Testing healthy men with no symptoms of prostate cancer is controversial. There is disagreement among medical institutions as to whether the benefits of the test outweigh the potential risks.
Most medical institutions recommend that men over 50 discuss the pros and cons of prostate cancer screening with their doctor. The discussion should include your risk factors and screening options.
If you are black, have a family history of prostate cancer, or other risk factors, you may want to consider starting the discussion earlier.
Prostate screening tests include:
Digital rectal examination (DRE). During a DRE, a doctor inserts gloved, lubricated fingers into your rectum to examine the prostate gland, which is adjacent to your rectum. If your doctor finds any abnormalities in the structure, shape, or size of your glands, they may need additional tests.
Prostate-specific antigen (PSA) test. A blood sample is taken from a vein in your arm and tested for PSA, a natural substance produced by the prostate. It is normal to have low levels of PSA in your blood. However, if it is higher than normal, it may indicate infection, inflammation, enlargement, or cancer of the prostate.
Diagnosis of prostate cancer
Rectal biopsy of the prostate
Prostate Rectal Biopsy Open Dialog Box
If your prostate cancer screening shows abnormalities, your doctor may recommend additional tests to determine if you have prostate cancer, such as:
Ultrasound. During a rectal ultrasound, a small probe about the size and shape of a cigarette is inserted into the rectum. The probe uses sound waves to create a picture of your prostate.
Magnetic resonance imaging (MRI). In some cases, your doctor may recommend an MRI scan of the prostate to provide a more detailed picture. MRI images can help your doctor plan the procedure to remove a sample of prostate tissue.
Collection of prostate tissue samples. Your doctor may recommend a sample of prostate cells (prostate biopsy) to determine the presence of prostate cancer cells. A prostate biopsy is usually performed using a thin needle to collect tissue from the prostate gland. A tissue sample is analyzed in a laboratory to determine the presence of cancer cells.
Determine whether prostate cancer is aggressive
When a biopsy confirms the presence of cancer, the next step is to determine the level of aggressiveness (grade) of the tumor cells. A laboratory doctor analyzes a sample of cancer cells to determine how different the cancer cells are from healthy cells. A higher grade indicates a more aggressive cancer that is more likely to spread quickly.
Techniques for determining the aggressiveness of cancer include:
Gleason score. The most common scale used to evaluate the level of prostate cancer cells is called the Gleason score. The Gleason score combines the two numbers and ranges from 2 (non-aggressive cancer) to 10 (very aggressive cancer), but lower limits are not often used.
Most Gleason scores used to evaluate prostate biopsy specimens range from 6 to 10. A score of 6 indicates low prostate cancer. A score of 7 indicates moderate prostate cancer. A score of 8-10 indicates high-grade cancer.
Genome testing. Genomic testing is done to determine which gene mutations are present in prostate cancer cells. This type of test can provide more information about your prognosis. But the test isn’t widely used because it’s unclear who would benefit most from the information. Genomic testing is not necessary for everyone with prostate cancer, but it can provide more information for treatment decisions in certain situations.