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Prostate cancer testingYour doctor can check for prostate cancer before you have any symptoms. During an office visit, your doctor will ask about your personal and family medical history. You will have a physical exam as well.

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Your physician may perform
one or both of the following tests:

1. Digital rectal exam (DRE)

Your doctor inserts a lubricated, gloved finger into the rectum and feels your prostate through the rectal wall. The test lasts about 10-15 seconds.

This exam checks for:

  • The size, firmness, and texture of the prostate
  • Any hard areas, lumps, or growth spreading beyond the prostate
  • Any pain caused by touching or pressing the prostate

The DRE allows the doctor to feel only one side of the prostate. A PSA test is another way to help your doctor check your prostate.

2. Blood test for prostate-specific antigen (PSA)

A lab checks the level of PSA in your blood sample. The prostate makes PSA, a protein made by normal cells and prostate cancer cells. It is found in the blood and can be measured with a blood test. PSA tests are often used to follow men after prostate cancer treatment. PSA testing is still being studied to see if finding cancer early lowers the risk of dying from prostate cancer.

PSA levels can rise if a man has prostate cancer, but a high PSA is not proof of cancer. Other things can also make PSA levels go up. These may give a false positive test result. These include having BPH or prostatitis (inflammation of the prostate), or if the prostate gland is disturbed in any way (riding a bicycle or motorcycle, a DRE, orgasm within the past 24 hours, and prostate biopsy or surgery can disturb the prostate). Also, some prostate glands naturally produce more PSA than others. PSA levels go up with age. African-American men tend to have higher PSA levels in general than men of other races.

The digital rectal exam and PSA test can detect a problem in the prostate. However, they cannot show whether the problem is cancer or a less serious condition. If you have abnormal test results, your doctor may suggest other tests to make a diagnosis. For example, your visit may include other lab tests, such as a urine test to check for blood or infection.

Abnormal Test Results

For abnormal, your doctor may order other procedures:

Transrectal ultrasound:
The doctor inserts a probe into the rectum to check your prostate for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.

Transrectal biopsy:
A biopsy is the removal of tissue to look for cancer cells. It’s the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.

Questions to ask before having a transrectal ultrasound or biopsy:

  • Where will the procedure take place? Will I have to go to the hospital?
  • How long will it take? Will I be awake?
  • Will it hurt? Will I need local anesthesia?
  • What are the risks? What are the chances of infection or bleeding afterward?
  • How do I prepare for it? Will I need to avoid taking aspirin to reduce the chance of bleeding? Will I need an enema before the procedure?
  • How long will it take me to recover? Will I be given an antibiotic or other medicine afterward?
  • How soon will I know the results? If a biopsy is done, will I get a copy of the pathology report?
  • If I do have cancer, who will talk to me about the next steps? When?

If Cancer Is Not Found

If cancer cells are not found in the biopsy sample, ask your doctor how often you should have checkups.

If Cancer Is Found

If cancer cells are found, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow.

Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with your age and other factors to suggest treatment options.

One system of grading is with the Gleason score. Gleason scores range from 2 to 10. To come up with the Gleason score, the pathologist uses a microscope to look at the patterns of cells in the prostate tissue. The most common pattern is given a grade of 1 (most like normal cells) to 5 (most abnormal). If there is a second most common pattern, the pathologist gives it a grade of 1 to 5, and adds the two most common grades together to make the Gleason score. If only one pattern is seen, the pathologist counts it twice. For example, 5 + 5 = 10. A high Gleason score (such as 10) means a high-grade prostate tumor. High-grade tumors are more likely than low-grade tumors to grow quickly and spread.

If the biopsy shows that you have cancer, read Stages of Prostate Cancer to help choose the best treatment.

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Source: National Cancer Institute

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