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Diagnosis of Prostate Cancer

Authors:
  • Michael Jubinville, MPH
Publication Type:

Condition InDepth

Diagnosis of Prostate Cancer

The doctor will ask about symptoms and health history. A physical exam will be done. This will include checking the prostate with a digital rectal exam. The doctor inserts a lubricated, gloved finger into the rectum. The prostate can be felt through the rectum wall.

Anatomy of the Prostate Gland.

Copyright © 2002 Nucleus Communications, Inc. All rights reserved.

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Suspicion of Prostate Cancer

More tests may be needed if the prostate feels abnormal or there are 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 for people with cancer.
  • Imaging tests—Can show increased size or shape of prostate and tumors. Common tests are:

Suspicion of Prostate Cancer

More tests may be needed if the prostate feels abnormal or there are 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 for people with cancer.
  • Imaging tests—Can show increased size or shape of prostate and tumors. Common tests are:

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 do not cause symptoms or need to be treated. They do raise the risk that prostate cancer may grow. People with HGPIN are watched for any changes. Another biopsy may be needed to test different parts of the prostate.

Staging Prostate Cancer

If prostate cancer is found, results from different tests will help find out what stage it is in. The stage is based on how the tumor looks during testing. It will help doctors decide how to treat it. The stage of cancer is based on where the tumor is and how far it has 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 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 look at 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 the 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:
  • 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 helps to find the best way to treat the cancer. The lab will also look for problems in the genes. It may mean that certain kinds of treatment will not affect the cancer.

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 has spread are the lymph nodes, organs in the pelvis, and the bones.

References

  • Prostate cancer treatment. National Cancer Institute website. Available at: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq.
  • How is prostate cancer diagnosed? Urology Care Foundation website. Available at: https://www.urologyhealth.org/urologic-conditions/prostate-cancer#Diagnosis.
  • Prostate cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/prostate-cancer.
  • Stages of prostate cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq#_120.
  • Tests to diagnose and stage prostate cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html.
  • 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.
  • 7/17/2017 DynaMed Systematic Literature Surveillance http://www.dynamed.com/evaluation/prostate-cancer-diagnosis-and-staging: Coakley F.V., Oto A., et al. ACR Appropriateness Criteria for prostate cancer-pretreatment detection, surveillance, and staging. Available at: https://acsearch.acr.org/docs/69371/Narrative.

Contributors

  • Nicole S. Meregian, PA
Last Updated:
2022-02-01

(C) Copyright 2022 EBSCO Information Services

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.