Whether you’ve recently learned you have prostate cancer or you’re still waiting for answers, you may feel stressed and overwhelmed. Many people worry that one abnormal test result means cancer. But diagnosing prostate cancer usually takes more than one test. Doctors use several different screening and diagnostic tests to find out whether you have cancer and understand how fast it may be growing.

This article explains how prostate cancer is diagnosed, from the early screening tests to biopsy and imaging results. Knowing what to expect along the way can help you feel more prepared and confident when talking to your healthcare team.

How Doctors First Screen for Prostate Cancer

Most prostate cancers are first suspected during screening or routine checkups. Screening tests don’t diagnose cancer on their own. Instead, they help doctors decide whether more testing is needed.

Prostate-Specific Antigen Blood Test

The prostate-specific antigen (PSA) blood test measures the level of PSA, a protein made by the prostate gland, in your blood. A simple blood draw is all that’s required to collect this information. Some key facts about PSA include:

• PSA levels are usually low in healthy prostates.
• Higher PSA levels can be a sign of prostate cancer.
• PSA levels can also rise for reasons unrelated to cancer.

Common causes of a high PSA (that aren’t cancer) include:

• Benign prostatic hyperplasia (enlarged prostate)
• Prostate infection or inflammation
• Recent ejaculation
• Recent prostate procedures or manipulation (like a digital rectal exam)

Because PSA isn’t cancer-specific, an abnormal PSA test result alone doesn’t mean that you have prostate cancer. Likewise, some people occasionally have prostate cancer without a high PSA level. Doctors look at PSA trends over time and combine them with your physical exam and history.

Digital Rectal Exam

During a digital rectal exam (DRE), a doctor inserts a gloved, lubricated finger into the rectum to feel the prostate. This helps the doctor check for changes that could be a sign of a problem.

The doctor checks for:

• Hard areas
• Lumps or nodules
• Irregular shape or size

A DRE only takes a few seconds. While it may feel uncomfortable, it shouldn’t be painful. Some prostate cancers don’t cause changes that can be felt on an exam, which is why DRE is usually used with PSA testing rather than alone.

When Screening Results Raise Concern

If your PSA level is high, rising quickly, or combined with an abnormal DRE, your doctor may recommend more testing. This doesn’t always mean that you have cancer. It just means your doctor wants more information.

At this stage, options may include:

• Repeating the PSA test
• Checking PSA-related markers
• Ordering imaging tests

Many people find shared decision-making helpful. This is when you and your doctor talk through the risks, benefits, and your preferences before deciding what to do next.

Prostate Biopsy: Confirming the Diagnosis

A prostate biopsy is the only way to confirm prostate cancer. During a biopsy, doctors collect a small sample of prostate tissue and examine it under a microscope.

How a Prostate Biopsy Is Done

Most prostate biopsies are performed using transrectal ultrasound guidance. First, an ultrasound probe is placed into the rectum to create images of the prostate. Then, a thin needle removes small tissue samples from different areas.

This procedure usually takes 10 to 15 minutes. A local anesthetic is used to numb the area and reduce discomfort. Most people feel brief stinging sensations from the numbing shot and pressure from the ultrasound probe.

After the procedure, it’s common to have:

• Blood in the urine or stool for a few days
• Blood in the semen for several weeks
• Mild soreness

Serious complications, like infection or ongoing bleeding, are uncommon. Your doctor will likely prescribe antibiotics to lower infection risk.

How Biopsy Samples Are Checked

The tissue samples are sent to a pathologist, a doctor who specializes in diagnosing disease by examining cells. The pathologist looks for abnormal cells, including how abnormal they appear and how much tissue is affected.

Results usually take several days to return. If no prostate cancer cells are found, your doctor may still recommend follow-up testing if PSA levels remain concerning.

Understanding the Gleason Score

If cancer is found on biopsy, the report includes a Gleason score. This helps show how likely the cancer is to grow and spread.

The Gleason score is based on the two most common cell patterns seen in the biopsy sample. Each pattern is graded on a scale from 3 to 5. The two numbers are then added together to give a total score from 6 to 10. Because grades 1 and 2 aren’t typically used, 6 is usually the lowest Gleason score you’ll see. The higher the score, the more aggressive the cancer is.

Common Gleason scores include:

• 6 (3 plus 3) — Low-grade, slower-growing cancer
• 7 (3 plus 4 or 4 plus 3) — Intermediate-grade cancer
• 8 to 10 — High-grade, faster-growing cancer

Imaging Before or After Diagnosis

Before or after a diagnosis of prostate cancer, your doctor may order imaging tests to learn whether the cancer has spread beyond the prostate. Not everyone needs imaging, however. The next steps depend on your level of PSA, Gleason score, and other risk factors.

Prostate MRI

A multiparametric MRI scan provides detailed images of the prostate and nearby tissues. MRI can:

• Show tumor size and location
• Identify cancer outside of the prostate in the surrounding tissues
• Guide future biopsies
• Help plan treatment

MRI is especially useful for people with intermediate- or high-risk cancer.

Bone Scan

Prostate cancer can spread to the bones. A bone scan checks for cancer-related changes to the skeleton. You may get a bone scan if you have high or very high-risk prostate cancer.

CT Scans or PET Scans

In some cases, doctors may use CT or positron emission tomography (PET) scans to check whether the cancer has spread beyond the prostate. These tests involve radiation, unlike MRI, and are usually reserved for people with higher-risk or more advanced disease.

Staging Prostate Cancer

Once all test results are available, doctors assign a stage to the cancer. Staging describes:

• How large the tumor is
• Whether cancer has spread
• How aggressive it appears

Stages of prostate cancer range from stage one (localized) to stage four (metastatic). Staging helps to guide treatment options and expectations about prognosis.

Communicating With Your Doctor

If you’re going through the process of prostate cancer diagnosis, consider asking your doctor:

• What do my PSA and biopsy results mean for me?
• How aggressive does my cancer appear?
• Do I need any additional imaging tests?
• What are my treatment options?
• Should I get a second opinion?

Keeping an open line of communication with your healthcare team can help you feel more in control during this challenging time. If you or a loved one is facing prostate cancer, remember that you are not alone. Your healthcare team is there to guide you, answer questions, and help you make informed decisions that fit your values and goals.

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