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.
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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:
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.
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:
Prostate cancer is staged from 1-4:
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 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.
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Stages of prostate cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq#section/_120. Updated July 7, 2016. Accessed October 26, 2018.
Tests for prostate cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html. Updated May 15, 2017. Accessed October 26, 2018.
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 October 26, 2018.
7/17/2017 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T905769/Prostate-cancer-staging-and-imaging: 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 2018 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP Last Updated: 10/26/2018