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How Is Prostate Cancer Diagnosed?
Prostate cancer is diagnosed step by step, and no single test does it alone. It usually starts with two simple screenings: a PSA blood test and a digital rectal exam. If those point to a possible problem, your doctor may recommend further tests, and only a biopsy can confirm cancer for certain. Understanding the path ahead makes it far less frightening, so here is what to expect at each step.
Detecting prostate cancer early gives you the best chance of living a long, healthy life. More than 99 percent of men survive prostate cancer when it is caught early, which is exactly why screening matters.
The Path to a Diagnosis
Here is how prostate cancer is diagnosed, step by step. Select any step to learn more about what to expect.
- PSA Blood TestA simple blood test that measures a protein made by the prostate. Often the first step.
- Digital Rectal ExamA quick physical exam so your doctor can feel the prostate for lumps or hard areas.
- Biopsy and ImagingIf results are abnormal, a tissue sample and imaging can confirm and locate cancer.
- Additional TestingNewer tests help gauge how likely and how aggressive prostate cancer may be.
Start With a Conversation
The decision to get tested is personal, and it is best made with a doctor who knows your history. Important factors include your age, race, family history, and any history of exposure to Agent Orange, other defoliants, or pesticides. All men are at risk of prostate cancer, so it is worth having the conversation. Not sure whether it is time? Read our guide on when you should get tested, or check your personal risk factors.
The First Steps: PSA Test and Digital Rectal Exam
A general practitioner or a urologist can perform a full prostate exam, which usually includes a PSA blood test and a digital rectal exam (DRE).
PSA Blood Test
A Prostate Specific Antigen (PSA) test measures the level of PSA, a substance made by the prostate, in your blood. PSA can be higher in men who have prostate cancer, though it may also be elevated by other, non-cancerous conditions. It is a simple blood draw and often the very first step in screening. Learn more about PSA screening.
Digital Rectal Exam (DRE)
During a digital rectal exam, a doctor or nurse inserts a gloved, lubricated finger into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities. It takes only a moment and gives your doctor information a blood test cannot. Learn more about the digital rectal exam.
No Doctor or Insurance? We Can Help.
If you do not have a doctor, do not have insurance, and cannot afford a test, contact us to find out what free screenings are available in your area. Many screenings happen in September, during Prostate Cancer Awareness Month.
What if My Test Results Are Abnormal?
If a PSA test or digital rectal exam suggests you might have prostate cancer, your doctor will recommend further testing. Your PSA may simply be repeated, or you may be referred to a specialist for a transrectal ultrasound and a prostate biopsy. In a biopsy, a small tissue sample is taken from your prostate.
This is an important point to remember: prostate cancer can only be diagnosed with a tissue sample. A high PSA or an abnormal exam raises a question; a biopsy is what answers it. Learn more about biopsy and imaging.
Additional Tests That Refine the Picture
Beyond the PSA, DRE, and biopsy, research has produced tests that can help a doctor gauge both the chance of finding cancer during a biopsy and how aggressive that cancer is likely to be. These help you and your doctor make an informed decision. Explore them in depth on our additional testing page.
Phi (Prostate Health Index)
The Prostate Health Index combines three blood tests into a single “Phi Score.” For a man with an elevated PSA, it gives more accurate information to better determine the probability of finding cancer during a biopsy.
PCA3
PCA3 is a urine test that looks at the expression of PCA3, a gene specific to prostate cancer, to more accurately gauge the possibility of prostate cancer. The PCA3 score is used to help decide whether a repeat biopsy is needed.
4Kscore
The 4Kscore is a blood test that provides a patient-specific probability of finding an aggressive form of prostate cancer during a biopsy. It measures total PSA, free PSA, intact PSA, and an enzyme called human kallikrein 2, then combines the results with your age and physical exam to estimate the chance of aggressive disease. Doctors and patients can use that number to decide whether to proceed with a biopsy.
What if I Am Diagnosed With Prostate Cancer?
Many people have stood exactly where you are standing. Don’t lose hope: more than 2.9 million American men have been diagnosed with prostate cancer and are alive today. Your first step is to learn the specifics of your cancer, including your stage (the location and extent of the tumor) and your grade, also known as the Gleason score (a measure of how aggressive the tumor is). From there, you can explore treatment options with your healthcare team, seek a second opinion, and connect with others who have been through it.
Get a Free PSA Test in Nebraska
The whole process starts with one simple blood test. The Nebraska Prostate Cancer Alliance offers free PSA tests to men 40 and older at Cruisin’ for a Cure and community events across Nebraska. No insurance required. Results stay private. Early detection saves lives.
Keep Learning
Explore related topics: the symptoms to watch for, whether you are at risk, and when you should get tested.