Prostate Cancer Tests & Diagnosis
What Tests Are Needed to Confirm Your Cancer?
After age 45, testing for prostate cancer should be part of a routine annual examination by your primary care doctor. If you are African-American or have family members diagnosed with prostate cancer, begin testing at age 40, as you have an increased risk for prostate cancer. To learn about other factors that can increase your chances of prostate cancer, check out our page on Prostate Cancer Risk Factors.
The standard screen test or early detection tests for prostate cancer are the Digital Rectal Exam, DRE, combined with the PSA Test. The DRE is physical test performed by your physician, while the PSA test requires a blood draw. PSA is a protein created by prostate and found in the blood. To learn more about PSA, check out our page on Prostate Specific Antigen - PSA. Abnormal results in either the DRE or PSA test will typically require additional testing.
Prostate Cancer Screen Tests
Your physician will determine if you may have prostate cancer by ordering or performing the following tests, DRE and PSA blood test. If there is nothing abnormal noted during the DRE and PSA levels are found to be normal, typically, no other tests are performed and the patient has passed the screen for prostate cancer.
DRE Digital Rectal Exam
What is it?:
Doctor inserts a gloved and lubricated finger into the rectum.
Why?
Allows the doctor to feel the back portion of the prostate gland for size, and any irregular or firm areas.
Additional Information
It is not accurate at detecting prostate cancer that is situated deep within the gland or is very small. For this reason, the DRE test is usually augmented with the PSA Blood Test.
Prostate Specific Antigen (PSA)
What is it?:
Blood test to determine if PSA levels are within the normal range.
Why?
Growth of prostate cancer cells as well as other conditions (benign enlargement of the prostate (BPH) or inflammation/infection or prostatitis) can cause anelevation of the PSA level in the blood.
Additional Information
Men can be diagnosed with prostate cancer even with a PSA in the normal range. In one large study, about 15% of men diagnosed with prostate cancer did indeed have a PSA in the normal range. To learn more about PSA, select Prostate Cancer , then PSA from the drop down menu.
Is PSA Screening Really Necessary?
Prostate cancer screening became controversial in 2012 when the United States Preventative Task Force (USPSTF) recommended against routine PSA-based screening. This recommendation was based on a flawed study and there still remains much disagreement within the medical community regarding the merits of screening. Many professional medical societies, including the American Cancer Society and American Urologic Association still recommend some form of prostate cancer screening. Patients should discuss with their doctors the merits and drawbacks to screening.
The American Cancer Society recommends annual screening for men whose PSA level is 2.5 ng/mL or higher.
Prostate Cancer Tests after Failed Screen
If your prostate cancer screen test failed, it is typically due to a elevated PSA level, or something abnormal in the DRE. This could be caused by an an infection, enlarged prostate, or prostate cancer. To narrow this list down your physician is likely to order the following tests.
Transrectal Ultrasound (TRUS)
What is it?:
A specific ultrasound test that uses a probe inserted into the rectum to visualize the prostate gland.
Why?
Used to measure the size of the gland, detect anatomic variations and sometimes detect abnormal tissue.
Additional Information
Needle biopsies of the prostate are usually done under TRUS guidance. Typically, a urologist performs these procedures in the office by placing the patient on his side and inserting the ultrasound probe into the rectum. Needles are pushed alongside the ultrasound probe through the rectal wall and into the prostate to sample the tissue. Usually 10-12 biopsies are taken covering the entire gland.
Prostate Biopsy
What is it?:
A prostate gland biopsy is a test to remove small samples of prostate tissue to be examined under a microscope. Needle biopsies of the prostate are usually done under TRUS guidance.
Why?
Based on the above mentioned screening tests, a biopsy may be recommended.
Additional Information
Urologist usually performs these procedures in the office. Usually 10-12 biopsies are taken covering the entire gland.
Percent-Free PSA Ratio
What is it?:
Blood test that compares the amount of PSA bound to proteins in the blood to the amount of PSA that circulates by itself (unbound).
Why?
When the percent-free PSA ratio is found to be 22% or less, prostate cancer is more likely to be present.
Additional Information
This test can be useful when the standard PSA test is at or just over the high end of the normal range.
