Diagnosing Prostate Cancer

Diagnosing prostate cancer can involve a number of different exams and tests that help to identify the disease. In its early stages, this cancer rarely produces noticable symptoms. Therefore, a lot of early prostate cancer diagnosis is made by routine screening tests that are performed in men as they get older.

Prostate Cancer Screening Tests

Digital Rectal Exam (DRE): The digital rectal exam is part of the physical examination. Your doctor uses a finger to examine the anus and end part of the rectum manually. Because the prostate sits just anterior to the anus and rectum, its posterior surface can be felt in this manner. An experienced physician can detect changes in size, shape and consistency of the prostate gland. Although other diseases can cause enlargement of the prostate, many prostate cancers can be detected with this method. If an abnormality is detected, it usually leads to further testing and biopsy to determine if cancer is present (see below).

Prostate Specific Antigen (PSA) Testing: PSA is a protein that is produced in the prostate gland. Normally, the levels of PSA in the blood are low. However, some conditions, including benign prostatic hypertrophy, inflammation and prostate cancer, can lead to higher levels of PSA in the blood. This is a blood test that is done as a screening test in diagnosing prostate cancer. If it is positive for an elevated PSA, further testing to identify the underlying cause and diagnosing prostate cancer may be indicated.

Further Testing to Confirm or Work-Up a Prostate Cancer Diagnosis

Biopsy: One of the most important tests for diagnosing prostate cancer is a biopsy of the prostate gland. This test, which can be performed by a few different methods either in the outpatient clinic or during surgery, attempts to isolate cancerous cells to make the diagnosis of prostate cancer. It can also help with the grading of the cancer. The biopsy may be performed with ultrasound guidance which can help identify abnormal appearing portions of the prostate gland which should be biopsied.

Tumor Work-Up and Staging: Once a biopsy has confirmed the presence of cancer, there are various tests which may be used to help determine the extent of tumor growth and invasion in the body. In particular, many of the tests look for evidence of spread of the cancer beyond the prostate gland into surrounding tissues or to distal tissues such as to lymph nodes or to the bone. Common staging tests include a bone scan, chest x-ray, CT scans and MRI scans.

Surgery: Treatment for prostate cancer may include surgery in many cases. Which part of the goal of this surgery is to remove the cancer itself, it is also a part of the staging of prostate cancer. At the time of surgery, lymph nodes may be sampled in the area to look for spread of cancer to the lymph nodes. If other testing (bone scan, CT, MRI, etc.) clearly indicated that the cancer has spread outside the prostate, lymph node biopsy may not be indicated.