If you have a symptom or test result that suggests cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor will ask about your personal and family medical history. You will have a physical exam. You may have lab tests. Your visit may include a digital rectal exam, a urine test to check for blood or infection, and a blood test to measure PSA level.
You also may have other exams:
Transrectal ultrasound: The doctor inserts a probe into the man's rectum to check for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.
Cystoscopy: The doctor uses a thin, lighted tube to look into the urethra and bladder.
Transrectal biopsy: A biopsy is the removal of tissue to look for cancer cells. It is the only sure way to diagnose prostate cancer. The doctor inserts a needle through the rectum into the prostate. The doctor takes small tissue samples from many areas of the prostate. Ultrasound may be used to guide the needle. A pathologist checks for cancer cells in the tissue.
You may want to ask the doctor these questions before having a biopsy:
Where will the biopsy take place? Will I have to go to the hospital?
How long will it take? Will I be awake? Will it hurt?
What are the risks? What are the chances of infection or bleeding after the biopsy?
How long will it take me to recover?
How soon will I know the results?
If I do have cancer, who will talk to me about the next steps? When?
If Cancer Is Not Found
If the physical exam and test results do not suggest cancer, your doctor may suggest medicine to reduce symptoms caused by an enlarged prostate. Surgery also can relieve these symptoms. The surgery most often used in such cases is transurethral resection of the prostate (TURP or TUR). In TURP, an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine. You should talk to your doctor about the best treatment option.
If Cancer Is Found
If cancer is present, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow. Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread.One system of grading prostate cancer uses G1 through G4. Another way of grading is with the Gleason score. The pathologist gives each area of cancer a grade of 1 through 5. The pathologist adds the two most common grades together to make a Gleason score. Or the pathologist may add the most common grade and the highest (most abnormal) grade to get the score. Gleason scores can range from 2 to 10.