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Prostate Cancer Diagnosis


Men who have prostate cancer usually don’t have symptoms, especially in the early stages.

Prostate problems, similar to those for prostate cancer, can be caused by other conditions including BPH (benign prostatic hyperplasia). BPH is when the prostate grows larger, a result of normal prostate cells reproducing too fast. This is common in men over the age of 50.

Let your doctor know if you have these symptoms, so problems can be diagnosed and treated promptly:

  • Difficulty with urination, including burning or pain
  • Difficulty having an erection
  • Pain in the pelvis or lower back

Screening Tests

These exams can detect a problem in the prostate. However, they are only screening tests — they can’t determine for sure whether the problem is cancer, BPH, or another disease.

  • Digital rectal exam (DRE): Your doctor will use a gloved finger to examine your prostate through your rectum. Your doctor feels for areas that are hard or lumpy.  
  • Prostate-specific antigen (PSA) blood test: A high PSA reading could mean several things:
    • Cancer cells in your prostate
    • An enlarged prostate (BPH)
    • Infection of the prostate

If your doctor is concerned about your screening test results, he or she will refer you to a urologist (specialist in kidney and urinary problems).

Diagnostic Tests

The urologist will review the results of your screening tests and do a physical exam.

Depending on the results of your tests and physical exam, the next step might be watchful waiting (also known as active surveillance). You won’t undergo treatment during watchful waiting.

Instead, your doctor will monitor your prostate condition through regularly scheduled checkups. Or the urologist might do more tests to find out if changes in your prostate show signs of cancer. These tests include:

  • Transrectal ultrasound (TRUS): Transrectal ultrasound creates an image inside the body using sound waves. The urologist examines the image of your prostate for abnormal areas.
  • Biopsy: The urologist might take a small tissue sample from your prostate gland and send it to the lab for testing. A pathologist (specialist in studying tissue) will examine your tissue sample for cancer.

Grades and Stages of Prostate Cancer

If cancer is found in the tissue sample, the pathologist will examine and grade the cancer cells. The grade is based on how similar your prostate cells are to normal prostate cells. Cells in the tissue sample may have several different patterns that might or might not look like normal cells.

The Gleason score combines the grade of the two most common cell patterns in your tissue sample. The score, which will be between 2 and 10, tells how aggressive the cancer is, meaning how fast it’s spreading and growing. The higher the score, the more aggressive the cancer.

Staging looks at the tumor. It measures its size, whether it has spread to nearby lymph nodes, and whether it has spread (metastasized) to other parts of the body. Staging also takes into account your Gleason score.

Prostate cancer is staged from 1 to 4.

Stage 1

  • Cancer is in just a small area of the prostate.

Stage 2

  • This stage could mean one of two things. It might indicate that the tumor is small but is a more aggressive type of cancer. Or it may mean that the cancer is larger and has grown to both sides of the prostate gland.

Stage 3

  • Cancer has spread outside of the prostate to nearby tissue.

Stage 4

  • Cancer has spread to other areas of the body.

Based on all of this information, your doctor can recommend a treatment plan to discuss with you. Many people like to take some time to think about what the doctor recommends before starting treatment, since each treatment has pros and cons.

Your doctors and cancer care team at Kaiser Permanente medical offices can answer any questions that might arise during and after testing and diagnosis.