The symptoms of prostate cancer may take years to appear since this is typically a slow growing cancer. Furthermore, the urinary symptoms of prostate cancer are also seen in other prostatic conditions such as benign prostatic hyperplasia (BPH) and prostatitis or inflammation of the prostate.
An outline of the steps taken to diagnosis prostate cancer is given below:
Details of symptoms such as their duration and severity are obtained along with details of any family history of the condition.
A routine urine and blood examination is performed to check for infection.
A digital rectal examination is carried out. This is a test performed by a nurse or doctor to feel for abnormalities of the prostate through the wall of the rectum. The area is checked for enlargement, irregularity or hardening of the prostate which it may be possible to feel with the finger as the rectum lies behind the prostate gland. The procedure is not usually painful but may be a bit uncomfortable. In BPH, the enlargement feels smooth and firm, while in prostate cancer the gland may feel hard and lumpy.
Blood tests are carried out to measure prostate-specific antigen (PSA) levels. PSA is a protein secreted by the prostate gland and small amounts are usually present in a man's blood. The PSA level increases with age but is significantly raised in the case of prostate cancer. However, this test is not specific for prostate cancer and is raised in other conditions such as prostatitis and BPH and even after physical activity or sex.
A transrectal ultrasound examination may be performed which involves a probe being inserted into the rectum so that ultrasound waves can be used to generate images of the prostate gland for evaluation.
Cystoscopy may be performed to check the urethra and the inside of the bladder.
Biopsy is the gold standard for detecting and confirming prostate cancer. A small sample of tissue is taken and examined under a microscope for the presence of cancer cells.
In more advanced cases of prostate cancer, the whole body is examined using imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT) to assess the spread of cancer to other organs. A bone scan may also be recommended to check for involvement of the bones.
Reviewed by Sally Robertson, BSc