Health history and current symptoms
Digital rectal exam (DRE)
Prostate-specific antigen test (PSA test)
What do PSA results mean?
Prostate biopsy
Deciding about repeat biopsy
If a biopsy is positive

These types of tests are most often used to check the prostate:

Health history and current symptoms

This first step lets your doctor hear and understand the "story" of your prostate concerns. You'll be asked about whether you have symptoms, how long you've had them, and how much they affect your lifestyle. Your health history also includes any risk factors, pain, fever, or trouble passing urine. You may be asked to give a urine sample for testing.

Digital rectal exam

DRE is the standard way to check the prostate. With a gloved and lubricated finger, your doctor feels the prostate from the rectum. The test lasts about 10-15 seconds.

This exam checks for:

• The size, firmness, and texture of the prostate
• Any hard areas, lumps, or growth spreading beyond the prostate
• Any pain caused by touching or pressing the prostate

The DRE allows the doctor to feel only one side of the prostate. A PSA test is another way to help your doctor check your prostate.

PSA (Prostate-Specific Antigen) test

PSA is a protein made by normal cells and prostate cancer cells. It is found in the blood and can be measured with a blood test. PSA tests are often used to follow men after prostate cancer treatment. PSA testing is still being studied to see if finding cancer early lowers the risk of dying from prostate cancer.

PSA levels can rise if a man has prostate cancer, but a high PSA is not proof of cancer. Other things can also make PSA levels go up. These may give a false positive test result. These include having BPH or prostatitis, or if the prostate gland is disturbed in any way (riding a bicycle or motorcycle, a DRE, orgasm within the past 24 hours, and prostate biopsy or surgery can disturb the prostate). Also, some prostate glands naturally produce more PSA than others. PSA levels go up with age. African-American men tend to have higher PSA levels in general than men of other races.

Researchers are trying to find more answers about:

• The PSA test's ability to tell cancer from benign prostate problems
• The best thing to do if a man has a high PSA level

For now, men and their doctors use PSA readings over time as a guide to see if more follow-up is needed.

What do PSA results mean?

PSA levels are measured in terms of units per volume of fluid tested. Doctors often use a score of 4 nanograms (ng) or higher as the trigger for further tests, such as a prostate biopsy.

Your doctor may monitor your PSA velocity, which means looking at the rate of change in your PSA levels over time. Rapid increases in PSA readings can suggest cancer. If you have a mildly elevated PSA, you and your doctor may choose to check PSA levels on a scheduled basis and watch for any change in the PSA velocity.

Prostate biopsy

If your symptoms or test results suggest cancer, your doctor will refer you to a specialist (a urologist) for a prostate biopsy. A biopsy is usually done in the doctor's office.

For a biopsy, small tissue samples are taken directly from the prostate. Your doctor will take samples from several areas of the prostate gland. This can help lower the chance of missing any areas of the gland that may have cancer cells. Like other cancers, doctors can only diagnose prostate cancer by looking at tissue under a microscope.

Most men who have biopsies after routine exams do not have cancer.

Deciding about repeat biopsy

A test that can help your doctor decide if you need a repeat biopsy is called free PSA. This test is used for men who have higher PSA values. The test looks at a form of PSA in the blood. Free PSA is linked to BPH but not cancer.

Free PSA is figured as a percentage of the total PSA:

• If both total PSA and free PSA are higher than normal, this suggests BPH rather than cancer.
• If regular PSA is high but free PSA is not, cancer is more likely. More testing should be done.

Free PSA may help tell what kind of prostate problem you have. It can be a guide for you and your doctor to choose the right treatment. You and your doctor should talk about your personal risk and free PSA results. Then you can decide together whether to have follow-up biopsies and, if so, how often.

If a biopsy is positive

A positive biopsy means prostate cancer is present. A pathologist will check your biopsy sample for cancer cells and will give a Gleason score. The Gleason score ranges from 2 to 10 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is aggressive and may spread.

Treatment options depend on the stage (or extent) of the cancer (stages range from 1 to 4), Gleason score, PSA level, and your age and general health. These items will be available from your doctor and are listed on your pathology report.

Reaching a decision about treatment of your prostate cancer is a complex process. Many men find it helpful to talk with their doctors, family, friends, and other men who have faced similar decisions. There are many organizations that can provide more information and support to you, your partner, and family.

"While it's important to make your own decision about cancer screening, everybody should consider getting a second opinion before getting something like a biopsy."

It is a good idea to get a copy of your pathology report from your doctor and carry it with you as you talk with your health care providers.

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