Prostate Cancer Tests & Diagnosis

Tests that Confirm
Prostate 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. Click on the Tabs below to expand the sections outlining additional testing. see table below.

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. Click on the Tabs below to expand the sections outlining additional testing. see table below.

Prostate Cancer Screen Tests

Your physician will determine if you may have prostate cancer by ordering the following tests:

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 an elevation 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. Learn more about PSA testing here.

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 Test after Failed Screen

If your prostate is enlarged and /or PSA levels are high, 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 Intermediate to High Risk

Each of the tests below will assist your physician in determining if cancer has spread outside the prostate:

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.

Advice for Men Diagnosed with Prostate Cancer

Edward Weber, M.D. offers advice For Patients of Prostate Cancer. It is important to be informed, but you do not need to do this alone. That is what the specialists are there for. This is the time for deliberation, since once treated you cannot reverse the course. Watch this video to learn more.

  UNDERSTAND PROSTATE CANCER.

Prostate Cancer

What is Prostate Cancer?

What is Prostate Cancer, the Symptoms, Risk Factors? What does the Prostate do, where is it located?

Prostate Cancer Treatments

Prostate Cancer Risk Groups

PSA, Gleason Score and Stage, match patients with appropriate treatment choices. What is your Risk Group?

Prostate Cancer Treatments

Treating Prostate Cancer.

Patients have options when it comes to the prostate cancer treatments. Learn about your options.

Help other men make better treatment decisions.

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