodstream and other areas of the body. Lymph nodes may be checked if prostate tissue is removed, or if the nodes are swollen.
Seminal vesicle biopsy—A sample of fluid that makes up semen is taken. A needle is used to take the sample.
Tissue evaluation—A lab will closely check the tissue that has cancer. This help to find the best way to treat the cancer. The lab will also look for problems in the genes. It may mean that the cancer is resistant to certain kinds of treatment.

Stages of Prostate Cancer

Prostate cancer is staged from 1 to 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.

References

General information about prostate cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq. Updated October 12, 2018. Accessed December 11, 2019.

How is prostate cancer diagnosed? Urology Care Foundation website. Available at: https://www.urologyhealth.org/urologic-conditions/prostate-cancer/diagnosis. Updated January 2020. Accessed December 11, 2019.

Prostate cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/prostate-cancer. Updated October 16, 2018. Accessed December 11, 2019.

Stages of prostate cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq#section/_120. Updated June 12, 2019. Accessed December 11, 2019.

Tests for prostate cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html. Updated August 1, 2019. Accessed December 11, 2019.

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 December 11, 2019.

7/17/2017 DynaMed Systematic Literature Surveillance http://www.dynamed...: 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 2019 by EBSCO Medical Review Board Nicole Meregian, PA
Last Updated: 11/25/2020

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