Prostate Screening

Prostate screening tests might include:

  • Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape, or size of your gland, you may need more tests.
  • Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that’s naturally produced by your prostate gland. It’s normal for a small amount of PSA to be in your bloodstream. However, if a higher-than-normal level is found, it may be an indication of prostate infection, inflammation, enlargement, or cancer.
  • Prostate-specific antigen (PSA) test + Digital rectal exam (DRE). PSA testing combined with DRE helps identify prostate cancer in its early stage.

Diagnosing Prostate Cancer

If an abnormality is detected on a DRE or PSA test, your doctor may recommend additional tests such as:

  • Ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to create a picture of your prostate gland.
  • Collecting a sample of prostate tissue. If initial test results suggest prostate cancer, your doctor may recommend a procedure to collect a sample of cells from your prostate, a procedure known as a prostate biopsy. Prostate biopsy is often done by inserting a thin needle into the prostate to collect tissue. The tissue sample is analyzed in a lab to determine the presence or absence of cancer cells.

Determining Whether Prostate Cancer is Aggressive

When a biopsy confirms the presence of cancer, the next step is to determine the level of aggressiveness (grade) of the cancer cells. In a laboratory, a pathologist examines a sample of your cancer to determine how much cancer cells differ from the healthy cells. A higher grade indicates a more aggressive cancer, which is more likely to spread quickly.

The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Scoring combines two numbers and can range from 2 (non-aggressive cancer) to 10 (very aggressive cancer).

Determining How Far the Cancer has Spread

Once a prostate cancer diagnosis has been made, your doctor works to determine the extent (stage) of the cancer. If your doctor suspects your cancer has spread beyond your prostate, your doctor may recommend the following imaging tests:

  • Bone scan
  • Ultrasound
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET) scan

Not every person should have every test. Your doctor will help determine which tests are best for your individual case.

Once testing is complete, your doctor assigns your cancer a stage to determine treatment options. The stages of prostate cancer are listed below:

  • Stage I. Cancer at this stage signifies an early stage of cancer confined to a small area of the prostate. When viewed under a microscope, the cancer cells are not considered aggressive.
  • Stage II. Cancer at this stage may still be small but may be considered aggressive when cancer cells are viewed under the microscope. However, cancer at this stage may be larger and may involve both sides of the prostate gland.
  • Stage III. Cancer at this stage has spread beyond the prostate to the seminal vesicles or other nearby tissues.
  • Stage IV. Cancer at this stage has spread to numerous areas of the body such as lymph nodes, bones, and organs.