Diagnosing prostate cancer
How is prostate cancer diagnosed?
Prostate cancer is often slow growing, so it can be some years before a man sees a doctor about symptoms, such as difficulty urinating.
There is no NHS screening programme for prostate cancer.
A doctor will ask about symptoms, and consider a man's risk factors, such as being over 65 or being from a black African-Caribbean ethnic background.
Then the doctor will perform a digital rectal examination (DRE) and tests may be carried out or arranged.
Two initial tests are commonly used to look for prostate cancer.
One is the digital rectal examination (DRE), in which your doctor feels the prostate through your rectum to find any hard or lumpy areas, known as nodules. The other is a blood test to detect a substance made by the prostate called prostate-specific antigen (PSA). When used together, these tests can detect abnormalities that may suggest prostate cancer.
Neither of the initial tests for prostate cancer is infallible. Many men with elevated PSA do not have prostate cancer, and men with prostate cancer may have normal levels of PSA. Also, the digital rectal examination does not detect all prostate cancers.
Depending on the initial test results and findings, further testing may be arranged, which may involve a referral to a urologist.
The urologist will discuss the advantages and disadvantages of further tests and talk through any concerns.
Further tests include:
- A second PSA blood test
- A trans-rectal ultrasound (TRUS) guided prostate needle biopsy. A special ultrasound probe is passed through the rectum and towards the prostate where tissue samples are taken for laboratory testing.
- Computerised tomography (CT) scan
- Magnetic resonance imaging (MRI) scan
- Bone scan to check whether any cancer cells have spread from the prostate to the bone.
An ultrasound scan and a urine flow test may be arranged to rule out the symptoms being caused by an enlarged prostate rather than prostate cancer.
Prostate cancer test results
If cancer is found from the tissue samples taken in the biopsy, doctors will assess how active the cancer is using a points system called the Gleason score.
Doctors will also assess the stage any cancer has reached using a TNM scale – tumour or localised, nodes meaning spread to lymph nodes, or metastasised or spread to other parts of the body, including bone.
Once this information is available, doctors will discuss prostate cancer treatment options, or monitoring, called watchful waiting or active surveillance.
Coping with a prostate cancer diagnosis
Even if a man suspects he has cancer, getting a diagnosis of prostate cancer confirmed can be an emotional time, with feelings of shock, anger and concern.
It may help to talk to someone about these concerns, such as a specialist cancer nurse.