PCA3Plus®
What is it?:
Doctor performs a digital rectal exam and massages the prostate to induce the shedding of prostate cells into the urine. A urine sample is collected and sent to a laboratory to obtain a PCA3 score.
Why?
Test detects a specific gene called PCA3, which is highly expressed in prostate cancer cells.
Additional Information
The higher the score, the more likely a biopsy will be positive for prostate cancer.
Prostate Cancer Test once Cancer has been Found
Each of the tests below will assist your physician in determining the stage and spread of cancer, once it has been found. It is important to determine the progression of the cancer. Has the remained within the prostate or spread beyond the prostate? These tests determine if the diagnosis will place the patient into the low, intermediate or high risk group. The risk group designation is imperative in building the treatment plan.
Bone Scan
What is it?:
A nuclear medicine test in which a small amount of radioactive material is injected into the blood.
Why?
Test provides images of the bones which can show areas of increased uptake of the radioactive material suggesting the presence of cancer.
Additional Information
The patient lies on a table that slides underneath a scanner which detects the radioactive material.
CAT Scan (Computerized Axial Tomography)
What is it?:
A detailed x-ray that can show both bones and soft tissue of the body.
Why?
Often used to look for enlarged lymph nodes in the pelvis which may indicate the spread of cancer outside of the prostate.
Additional Information
The patient lies on a table which slides through a donut shaped scanner which directs x-rays through the body from many different angles. An iodine-based dye may be injected into a vein to help organs or tissues show up more clearly.
MRI Scan (Magnetic Resonance Imaging)
What is it?:
A MRI scan uses a very strong magnet, radio waves, and a computer to make very detailed images of areas inside the body. A device called an endorectal coil, which is placed inside the rectum just before the scan, can be used to give very detailed images of the prostate and the immediate surrounding tissue.
Why?
Can be very helpful in determining if cancer has extended outside the prostate and into adjacent organs or tissues. Newer techniques such as diffusion weighting and dynamic contrast enhancement provide even more detail within and around the prostate. MRI images can be fused with real-time ultrasound images to more accurately direct biopsy needles at areas suspicious for cancer within the prostate.
Additional Information
The patient lies on a table which slides through a tube shaped scanner which applies a magnetic field across the body. Newer techniques such as diffusion weighting and dynamic contrast enhancement provide even more detail within and around the prostate. These newer techniques are also being used to help improve the accuracy of prostate biopsies since prostate cancer is not well visualized within the prostate with ultrasound imaging.
Sodium Fluoride PET Scan
What is it?:
A nuclear medicine test similar to a bone scan (above) using a radioactive dye called 18F-sodium fluoride.
Why?
Test can be used if findings on bone scan are negative, but there is still a high suspicion of spread of prostate cancer to the bones.
Additional Information
The process for obtaining the test is similar to a bone scan, but this test more sensitive with shorter uptake and scan times.
LEARN TO FIGHT PROSTATE CANCER.
Top Ten Steps in Your Fight Against Prostate Cancer
Learn the Top Ten Steps, a guide through knowledge about the prostate, prostate cancer, diagnosis and treatment. Watch our video, introducing Edward Weber, MD. and hear his advice to men just diagnosed with prostate cancer. Expert advice for your fight against Prostate Cancer.
Remission versus Recurrence?
Relapse of prostate cancer is way more common than you might think. Many men treated for prostate cancer have their cancer return, which can lead to a lifetime of treatment. Prostate Cancer Free studies treatment outcomes documented in "The STUDY", recently updated for 2021. Take this Study to your doctor, and discuss your chance of cancer recurrence. The Study is available with the new, just released booklet, to help you learn about prostate cancer. Both the Prostate Cancer Free Study and the booklet, “What You Need to Know About Prostate Cancer” are available NOW for you to VIEW, PRINT or DOWNLOAD.
Help To Continue the Work!
The Prostate Cancer Free Foundation, reviews the results of hundreds of thousands of men treated for prostate cancer. Tracking them for years. This information is available to you, and others like you, to help find the best prostate cancer treatment. This work takes time, effort, resources all of it done by volunteers. Please help us continue. Please Donate!