Prostate Cancer Diagnosis

A prostate cancer diagnosis involves several tests. The findings determine the stage of the disease, how aggressive it is, and whether it’s likely to spread.

About 13 out of every 100 American men will develop prostate cancer, according to the Centers for Disease Control and Prevention (CDC). While two to three of these men will die from the disease, prostate cancer screening and diagnosis can go a long way in finding the malignancy in its most treatable stage.

What’s more, a prostate cancer diagnosis doesn’t necessarily mean you face aggressive treatment, or even any treatment at all. Depending on the stage of the disease, some men can opt for “watchful waiting,” meaning no treatment is necessary unless check-ups with your oncologist reveal a slow growing prostate cancer is significantly increasing in size or spreading.

However, doctors don’t guess about whether a man has prostate cancer — the disease doesn’t always cause symptoms — or what stage it may be in. Instead, specific findings on an exam and from several tests indicate whether you will need a biopsy to definitively check for prostate cancer.

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The steps in making a prostate cancer diagnosis

The majority of prostate cancer diagnoses are found as a result of screening for the disease, although advanced prostate cancers are sometimes diagnosed because of symptoms, including difficulty urinating, that bring a man to his doctor’s office, the American Cancer Society explains.

The patient and his doctor should decide whether a man needs regular screenings, taking an individual’s risks for prostate cancer into consideration. The most common risk factor for developing the disease is getting older, according to the Centers for Disease Control and Prevention (CDC). Depending on your age (especially if you are over 50) and other factors that increase your odds for developing prostate cancer (including a family history of the disease and being African American), your family doctor or internist may recommend prostate cancer screening.

The first step in making a prostate cancer diagnosis, or ruling out the malignancy, involves a physical exam to check general health and look for any lumps or other unusual symptoms. A careful history of health habits and a man’s personal and family medical history should be discussed, too, The National Cancer Institute explains.

Tests used to check for prostate cancer

• Digital rectal exam (DRE): Your doctor inserts a lubricated, gloved finger into your rectum to feel through the rectal wall for lumps or other abnormalities in your prostate.
• PSA test: Prostate-specific antigen (PSA) is a substance made in the prostate, which is often, but not always, higher than normal in the blood of men who have prostate cancer. Other non-cancerous problems, such as inflammation or infection of the prostate gland, or BPH (benign prostatic hyperplasia), an enlarged but non-cancerous prostate gland) can also raise PSA levels.
• Transrectal ultrasound: A finger-sized probe is inserted into the rectum to bounce high-energy sound waves (ultrasound) off internal tissues. The resulting echoes form a sonogram, a picture of body tissues in and around your prostate.
• Transrectal magnetic resonance imaging (MRI): A probe that gives off radio waves is placed in the rectum, close to the prostate, to facilitate clear MRI pictures of the prostate and nearby tissues. A transrectal MRI is used to search for cancer that may have spread outside your prostate.

Bottom line? Only a biopsy can determine a prostate cancer diagnosis

If the results of the tests above suggest you may have cancer of the prostate, a biopsy is usually performed next. It’s the only way to make a positive diagnosis. Small samples of the prostate are removed by a urologist, via a core noodle biopsy, after the area near the prostate is numbed with a local anesthetic. Around 12 samples are taken from different parts of the prostate and sent to a lab and examined with a microscope.

The pathology report is positive for prostate cancer if cancer cells were found in the sample and negative if no cancer cells were spotted. The biopsy might also reveal findings that are abnormal and suspicious, but not definitely cancer.

Doctors use the Gleason score system to assign a grade between two and 10 to a prostate cancer diagnosis, based on the biopsy results. A lower number indicates the cancer cells look more like normal cells and are likely to grow and spread very slowly compared to the higher score.

Next, using results of diagnostic test including the PSA level and Gleason grade, the prostate cancer diagnosis is put into one of four stages — ranging from the most localized disease to at stage I to significantly spreading disease in stage IV; there are also different sub-categories in these stages.

All of this information, combined with any additional testing for cancer that has metastasized, is used to plan the best treatment based on an individual’s prostate cancer diagnosis.

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