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Diagnosing Prostate Cancer

How is prostate cancer diagnosed?

When a PSA test or a digital rectal exam (DRE) reveal abnormal results, further testing is needed to determine whether prostate cancer is present.

Your doctor will evaluate your test results and your symptoms, learn about your family history, and recommend any additional tests you may need.  

What is a prostate biopsy?

A prostate biopsy removes samples of tissue from the prostate in order to diagnose prostate cancer. This is used after an elevated PSA or abnormal DRE. A biopsy is the only test that can diagnose cancer.

What can I expect during a biopsy?

During the biopsy, the doctor will take 12 or more ‘core’ samples from different parts of the prostate using a fine needle. This is called a core needle biopsy. Ultrasound is often used to guide the needle and limit damage to any tissue.

What are the different types of prostate biopsy?

There are three types of prostate biopsies:

  • Transrectal – This is the most common biopsy procedure. The doctor – with the guidance of an ultrasound device – inserts needles through the wall of the rectum and into the prostate to take tissue samples.
  • Transurethral – A lighted tiny lens is inserted into the urethra to allow the doctor to see the prostate and then uses a microscopic cutting loop to take samples of tissue.
  • Transperineal – The doctor makes an incision in the perineum (the area between the anus and scrotum) and inserts a needle to take tissue cores of the prostate.

What happens after a prostate biopsy?

The tissue taken during the biopsy is examined by a pathologist to determine if cancer is present.

A negative biopsy indicates that none of the biopsy samples found any evidence of prostate cancer. This is usually good news—however, this does not necessarily mean that there is no prostate cancer present. Your doctor may want to continue to monitor your PSA levels or do a repeat biopsy at some point in the future.

A positive biopsy indicates that there is evidence of prostate cancer. This would be considered a diagnosis of prostate cancer. The biopsy results are used to determine the stage and grade of the tumor. These provide information on the approximate location and size of the cancer, and how aggressive it may be.

What are other common diagnostic tests?

Imaging tests such as MRI scans, CT scans, and ultrasounds can also be used to aid the detection of prostate cancer. These methods, some of them new or under development, can often help determine the presence of prostate cancer and help doctors minimize the risk of side effects.

An ultrasound may be used to look for suspicious areas in the prostate. This involves inserting a small ultrasound probe into the rectum. The ultrasound uses sound waves to take pictures of the inside of the body, in this case the prostate and surrounding areas.

Magnetic resonance imaging (MRI) uses a magnetic field to produce clear images that may not be seen clearly with an X-ray or pictures derived from ultrasounds. It is painless and usually takes about 45 minutes to complete. After prostate cancer has been confirmed by a biopsy, an MRI is useful in enabling doctors to determine malignant areas. Some research has even suggested MRIs can help predict prostate cancer recurrence.

Most MRI machines place the patient into a tube-like tunnel for the test. This is called a closed MRI. Some people, particularly those with claustrophobia, find it difficult to have the test in the closed machine and can seek to have an open MRI. If an open MRI is not accessible and the test must be done, ask your doctor for medication to help reduce anxiety before the test.

A PET (positron emission tomography) scan for prostate cancer is noninvasive and uses a nuclear imaging technique to best determine if and how far cancer has spread beyond the prostate by using radioactive materials that can diagnose the disease. After the substances are released, the PET scanner machine is passed over the body to determine any cancer spread. 

Go to our prostate cancer imaging section to learn more information about the various imaging tests. This includes advanced imaging procedures such as a PSMA (prostate-specific membrane antigen) PET scan, which is an advancement in not only diagnosing, but even treating some types of prostate cancer.

Additional Testing

There are additional tests that can give your doctor more information on how to determine the probability of both finding cancer during a biopsy and determining how aggressive that cancer is likely to be.

While none of these tests are conclusive on their own, when performed in addition to a PSA test, DRE, and a biopsy, they can provide each patient with more information about their specific cancer and can aid in both the diagnosis and decision on treatment. Read more about additional testing.​

What if I Am Diagnosed with Prostate Cancer?

If you or a loved one is diagnosed with prostate cancer, don’t lose hope. More than 3.1 million American men have been diagnosed with prostate cancer and are alive today. ZERO is here to help. Check out the Newly Diagnosed section of our website for helpful information and support resources.