Prostate cancer - Tests and diagnosis

Routine screening

Different countries have different approaches to prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. screening. Some have routine screening, some screen those at risk and some do not screen at all.

See the hot topic feature, PSA screening debate to learn more about the pros and cons of routine screening.

If you are concerned about your symptoms, see Symptoms and signs.

What do doctors check first?

Your doctor will first ask you whether you have any symptoms and may also talk to you about your family's medical history for prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

Your doctor will then examine you and offer you some tests, which will include:

  • A digital rectal examination (DREDigital rectal examination, physical examination that involves inserting a finger into the patient’s rectum, their back passage.), where your doctor will feel the prostate glandAn organ with the ability to make and secrete certain fluids. from inside your rectum with a gloved finger


    Interactive illustration explaining the digital rectal examination

  • A urine test to check for infectionInvasion by organisms that may be harmful, for example bacteria or parasites.
  • A bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. test to measure prostate specific antigenA substance that prompts the immune system to fight infection with antibodies. (PSA) - the PSA test.  Your doctor should talk to you about the pros and cons of having the PSA bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. test - see the hot topic feature, The PSA screening debate.

Remember, these tests are used to help your doctor decide whether more tests are necessary.

Sometimes, the following initial tests may also be recommended:

  • A urine flow test to measure the volume and speed of your urine flow
  • An ultrasound scan to check how much urine your bladderThe organ that stores urine. holds and whether it empties properly.

Your PSA bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. test will be analysed. Sometimes there is a wait for the results to come back and you may be asked to make another appointment.

If the prostate glandAn organ with the ability to make and secrete certain fluids. feels normal during the DREDigital rectal examination, physical examination that involves inserting a finger into the patient’s rectum, their back passage., cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is less likely, even if the PSA level is abnormal.

If the prostate glandAn organ with the ability to make and secrete certain fluids. feels abnormal during the DREDigital rectal examination, physical examination that involves inserting a finger into the patient’s rectum, their back passage., and the PSA level is also abnormal, the risk of prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is higher.

If your doctor is concerned about your PSA level, findings from the DREDigital rectal examination, physical examination that involves inserting a finger into the patient’s rectum, their back passage. or the problems you are having, you may be referred to a specialist for secondary tests.

Learn more about the initial tests introduced above

David, Rawle and Ray describe the tests they had for prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.

What are the secondary tests?

Based on the results of your initial tests, your doctor might decide that you need further tests. Depending on your symptoms, you may be referred to a specialist straight away.

Your doctor will refer you to a hospital, where you will be seen by a specialist or consultant with particular experience in diagnosing prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., often called a urologist.

The urologist will look at the results of your initial tests, examine you again and may want to repeat the PSA test and the DREDigital rectal examination, physical examination that involves inserting a finger into the patient’s rectum, their back passage.. In some countries you may also be offered a PCA3 test, a new geneThe basic unit of genetic material carried on chromosomes.-based urine test that is hoped will be a more reliable test than the PSA test.

After this, you are most likely to have a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. of the prostate. The most common way of doing this is a procedure called transrectal ultrasound (TRUS) with biopsy.

This is very useful in diagnosing prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. and can also tell your doctors a great deal about the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. itself, which is very important for deciding treatment options.

Interactive illustration of the TRUS with biopsy procedure
Interactive illustration of the TRUS with biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. procedure

Depending on the results of the biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself., other tests may also be recommended.

These may include:

  • CTA scan that generates a series of cross-sectional X-ray images. scan
  • MRIAn abbreviation for magnetic resonance imaging, a technique for imaging the body that uses electromagnetic waves and a strong magnetic field. scan
  • X-rays
  • Bone scan.

Trained professionals carry out all of these tests. You may like to talk to them about what they are looking for, although the technicians will not be able to discuss the results with you there and then.

Find out about each test, including how it might make you feel and what you can do to prepare yourself. It usually helps to know in advance what is going to happen.

Following these tests, you may have to wait a while for the results to come back. This is because the information needs to be looked at by a team of different specialists (a urologist, a radiologist, an oncologist, a pathologist and a specialist nurse). You may be asked to make another appointment at the hospital or with your doctor to get the results of the tests in person. You may also have more contact with this team if you need treatment, which you can learn more about it in the Choosing treatments section.

Learn more about the further tests introduced above