Prostate Cancer: Diagnosis

Men should discuss the risk and benefits of prostate cancer screening with their doctors.

The American Cancer Society recommends that men with no symptoms of prostate cancer, who are in relatively good health and can expect to live at least 10 more years, begin this conversation at the age of 50.

Men at high risk—African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65—should begin those conversations at age 45. Men at even higher risk—those with multiple family members affected by the disease before age 65—should talk with their physicians about prostate cancer screening at the age of 40.

Men with no symptoms who are not expected to live more than 10 years (because of age or poor health) may not need to undergo prostate cancer screening.

  • Rectal Exams and Blood Test The PSA (prostate specific antigen) test is a blood test looking for a protein made by the prostate and prostate cancer cells. It, along with a digital rectal exam (DRE) may be used as initial screening tools for prostate cancer. However, prostate cancer is most often diagnosed by a needle biopsy of the prostate.
  • Needle Biopsy A thin needle is used to obtain tissue samples from within the prostate. This procedure can use a number of approaches: through the rectum with ultrasound guidance, through the urethra, or through the area between the anus and scrotum (perineum). Often local anesthesia is used.

After the biopsy is performed, a pathologist examines the cells under a microscope to determine whether or not there are cancer cells present. When cancer cells are present, the pathologist assigns a Gleason score to the tumor. This score is based on the appearance of the prostate cancer cells and is used to determine which prostate cancers are likely to be aggressive and require more immediate treatment.