If symptoms of prostate cancer occur, the doctor asks about the patient's medical history, performs a physical exam, and may order laboratory tests. These exams and tests may be used for prostate cancer diagnosis:
Digital rectal exam - the doctor inserts a gloved, lubricated finger into the rectum and feels the prostate through the rectal wall to check for hard or lumpy areas.
Blood tests - a lab measures the levels of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) in the blood. The level of PSA in the blood may rise in men who have prostate cancer, BPH, or an infection in the prostate. The level of PAP rises above normal in many prostate cancer patients, especially if the cancer has spread beyond the prostate. The doctor cannot diagnose prostate cancer with these tests alone because elevated PSA or PAP levels may also indicate other, noncancerous problems. However, the doctor will take the results of these tests into account in deciding whether to check the patient further for signs of cancer.
Urine test - a lab checks the urine for blood or infection.
The doctor may order other tests to learn more about the cause of the symptoms and to help determine whether conditions of the prostate are benign or malignant, such as:
Transrectal ultrasonography - sound waves that cannot be heard by humans (ultrasound) are sent out by a probe inserted into the rectum. The waves bounce off the prostate, and a computer uses the echoes to create a picture called a sonogram.
Intravenous pyelogram - a series of x-rays of the organs of the urinary tract.
Cystoscopy - a procedure in which a doctor looks into the urethra and bladder through a thin, lighted tube.
If test results suggest that prostate cancer may be present, the patient will need to have a biopsy. A biopsy is the only sure way to know whether a problem is cancer. During a biopsy, the doctor removes a small amount of prostate tissue, usually with a needle. A pathologist looks at the tissue under a microscope to check for cancer cells. If a prostate cancer diagnosis is made, the pathologist usually reports the grade of the tumor. The grade tells how closely the tumor resembles normal prostate tissue and suggests how fast the tumor is likely to grow. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. Tumors with lower scores are less likely to grow or spread than tumors with higher scores.
If the physical exam and test results do not suggest cancer, the doctor may recommend medicine to reduce the symptoms caused by an enlarged prostate. Surgery is another way to relieve these symptoms. The surgery used in such cases is transurethral resection of the prostate (TURP or TUR). In TURP, an instrument is inserted through the penis to remove prostate tissue that is pressing against the upper part of the urethra.
For more information on prostate cancer diagnosis, visit Cancer Treatment Centers of America's website.