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Prostate Cancer

Prostate Cancer Testing & Diagnosis

Even though you may feel completely fine, prostate cancer could be present. This is because it doesn't always cause symptoms, especially when it's smaller and contained inside the prostate. Your doctor will typically recommend a periodic exam and blood test to screen for prostate cancer.

Prostate Cancer Testing

Your doctor may decide to do prostate cancer testing if:

  • You have a high risk of prostate cancer due to family or medical history
  • You have symptoms of prostate cancer, such as difficulty urinating or erectile dysfunction
  • You are over the age of 50 with an average risk of prostate cancer

PSA Blood Tests

The PSA (prostate-specific antigen) blood test involves looking at the levels of PSA in the blood. High PSA levels can be a sign of prostate inflammation, but high levels can also be a sign of cancer.

The Digital Exam of the Rectum

The rectal exam involves "feeling" for problems with the prostate. The doctor will use a glove-protected finger to feel for your prostate by gently pressing against the interior wall of the rectum. The doctor is looking for abnormalities like lumps, lumpy spots, or hardness.

Prostate Cancer Diagnosis

While a digital exam and PSA tests may signal something is up with the prostate, it doesn't always mean that cancer is present. To make a diagnosis, further tests may be performed. Two of these tests are the transrectal ultrasound and biopsy. An ultrasound involves inserting a thin probe into the rectum to get a digital image of the prostate. A biopsy is usually performed by inserting a needle into the rectal wall to collect cells for testing. If cancer cells are found, further steps are taken to get an accurate look at the cancer.

The Gleason Score and Prostate Cancer Grading

After a prostate cancer diagnosis, Gleason scores are assigned to explain how much the tissue differs from healthy tissue. The less-aggressive types of cancer cells can look closer to healthier tissue. More aggressive tissue looks much more different under a microscope, but less aggressive types are more common.

Gleason scores are assigned by using a grading system of between 3 and 5. Cells that look more like healthy cells getting a lower score. Cancer cells from two locations in the prostate are examined. The two scores are added together to get a score from 6 to 10. For example, one cell sample receives a score of 3 and another receives a score of 5. The total score would then be 8.

Sometimes, just the combined score doesn't give the most accurate look. The number assigned from the part of the prostate where the most cancer cells were found can be more important than the second number. For that reason, once Gleason scores are determined, the pathologist will simplify the score into a grade group for further clarity. For example:

  • Gleason score of 6 (cells look similar to healthy cells) = Grade Group 1
  • Gleason score of 4 and 3 (somewhat similar to healthy cells) = Grade G2
  • Gleason score of 3 and 4 (somewhat similar to healthy cells) = Grade G3
  • Gleason score of 8 (very different from healthy cells) = Grade G4
  • Gleason score of 9 or 10 (even more different from healthy cells) = Grade G5

Grade group 1 is going to be a slower-growing form of cancer, while grade group 5 is more likely to grow faster.

After a Diagnosis: What to Expect

If your testing results show that cancer is present you will meet with a prostate cancer specialist who will talk to you about treatment options. And for many men, treatment is necessary right away. Learn more about prostate cancer treatments.