Prostate Cancer

If a man has symptoms suspicious of prostate cancer, his doctor will review his medical history, perform a physical exam, and order tests to help make a diagnosis or to rule out other causes, such as an enlarged prostate (benign prostatic hyperplasia, BPH) or an infection.

The following tests and procedures may be used:

• Digital rectal exam: This test is used to detect abnormalities of the prostate. The doctor will insert a lubricated, gloved finger into the rectum and feel the prostate through the rectal wall.
• Prostate-specific antigen (PSA) test: This test measures the level of PSA in the blood. PSA levels can be increased in men who have prostate cancer. However, they can also be elevated in men with BPH or an infection. For this reason, a doctor may also order a urine test to check for an infection or additional blood tests.
• Transrectal ultrasound: This test uses high-energy sound waves to create a picture of internal tissues and organs. During the procedure, a thin, lighted tube (endoscope) is inserted into the rectum in order to view the prostate in more detail.
• Biopsy: If results of the tests performed thus far suggest the presence of cancer, a biopsy (the removal of a small amount of tissue or cells) is often performed. This is usually done by inserting a needle in the prostate gland through the rectum or through the skin in front of the rectum and removing a small sample.

A pathologist will examine the sample under a microscope to determine if cancer cells are present. If so, the pathologist will grade the cancer cells by how abnormal they look. A common grading system for prostate cancer is the Gleason system, which assigns a score between 2 and 10, based upon the appearance of the cells. The score suggests how fast a tumor is likely to grow and spread. The lower the number, the less likely this will happen.

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