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Detection and Diagnosis
If Cancer Is Not Found
If Cancer Is Found
Your doctor can check for prostate cancer before
you have any symptoms. During an office visit, your
doctor will ask about your personal and family medical
history. You'll have a physical exam. You may also
have one or both of the following tests:
The digital rectal exam and PSA test are being studied
in clinical trials to learn whether finding prostate
cancer early can lower the number of deaths from this
disease.
The digital rectal exam and PSA test can detect a
problem in the prostate. However, they can't show
whether the problem is cancer or a less serious
condition. If you have abnormal test results, your
doctor may suggest other tests to make a diagnosis. For
example, your visit may include other lab tests, such as
a urine test to check for blood or infection. Your doctor
may order other procedures:
- Transrectal ultrasound: The doctor inserts a probe
into the rectum to check your prostate for abnormal
areas. The probe sends out sound waves that people
cannot hear (ultrasound). The waves bounce off the
prostate. A computer uses the echoes to create a
picture called a sonogram.
- Transrectal biopsy: A biopsy is the removal of tissue
to look for cancer cells. It's the only sure way to
diagnose prostate cancer. The doctor inserts needles
through the rectum into the prostate. The doctor
removes small tissue samples (called cores) from
many areas of the prostate. Transrectal ultrasound is
usually used to guide the insertion of the needles. A
pathologist checks the tissue samples for cancer
cells.
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You may want to ask the doctor these
questions before having a transrectal ultrasound
or biopsy:
- Where will the procedure take place? Will I
have to go to the hospital?
- How long will it take? Will I be awake?
- Will it hurt? Will I need local anesthesia?
- What are the risks? What are the chances of
infection or bleeding afterward?
- How do I prepare for it? Will I need to avoid
taking aspirin to reduce the chance of
bleeding? Will I need an enema before the
procedure?
- How long will it take me to recover? Will I be
given an antibiotic or other medicine
afterward?
- How soon will I know the results? If a biopsy
is done, will I get a copy of the pathology
report?
- If I do have cancer, who will talk to me about
the next steps? When?
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If cancer cells are not found in the biopsy sample,
ask your doctor how often you should have checkups.
Information about BPH and other benign prostate
problems can be found in the NCI booklet
Understanding Prostate Changes: A Health Guide for
Men.
If cancer cells are found, the pathologist studies
tissue samples from the prostate under a microscope to
report the grade of the tumor. The grade tells how
much the tumor tissue differs from normal prostate
tissue. It suggests how fast the tumor is likely to grow.
Tumors with higher grades tend to grow faster than
those with lower grades. They are also more likely to
spread. Doctors use tumor grade along with your age
and other factors to suggest treatment options.
One system of grading is with the Gleason score.
Gleason scores range from 2 to 10. To come up with
the Gleason score, the pathologist uses a microscope to
look at the patterns of cells in the prostate tissue. The
most common pattern is given a grade of 1 (most like
normal cells) to 5 (most abnormal). If there is a second
most common pattern, the pathologist gives it a grade
of 1 to 5, and adds the two most common grades
together to make the Gleason score. If only one pattern
is seen, the pathologist counts it twice. For example,
5 + 5 = 10. A high Gleason score (such as 10) means a
high-grade prostate tumor. High-grade tumors are more
likely than low-grade tumors to grow quickly and
spread.
Another system of grading prostate cancer uses
grades 1 through 4 (G1 to G4). G4 is more likely than
G1, G2, or G3 to grow quickly and spread.
For more about tumor grade, see the NCI fact sheet
Tumor Grade: Questions and Answers.
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