Your doctor inserts a gloved finger into the rectum to feel the condition of the prostate that lies close to the rectal wall. If your doctor feels something suspicious such as a lump or bump, further tests will be carried out. Other tests are needed to enable a more accurate diagnosis.
A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate.
As men get older the prostate gland grows and so the PSA is likely to rise. A high PSA may indicate some type of prostate disease. The level can be raised due to inflammation of the prostate (prostatitis) and enlargement of the prostate gland (benign prostatic hyperplasia or BPH).
PSA is a useful tool for diagnosing and monitoring prostate diseases, but further tests are required to confirm which condition is present.
Trans rectal ultrasound guided biopsies are discussed elsewhere. Click on the link to find out more.
Staging and Grading
The tests performed are used to determine the stage of the prostate cancer. Biopsy specimens are analysed to find out how aggressive the cancer is.
The staging system describes how far the cancer has spread within and/or beyond the prostate capsule.
Stage T1: The tumour is confined within the prostate and the prostate feels normal. It is usually diagnosed on the basis of a raised PSA.
Stage T2: The tumour is confined to the prostate but the prostate feels irregular to examination
Stage T3: The tumour has spread just beyond the shell of the prostate into nearby tissue and / or the seminal vesicles at the back of the prostate gland.
Stage T4: The tumour has spread into adjacent organs such as the bladder, rectum, or pelvic side wall.
Prostate cancer can also spread to lymph glands and to other parts of the body such as to bone and other organs. if the cancer is advanced, then symptoms may include fatigue, weight loss, bone pain and difficulty urinating. It is important to note that prostate cancer does not typically produce symptoms until it is advanced. This is why it is important for men to get PSA tests as this is the main way that prostate cancer will be diagnosed before it has spread.
The International Society of Uropathologists (ISUP) has now recommended a simplified grading system, based on the Gleason Score which grades the cancer from 1-5. The Gleason Score was a score out of 10, but typically the lowest score was 6 which does not make inherent sense. The ISUP classification addresses this so that:
- ISUP 1 - Gleason Score 3+3 = 6
- ISUP 2 - Gleason 3+4 = 7
- ISUP 3 - Gleason 4+3 = 7
- ISUP 4 - Gleason Score 8
- ISUP 5 - Gleason Score 9,10
Nuclear Scans - Bone Scans / PSMA Scans
Your doctor may want to see if the cancer has metastasised and has affected your bones or other organs. A bone scan or a Gallium-68 PSMA Scan may be ordered. In these scans, a small amount of radioactive material is injected into your arm. You will then be scanned an hour later to ascertain whether the cancer has spread.