Prostate Cancer Testing & Diagnosis

The symptoms of prostate cancer are not always obvious until the cancer is at an advanced stage. Thankfully there is a way to detect it sooner. Prostate cancer screening tests are an important part of men's preventive health. They can identify cancer at an earlier stage when it's easier to treat.

Screening for Prostate Cancer

Your doctor can check for prostate cancer before you have any symptoms. Screening for prostate cancer is recommended for men by age 50, but for patients considered at a higher risk for developing the disease, that can be sooner. Family history of cancer, certain conditions, or the presence of other risk factors may require your screenings to start sooner. 

Screening for prostate cancer is usually a two-part process:

• Digital rectal exam: Your doctor inserts a lubricated, gloved finger into the rectum and feels your prostate through the rectal wall. Your prostate is checked for hard or lumpy areas.
• Blood test for prostate-specific antigen (PSA Blood Test): A lab checks the level of PSA in your blood sample. The prostate makes PSA. A high PSA level can indicate there is an issue with the prostate which can be BPH, prostatitis (inflammation of the prostate), or in some cases prostate cancer. A single high PSA test result isn't a good indicator that cancer may be developing. A non-cancerous condition may need to be treated. Or, several tests may be run before further action is taken.

Determining a Prostate Cancer Diagnosis

If the PSA tests return several high results, and non-cancerous conditions are ruled out, it may be time to test to see if cancer has developed.  Your doctor may order other procedures:

• Transrectal ultrasound: The doctor inserts a probe into the rectum to check your prostate for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram. If a tumor has developed the ultrasound pictures are likely to show it.
• Prostate biopsy: A biopsy is the removal of tissue to look for cancer cells. It’s the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from several areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.

If cancer cells are found, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow.

Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with your age and other factors to suggest treatment options.

If cancer cells are found, further steps are taken to understand the size of the tumor and whether it's grown to other areas of the body.

One system of grading is with the Gleason score. Gleason scores range from 2 to 10. To come up with the Gleason score, the pathologist uses a microscope to look at the patterns of cells in the prostate tissue. The most common pattern is given a grade of 1 (most like normal cells) to 5 (most abnormal). If there is a second most common pattern, the pathologist gives it a grade of 1 to 5 and adds the two most common grades together to make the Gleason score. If only one pattern is seen, the pathologist counts it twice. For example, 5 + 5 = 10. A high Gleason score (such as 10) means a high-grade prostate tumor. High-grade tumors are more likely than low-grade tumors to grow quickly and spread.

Another system of grading prostate cancer uses grades 1 through 4 (G1 to G4). G4 is more likely than G1, G2, or G3 to grow quickly and spread.

What to Expect After a Prostate Cancer Diagnosis

Often, the doctor who orders the ultrasound and performs the biopsy to determine if prostate cancer is present is a urologist. The next step is to consider your treatment options based on the Gleason score and the extent of cancer, also known as the prostate cancer stage.

If you have received a diagnosis of prostate cancer, the oncologists at Compass work with you to create a plan for prostate cancer treatment based on your specific situation. Find a prostate cancer specialist at one of our cancer centers located throughout the Portland, Oregon, and Vancouver, Washington area.