Being diagnosed with prostate cancer

If you have prostate symptoms, your doctor will first check to see if the prostate is enlarged. They can feel the prostate gland by inserting a gloved finger into your back passage (rectum). If cancer is present, the prostate is likely to be hard and knobbly.

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

If these tests suggest cancer, you may have a biopsy of the prostate. This is when a small sample of cells is taken from the prostate to be looked at under a microscope. A probe is gently inserted into the back passage to take a scan of the prostate (trans-rectal ultrasound). A sample of cells (biopsy) is often taken at the same time.

It will probably take up to a couple of weeks to get your test results back. Waiting for your test results can be a difficult time. It may help to talk to someone about how you are feeling.

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.

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

Digital rectal examination

The rectum (back passage) is close to the prostate gland. Your doctor can feel for any abnormalities in the prostate by gently inserting a gloved finger with lubrication into the rectum. This may be uncomfortable, but shouldn’t be painful and doesn’t take very long.

If there’s cancer in the prostate gland, it may feel hard and knobbly. With benign prostatic hyperplasia (BPH), the prostate usually feels enlarged, firm and smooth. However, the prostate may feel normal even when cancer cells are present.

I did have a digital examination which was uncomfortable, but thinking of my health and wellbeing it was just a minor inconvenience, so that wasn’t a problem at all.


PSA (prostate-specific antigen) test

You’ll have a sample of blood taken to check for PSA. This is a protein produced by the prostate. There is normally a small amount of PSA in the blood.

Men with prostate cancer tend to have a raised level of PSA. However, this test isn’t always reliable and some men who have a raised level of PSA don’t have prostate cancer.

The PSA level can also be raised by:

  • urine infections or an infection of the prostate (prostatitis)
  • recent prostate biopsies (within the last three months)
  • having a urinary catheter (a tube to drain urine)
  • prostate or bladder surgery (within the last three months)
  • recent ejaculation (within the last 48 hours)
  • prostate massage.

PSA levels also rise as men get older.

  • In men aged 50–59, a PSA level of 3 nanograms per millilitre of blood (ng/ml) or lower is considered normal.
  • In men aged 60–69, a PSA level of 4ng/ml or lower is considered normal.
  • In men of 70 and over, a PSA level of 5ng/ml is considered normal.

It’s 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 alter the result of your PSA test.

As a general rule, the higher the level of PSA, the more likely it is to be cancer. Following treatment, the level of PSA will fall. So measuring PSA levels can be a helpful way of assessing the cancer and the effectiveness of treatment.

If your PSA level is raised, or if your GP feels any abnormalities during the digital rectal examination, they will refer you to hospital for a discussion 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 a patient 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 a patient shares his experience.

About our cancer information videos

Screening for prostate cancer

Screening aims to detect cancer in people who do not have any symptoms. There is currently no screening programme for prostate cancer in the UK. This is because we still don’t know how reliable the PSA test is and there are no other tests that have been proven to be accurate enough.

Research suggests that while the lives of some men could be saved by PSA screening, many more men would be unnecessarily treated for cancers that would never have caused serious harm.

If you don’t have prostate symptoms but would like to have a PSA test, you should talk to your GP. They can give you information and arrange the test if you’d like to have it.

There is more information on the PSA test.

PCA3 (prostate cancer antigen 3) test

This test is still being researched. PCA3 is a protein made by normal prostate cells. When prostate cancer is present, more of the protein is made than usual. If a man has high levels of this protein, it can be found in the urine.

The PCA3 test can’t diagnose cancer on its own, but it might help doctors decide which men should have a biopsy. This would mean that men 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 at the moment, but it may be available privately. Your doctor or specialist nurse will be able to talk to you about how helpful it might be in your situation.

Trans-rectal ultrasound scan (TRUS) biopsy

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

Usually, the first biopsy you have is a TRUS biopsy. A small ultrasound probe is passed gently into the back passage using lubricating gel and an image of the prostate appears on a screen. A needle is then inserted into the prostate in order to take a sample of cells (a biopsy). You will usually have 12 small samples of tissue taken from the prostate. These are examined under a microscope by a pathologist.

Some men find having a TRUS biopsy uncomfortable. You may be given a local anaesthetic to reduce the discomfort. The doctor will also give you antibiotics to reduce the risk of infection.

For 24 hours after this test, it’s important to drink plenty of fluids. You may notice blood in your semen for up to a few weeks after the scan. You may also notice a small amount of blood in your urine or when opening your bowels. If these symptoms don’t go away, speak to your doctor.

Unfortunately, even if there is cancer in the prostate, it may not be found by a biopsy. This occurs in around 5–10% of men (fewer than 1 in 10). If this happens, you may be offered an MRI scan to decide if another biopsy is needed.

Template biopsy

You may have your PSA level 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 usually only used if previous biopsies have not shown cancer but your doctor still thinks there may be a high risk you have cancer.

Your doctor can tell you more about biopsies and discuss whether a template biopsy might be helpful in your situation.

Waiting for your test results

It can take a few days to a few weeks for test results to be ready. Many people feel anxious during this time.

You may feel like you have no control over what’s going to happen to you. The waiting period might feel very long and the future may feel very uncertain.

There is no right or wrong way to deal with these feelings. Some people find it helps to carry on with normal activities as much as possible. Continuing with everyday activities, such as going to work, can be a welcome distraction from worrying. Other people may feel they cannot concentrate on anything else.

Some 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. However, if you’re not sure of the diagnosis, some information can be confusing and upsetting. It may be better to wait until a diagnosis is made before looking for more information. If you do decide to find out more, it’s a good idea to make sure the information is from a reliable source.

Things that may help

  • It might be helpful to divide your day into different activities. For example, you could meet a friend for lunch, or do something you usually enjoy, such as watching sports or going to the cinema. This can provide a distraction from worrying thoughts, make you feel more in control and reduce feelings of uncertainty.
  • Try talking to a family member or close friend. Many people find that their fears and worries are reduced simply by telling someone else about them. ‘Offloading’ in this way can be a relief and you may find that you feel better afterwards. Some people prefer to talk to someone outside their circle of family and friends. You may find it helpful to speak to one of our cancer support specialists on 0808 808 00 00.
  • Try to relax. If you struggle to sleep during this time, simple breathing and relaxation exercises maybe useful in reducing anxiety, stress and any muscle tension you have. Many people find this relaxing, and experience a sense of calm when using these simple methods. Almost everyone can learn relaxation techniques. You could do this at home using a CD.
  • You can also download free podcasts from any website, or you can download relaxation apps to your smartphone.

Back to Tests and scans

Further tests after diagnosis

You may have further tests to find out more about the size of the cancer and if it as spread outside the prostate.