Diagnosing prostate cancer

Your doctor can feel the prostate gland by putting a gloved finger into your back passage (rectum). If a cancer is present it may feel hard.

You also have a PSA test to measures the level of prostate-specific antigen (PSA) in the blood. If cancer is present, you may have a raised PSA level.

Your doctor will talk to you about having a biopsy to check for cancer cells. They put an ultrasound probe into your back passage. It shows a picture that helps them guide the biopsy needle into the prostate. They usually take 12 small tissue samples to check for cancer cells.

If the biopsy does not show cancer but your PSA rises afterwards you may have a template biopsy. You have this under a general anaesthetic. They take tissue samples from different areas of the prostate.

Some men may have a special scan called a multi-parametric MRI scan to decide if they need another biopsy. In some hospitals they may do this scan first to see if a biopsy is necessary in the first place.

Tests and scans for prostate cancer

Men who have symptoms usually begin by seeing their GP. Your GP will examine you and ask about your general health. They may also ask you about any family history of cancer.

The first tests used to diagnose prostate cancer are a rectal examination and a PSA test.


Rectal examination

During a rectal examination, the doctor gently inserts a gloved finger (with lubrication) into the rectum (back passage). As the rectum is close to the prostate, your doctor can feel for any abnormalities in the prostate. This may be uncomfortable, but it is quick and should not be painful.

If there is cancer in the prostate, it may feel hard and bumpy. With benign prostatic hyperplasia (BPH), the prostate is usually enlarged, firm, and smooth. But the prostate can feel normal, even when there are cancer cells inside.

The examination can be embarrassing but it is important to remember that no matter how uncomfortable you feel about it, get yourself checked out. It could save your life.

Bill


PSA test

The PSA (prostate-specific antigen) test is a blood test that measures the level of PSA in your blood. PSA is a protein produced by the prostate. There is normally a small amount of PSA in the blood. You will have a sample of blood taken to check your PSA level.

Men with prostate cancer tend to have a raised level of PSA. But the test is not always reliable and some men who have a raised level of PSA do not have prostate cancer. This is because as men get older, the level of PSA in the blood rises slowly.

The figures below are a guide to the levels of PSA usually found in men.

  • For men in their 50s, a PSA level of up to 3 nanograms per millilitre of blood (3ng/ml).
  • For men in their 60s, a PSA level of up to 4ng/ml.
  • For men in their 70s, a PSA level of up to 5ng/ml.
  • There are no PSA level limits for men aged 80 and over.

The level of PSA in the blood can also be raised by:

  • urine infections (infections in your pee) or an infection of the prostate (prostatitis)
  • recent ejaculation (within the last 48 hours)
  • having a tube to drain pee (urinary catheter)
  • recent prostate biopsies (within the last 3 months)
  • prostate or bladder surgery (within the last 3 months)
  • receiving anal sex or prostate stimulation during sex – it is best to avoid this for 1 week before the PSA test.

It is important to let your GP or nurse know about any medicines you are taking before you have your PSA test. This is because some medicines can change the result of your PSA test.

The higher the level of PSA, the more likely it is to be cancer. PSA levels in men who have prostate cancer begin to go down after they have had treatment. So, measuring PSA levels can be a helpful way of checking the cancer and whether treatment is working.

Your GP will refer to the hospital if:

  • your PSA level is raised
  • your prostate feels abnormal.

At the hospital, you will be able to talk to a specialist doctor or nurse about further tests.

Prostate cancer symptoms and the PSA test

A urologist describes the symptoms of prostate cancer and the PSA (prostate-specific antigen) test, and Patrick shares his experience.

About our cancer information videos

Prostate cancer symptoms and the PSA test

A urologist describes the symptoms of prostate cancer and the PSA (prostate-specific antigen) test, and Patrick shares his experience.

About our cancer information videos


PCA3 (prostate cancer antigen 3) test

This test is still being researched. PCA3 is a protein made by normal prostate cells. Men with prostate cancer make more of this protein than usual. If someone has high levels of this protein, it can be found in their pee.

The PCA3 test cannot diagnose cancer on its own, but it might help doctors decide whether you should have a biopsy. So those who are very unlikely to have prostate cancer could avoid the possible risks and side effects of having a prostate biopsy.

