Virginia Commonwealth University

VCU Massey Cancer Center

Diagnostic procedures

Procedures used to evaluate prostate problems

In addition to an annual physical examination that includes blood, urine and, possibly, other laboratory tests, the National Cancer Institute suggests consulting your physician about these recommendations for the evaluation of the prostate gland:

  • DRE (digital rectal examination) – a physician or nurse places a gloved and lubricated finger into the rectum to examine the rectum and feel the prostate gland. As recommended by your physician, DREs are usually conducted annually for men over the age of 50. Men in high-risk groups, such as African Americans or those with a strong family history of prostate cancer, should consult their physicians about being tested at a younger age or more often.
  • PSA (prostate-specific antigen) – a blood test that measures the level of prostate-specific antigen. PSA is a substance produced by the prostate gland, which may be found in higher amounts in men who have prostate cancer. As recommended by your physician, the PSA test is usually done annually for men over the age of 50. Men in high-risk groups, such as African Americans or those with a strong family history of prostate cancer, should consult their physicians about being tested at a younger age or more often.

What are some other prostate cancer evaluation procedures?

If the results of the DRE or PSA are unusual, your physician may repeat the tests or request other procedures. These evaluation tools may include:

  • Transrectal ultrasound (TRUS) – a test using sound wave echoes to create an image of the prostate gland to visually inspect for abnormal conditions. A TRUS can show if the prostate gland is enlarged or if there are any growths in or around the prostate. Ultrasound also may be used to guide a needle for biopsies of the prostate gland and/or to guide the nitrogen probes in cryosurgery.
  • Computed tomography scan (also called a CT or CAT scan) – a diagnostic imaging procedure test that uses a combination of X-rays and computer technology to produce cross-sectional images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than standard X-rays.
  • Magnetic resonance imaging (MRI) – a diagnostic test that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body.
  • Radionuclide bone scan – a nuclear imaging method that helps to show whether the cancer has spread from the prostate gland to the bones. The test involves injecting a radioactive material into a vein that helps to locate diseased bone cells throughout the entire body.
  • Biopsy (lymph node and/or prostate) – a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope to determine if cancer or other abnormal cells are present.

The diagnosis of cancer is confirmed only by a biopsy.

What is staging of prostate cancer?

When prostate cancer is diagnosed, tests will be performed to determine how much cancer is present and if the cancer has spread from the prostate to other parts of the body. This step is called staging and is an important step toward planning a treatment program.

What are the different stages of prostate cancer?

As defined by the National Cancer Institute, the stages of prostate cancer include the following:

Stage I

  • Tumor cells are found in less than 5 percent of prostate tissue removed and the cells are not very aggressive in nature.
  • Sometimes referred to as stage A.

Stage II

  • Tumor cells are found in less than 5 percent of prostate tissue removed and the cells are more aggressive in nature

        or 

  • The tumor is larger in size, but is confined to the prostate gland.
  • Sometimes referred to as Stage B.

Stage III

  • The tumor has grown through the capsule that surrounds the prostate gland and may involve seminal vesicles (tubes that carry sperm).
  • Sometimes referred to as Stage C.

Stage IV

  • The tumor has spread to other structures beyond the seminal vesicles to any other organ or structure.
  • Sometimes referred to as Stage D1 or D2.

Recurrent

  • The cancer has come back (recurred) after treatment; it may recur in the prostate or in another part of the body.
  • Sometimes referred to as Stage D3

What is grading of prostate cancer?

Another step in the diagnostic process is grading the cancer cells by taking a measurement of how fast the tumor is likely to grow and spread. Grading is done in the laboratory with cells taken from the prostate gland during biopsy. The cancer cells are measured by how closely they resemble normal cells.

What is the Gleason System for grading cancer?

According to the National Cancer Institute, one way of grading prostate cancer is the Gleason System. This grading system is based on a number range from 2 to 10. The lower the number, the lower the grade, and the slower the cancer is growing. The higher the score, the higher the grade of the tumor. High-grade tumors grow more quickly than low-grade tumors and are more likely to spread to other parts of the body.

  • Grades under 4 – mean that the cancer cells look similar to your normal cells and the cancer is likely to be less aggressive.
  • Grades 5 to 7 – are in the intermediate range. This range means that the cancer cells do not look like normal cells and are more likely to be aggressive and grow faster. 
  • Grades 8 to 10 – indicate that the cancer cells are more likely to be very aggressive in growth.