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Diagnosis of Prostate Cancer

How is prostate cancer diagnosed?

Prostate cancer is found during screening with a blood test (PSA) or a digital rectal exam (DRE). Symptoms of prostate cancer are usually felt when the disease is at a more progressed stage. Early prostate cancer prevention can be aided by yearly physical examinations. The diagnosis of prostate cancer is made only with a prostate biopsy.


Your doctor will physically examine you by doing a digital rectal exam (DRE), where a doctor will check for bumps or hard areas on the prostate that may be cancer.

This test can help determine if the cancer is on one side or both. If it is both, the cancer may have spread to other areas.

PSA Blood Test

The PSA blood test is mainly used to find prostate cancer in men that do not have symptoms. However, it is also one of the first tests done for men that experience prostate cancer symptoms.

For men just diagnosed with cancer, the test can be used to decide if other tests (CT scans or bone scans) are necessary.

For men diagnosed with cancer, the PSA test can help determine if the cancer is still confined to the prostate gland. Depending on your PSA level, you will have different treatment options. Some forms of therapy, like surgery and radiation, will not be helpful if prostate cancer has spread to other areas.

Even during and after treatment, PSA tests are useful to patients to monitor the state of prostate cancer.

Prostate Biopsy

Once you have had a PSA or a DRE, a doctor will do a prostate biopsy to find out if you have prostate cancer.

A procedure which a sample of body tissue is removed and then looked at under a microscope, it is the main method used to diagnose prostate cancer. This is usually performed by a urologist. The prostate cancer is then graded by severity of its growth.


Prostate cancer is graded according to the Gleason system. It is based on 1 to 5 depending on how the cells in the cancerous tissue look like normal prostate tissue.


Grade 1: cancerous tissue looks like normal prostate tissue.

Grades 2-4: Features between extremes of 1 and 5.

Most biopsies are grade 3 or higher.

Grade 5: Cancer cells and growth patterns look abnormal.


A grade is assigned to the 2 areas that make up the cancer. These 2 grades are added together to produce the Gleason sum (which is between 2 and 10).


Gleason score of 6 or less: called well-differentiated or low-grade.

Gleason score of 7: called moderately differentiated or intermediate-grade.

Gleason scores of 8-10: called poorly differentiated or high-grade.


A higher Gleason score indicates that it is more likely that cancer will grow and spread quickly.