The PCA3 test is not available on the NHS, but it may be available privately. Your doctor or specialist nurse can talk to you about how helpful it might be for you.


Trans-rectal ultrasound scan (TRUS) biopsy

If the rectal examination and PSA tests show there is a possibility of cancer, you may have a prostate biopsy.

You will usually be offered a type of biopsy called a TRUS biopsy. You lie on your left side with your knees pulled up to your chest. A small ultrasound probe is passed gently into the rectum using lubricating gel. This will show an image of the prostate on a screen. This helps the doctor guide a needle into the prostate. The needle takes a sample of tissue (a biopsy). The doctor will usually take 12 small samples of tissue from the prostate. A pathologist (a doctor who specialises in studying cells) looks at the tissue under a microscope to check for cancer cells.

Some men find having a TRUS biopsy uncomfortable. You will have a local anaesthetic to numb the area and reduce any pain or discomfort. The doctor will also give you antibiotics to reduce the risk of infection.

For 24 hours after this test, it is important to drink plenty of fluids. You may have blood in your semen for up to a few weeks after the scan. You may also have a small amount of blood in your pee or poo (stools). If these symptoms do not go away, speak to your doctor.

If you are a man who receives anal sex, you should avoid this for a few weeks until the biopsy area has healed. Talk to your doctor or specialist nurse if you need more advice. 

In some situations, doctors may think there is cancer in the prostate even if it hasn’t been found by a biopsy. This may be because of the level of PSA. If this happens, you may be offered a specialised type of MRI scan (see below) to decide whether another biopsy is needed.

TRUS biopsy
TRUS biopsy

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Template biopsy

Your PSA level may be checked again after a few months. If it has started to rise, you may have another type of biopsy called a template biopsy. This is done under a general anaesthetic.

The doctors pass a needle through the skin between the scrotum (the skin that covers the testicles) and the anus. They use a needle which can take many small tissue samples from different areas of the prostate.

This test is used if your doctor thinks there is a high risk you have cancer, but biopsies have not found it.

Your doctor can talk to you about whether a template biopsy might be helpful in your situation.


Multi-parametric MRI scan

An MRI (magnetic resonance imaging) scan uses magnetism to build up a detailed picture of certain areas of the body. You may be given an injection of dye into a vein to improve the images from the scan.

In some hospitals, you may have an MRI scan before a biopsy. Specialised scans called multi-parametric MRI scans can give doctors more detailed images of the body. These images give doctors more information about a suspected area of cancer. This can help them to specifically target suspicious areas of the prostate if a biopsy is needed. Based on the information that the doctor gets from the image, you may decide together that a biopsy is not needed.


Waiting for your test results

Waiting for tests results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready. Many people can feel anxious during this time.

There is no right or wrong way to deal with these feelings. Some men find it helpful to carry on with normal activities as much as possible. 

Other men look for information about prostate cancer during this time. Searching for information can help you feel more in control while you wait for your results. But if you do not have a diagnosis, some information can be confusing and upsetting. It may be better to wait until you have a diagnosis before looking for more information. If you do decide to find out more, it is a good idea to make sure the information is from a reliable source.

It may have been a form of coping, but I just distracted myself with my job and my family while waiting for the results.

Mateo

Too much browsing the internet did me no good. I am happier just knowing enough to be able to understand my consultant and ask relevant questions.

Tim


Things that may help

People have different support networks. Whether yours is your family, your partner, a friend, or a social group, try to talk to someone you trust about how you are feeling.

If you feel you have no one to talk to, you can call our cancer support specialists on 0808 808 00 00. Or you can visit our Online Community, where you can speak to other people who understand. There are lots of other sources of support too.

If you struggle to sleep during this time, simple breathing and relaxation exercises may be useful. Almost everyone can learn relaxation techniques. You could do this at home using a CD, podcast, or app.

Back to Diagnosing

Further tests after diagnosis

If you are diagnosed with prostate cancer, you may have further tests to find out more about the size of your cancer and where it is.

Causes and risk factors

We don't know exactly what causes prostate cancer. But there are things that can increase your risk. Find out what these might be and the possible changes you could make to reduce your risk.