Diagnosing Prostate Cancer

How Is Prostate Cancer Diagnosed?

For men with an abnormal PSA or digital rectal examination, a prostate biopsy is often recommended. The diagnosis of prostate cancer can only be confirmed by examining prostate cells under a microscope. This is done by performing a biopsy, a test that is done to remove small samples of prostate tissue.


Prostate Biopsy
A prostate biopsy is usually done in your urologist’s office, but it can be done in an outpatient facility or even in the hospital.  Your physician will discuss the procedure with you and any risks associated with it. This is your opportunity to express any concerns you have regarding the biopsy, the risks discussed, how it will be performed, and what the results will mean.

Your physician will also inform you about any preparation needed prior to the biopsy. You may be placed on antibiotics to prevent infection. Local anesthesia is usually used for a prostate biopsy in an office setting. Using transrectal ultrasound, a thin needle is inserted through the rectum (transrectal), through the urethra, or through the area between the anus and the scrotum (perineum). Transrectal biopsies are the most common. Those samples will be examined under a microscope by a pathologist. Results are usually available within ten days.

Understanding Prostate Biopsy Results


The prostate gland tissue samples appear normal under the microscope, with no signs of infection or cancer.


Cancer cells or signs of infection are found.


Signs of an abnormal noncancerous enlargement of the prostate gland (benign prostatic hyperplasia, or BPH), tuberculosis, lymphoma or rectal or bladder cancer are present.

 If the pathologist does find prostate cancer, he will assign a stage and a grade. The most common grading system used for prostate cancer is the Gleason system.


Gleason Score
The gleason grading system uses numbers from one to five. The higher the score, the higher the grade of the tumor. Most cancers today are grades 5, 6 or 7. Scores of 8, 9 or 10 are more aggressive cancer that usually grow more quickly and are more likely to spread that low-grade tumors. Scores of four and below are very rare, as they usually would not warrant a biopsy in the first place.

  • Grade 1
    The cancerous tissue will closely resemble the normal tissue
  • Grade 2
    Tissue which still has well advanced structures, such as the glands; though they are also much larger and also the tissues are present amongst them.
  • Grade 3
    Tissue still has the recognizable glands; though, the cells are dimmer
  • Grade 4
    The tissue has hardly any glands which are identifiable
  • Grade 5
    There are no identifiable glands in the tissue


Tests to Identify Prostate Cancer Stage
After a prostate cancer diagnosis, tests are done to determine if cancer has spread outside of the prostate. Depending on the characteristics of a man’s prostate cancer seen on biopsy, tests may be ordered to help determine the stage of prostate cancer.

  • CT scan of the abdomen and pelvis, looking for prostate cancer metastasis to other organs
  • MRI of the skeleton, or a nuclear medicine bone scan, to look for metastasis to bones
  • Surgery to examine the lymph nodes in the pelvis for any prostate cancer spread