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.
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:
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.
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.
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 cancers.
Genomic testing is also being used. It looks at genes to better understand risk of a cancer.
Tests that may help with cancer stage are:
Prostate cancer is staged from 1-4:
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 Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114483/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 Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T905769/Prostate-cancer-...ging-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 2019 by EBSCO Medical Review Board Nicole Meregian, PA
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.