Diagnosis of Prostate Cancer

Your doctor will ask you about your symptoms, and medical and family history. This will include a thorough digital rectal exam to detect any abnormalities. Tests can rule out or confirm a cancer diagnosis.

Anatomy of the Prostate Gland
Copyright © Nucleus Medical Media, Inc.

Suspicion of Prostate Cancer

If you are having symptoms or your doctor detects abnormalities, you may need further testing. Tests can help confirm a cancer diagnosis or another condition, such as benign prostatic hyperplasia or prostatitis. Tests may include:Blood TestsBlood tests may identify tumor markers in the blood, such as prostatic specific antigen (PSA). PSA is elevated in the presence of cancer or other prostate disorders. Blood tests will also evaluate other types of proteins or markers that may indicate cancer.Imaging TestsImaging tests may be used to look for the presence of tumors. They can also help assess their size and location. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may include:

Diagnosis of Prostate Cancer

During a biopsy, suspicious tissue is removed so it can be examined under a microscope. This is the only way to confirm a diagnosis. These may include:

Staging of Prostate Cancer

The physical exam, combined with blood, imaging, and biopsy test results will determine the stage of the cancer. Staging is used to identify where and how far the cancer has spread. It is also used to guide your treatment plan. Treatment and outcomes depend on several factors, such as location, tumor size, stage, and overall health.
  • Gleason score—a measure of the aggressiveness of the cancer as seen under the microscope
  • TNM staging system:
    • Tumor size and local spread (T)
    • Spread to lymph nodes in the area (N)
    • Spread or metastasis to distant organs (M)
The TNM staging system is often used to classify cancer of the prostate. The Gleason score is often combined with the TNM system to predict the likelihood of survival over the next 5 years with treatment. The higher the numbers the worse the prognosis.
  • Tumor size and local spread (T):
    • T0: There is no evidence of tumor.
    • T1: The cancer is not felt during a rectal exam nor seen by ultrasound. It is usually found during treatment for benign prostatic hyperplasia or during evaluation of an elevated PSA test.
    • T2: The cancer can be felt during rectal exam, but is confined to the prostate.
    • T3: The cancer has spread just outside the prostate and may involve the seminal vesicles.
    • T4: The cancer has spread to local tissues beyond the prostate and seminal vesicles, organs, or lymph nodes.
  • Spread to lymph nodes (N):
    • N0: There is no evidence of cancer in any lymph node.
    • N1: Cancer has spread to one nearby lymph node that is < 2 cm in size.
    • N2: Cancer has spread to one nearby lymph node 2-5 cm in size or multiple lymph nodes all < 5 cm in size.
    • N3: Cancer has spread to any nearby lymph nodes > 5 cm in size.
  • Spread to distant organs (M):
    • M0: There is no evidence of distant spread.
    • M1: There is no distant spread to far removed lymph nodes, bones, or other organs.

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