Aging & Health A to Z

Prostate Diseases

Diagnosis & Tests

Benign Prostatic Hyperplasia (BPH) Examination

Your healthcare professional will ask about your symptoms, when they started, and how severe they are. The healthcare professional will also need to know exactly what medications you are taking, since some—such as diuretics (water pills)—may produce several of the symptoms similar to BPH. 

Often this diagnosis can be made just be description of the symptoms you are having. At times, to understand the impact of BPH on your body and to be certain of the diagnosis, other tests might be indicated. Various tests may be needed, including:

• digital rectal examination (DRE) – in which the healthcare professional inserts a finger into the rectum to feel for any bumps, hardening, or other abnormalities in the prostate
• urine tests (to check for bacteria, blood or sugar)
• blood tests 
  • creatinine – which is a marker of kidney disease
  • prostate-specific antigen (PSA) – a chemical made by prostate tissues
• tests of how well the bladder empties and how strong the urinary stream is with passing urine
• imaging studies of the urinary tract
• ultrasound of the prostate gland 

Prostatitis Examination

Your healthcare provider can usually diagnose prostatitis by: 

• taking a history (for example, asking about your symptoms, when they started, if you have had prostatitis before, how severe your symptoms are)
• analyzing a urine sample (bacteria may be identified this way)
• physical examination. 

Your healthcare professional may try to avoid performing a digital rectal exam since this may sometimes cause bacteria to spread. A computed tomography (CT) scan, magnetic resonance imaging (MRI), ultrasound of the prostate, and cultures of blood and urine may be necessary. 

Prostate Cancer Examination

The most common tests for diagnosing prostate cancer are

• digital rectal exam  
• prostate-specific antigen (PSA) test
• biopsy. 

The PSA test, a simple blood test, measures the amount of prostate-specific antigen your prostate is producing. Your prostate always sends a low level of PSA into the bloodstream, and it may rise with non-cancerous prostate conditions such as BPH or prostatitis. However, if the level of PSA increases beyond a certain point, especially if the change is rapid, your risk of prostate cancer becomes greater. 

None of these tests are very reliable in themselves, but they can raise suspicion that an abnormality might be present, and that more investigations are needed. For example, only about one-third of men with elevated PSA test results actually have prostate cancer, and PSA tends to increase with age even in people without cancer, so it is usually not tested in men over the age of 75, and when tested, interpreted with a lot of caution. 

If your healthcare professional thinks more information is necessary, a biopsy of the prostate gland will be ordered. Other tests, such as MRI or CT scans, or lymph node biopsy, may be recommended. 

Controversy About Prostate Cancer Screening
Many healthcare professionals now believe that early PSA screening for prostate cancer should not be done, because:

• early detection does not seem to reduce the risk of early death
• most men with prostate cancer do not die of it, but from something else
• early detection may result in unnecessary treatments, severe complications, and needless worry. 

Discuss the pros and cons of prostate cancer screening with your doctor. Your decision to be tested should be based on your own risk factors, your age, and your informed individual preference. Many professional organizations do not recommend PSA and DRE screening for prostate cancer in men over the age of 75. 

Prostate Cancer Staging
Staging reflects how large your tumor is and how much it has spread.

• Stage I: localized cancer that is confined to the prostate and is within the capsule. It cannot be seen by scanning or felt by DRE but has been confirmed by biopsy.
• Stage II: localized cancer still confined to the prostate but more advanced.
• Stage III: regional cancer that has grown through the capsule and into the neighboring seminal vesicles, muscles, or other organs.
• Stage IV: the most advanced type of cancer that has spread (metastasized) to lymph nodes and distant parts of the body, including bones. 

Prostate Cancer Grading – the Gleason Score
A pathologist will check the cells in your biopsied prostate tissue and assign a Gleason score depending upon how well differentiated the cells are. The higher the score, the more the cancer is likely to spread and cause serious disease.

Updated: May 2012
Posted:  May 2012