Prostate Diseases

Diagnosis & Tests

Benign Prostatic Hyperplasia (BPH) 

Your healthcare provider will ask about your symptoms, when they started, and how severe they are. It is important to tell your provider exactly what medications you are taking, including any over-the-counter medications or supplements, to see if they could be causing the symptoms. Other tests that your provider may do include:

  • Digital rectal examination (DRE). Your provider inserts a finger into the rectum to feel the size and shape of the prostate.
  • Urinalysis. A urine sample will be tested for possible urinary tract infection.
  • Blood tests. Your provider may check the level of prostate-specific antigen (PSA), a protein made by the prostate that may be elevated if you have BPH.
  • Urodynamic testing. This includes several tests that help show how the bladder and urethra are working.
  • Ultrasound. An ultrasound probe on the abdomen can show whether the bladder is emptying after urination; an ultrasound through the rectum can show the size of the prostate gland.

Prostatitis 

Your healthcare provider will diagnose prostatitis by asking about your symptoms and medical history.  Other tests your provider may do include:

  • Urinalysis. A urine sample will be tested for possible urinary tract infection.
  • Blood tests. Blood tests may be done to check for other signs of infection or prostate disease.
  • DRE. Your provider inserts a finger into the rectum to see if the prostate is swollen or tender.
  • A CT or ultrasound scan may be done to better visualize the prostate.

Prostate Cancer 

Screening

Prostate cancer that is found and treated in early is more likely to be treated successfully. However, men with early stage disease usually have no symptoms. The question of screening men without symptoms for prostate cancer in order to find and treat it in the early stages is controversial.

Many healthcare professionals and medical organizations now believe that 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 die from something else.
  • Early detection may result in unnecessary treatments, severe complications, and needless worry.

Older men are less likely to benefit from screening, and many organizations now recommend against screening men over the age of 75. Your decision to be tested should be based on talking with your healthcare provider about your individual preferences, your personal risk factors, and the likelihood that you would benefit from treatment versus harm from complications or unnecessary treatments.

Click here to read the Choosing Wisely recommendations "Tests and treatments for prostate cancer: the latest advice for men"

Discuss the need for prostate cancer screening with your healthcare provider. If you are over 75 or at low risk, you probably will not benefit from screening tests.

Diagnosis

The most common tests for prostate cancer are:

  • DRE. In this test, the healthcare provider inserts a finger into the rectum to feel the size and shape of the prostate. Although this test can sometimes help distinguish between BPH and prostate cancer, it is not a very good test for either screening for or diagnosing prostate cancer. Your healthcare provider may or may not do this test.
  • Prostate-specific antigen (PSA) blood test. PSA is a protein made by the prostate gland and is released into the bloodstream. There is always a low level of PSA that can be measured in your blood. When prostate cancer is present, the PSA tends to be elevated. However, PSA can be elevated for other reasons. PSA increases with age, and when you have conditions such as BPH and prostatitis. If PSA levels are very elevated, or if they are rising rapidly, your healthcare provider may recommend additional tests.
  • Prostate biopsy. If the PSA test is positive, the next test is normally a prostate biopsy. A prostate biopsy uses a rectal ultrasound and a needle to obtain tissue samples from the prostate. The tissue is then examined to see if any cancer cells are present.

Prostate Cancer Grading and Staging

If the prostate biopsy shows cancer cells, the next step is to determine the size of the tumor, how aggressive it is, and how much it has spread. This helps determine the best treatment.

Grading is the process of determining how different the cancer cells are from normal cells. A higher grade means the cancer cells are very different from normal cells, and more likely to spread. The system for grading prostate cancer is called the Gleason Score. Scores can range from 2 (not aggressive) to 10 (very aggressive).

Staging is the process of determining how large the tumor is and how much it has spread. A number of different tests may be used for staging. Your healthcare provider will help decide which tests are needed for staging. Some of these tests may include:

  • Ultrasound of the prostate
  • Computerized tomography (CT or CAT) scan
  • Magnetic resonance imaging (MRI) scan
  • Positron emission tomography (PET) scan
  • Bone scan

Prostate cancer is given a stage from 1 (I) to 4 (IV). Higher stages indicate more advanced cancer.

  • Stage I:  This is very early cancer that is confined to a small area. The cancer cells are not considered aggressive.
  • Stage II: These cancers may still be small but the cells may be considered aggressive.  This stage can also indicate cancer that is larger and has grown to involve more of the affected area.
  • Stage III: The cancer has spread beyond where it began to other nearby areas.
  • Stage IV: The cancer has grown to invade nearby organs (such as the bladder if you have prostate cancer), or spread (metastasized) to lymph nodes, bones, lungs or other organs.

Updated: March 2018