Your doctor will start by asking about your symptoms, your medical history and your family history of prostate cancer. Your doctor will want to know whether you have ever been diagnosed with any noncancerous condition of the prostate, such as prostatitis (inflammation of the prostate) or enlarged prostate (benign prostatic hypertrophy), that could have symptoms similar to prostate cancer.
Your doctor will examine you, and will do a digital rectal exam to feel the prostate gland. In this exam, the doctor will insert his or her index finger into your rectum and gently feel the surface of the prostate through the rectal wall to check for lumps, hardness and enlargement. He or she also will ask you for a urine specimen, and probably will order a prostate-specific antigen (PSA) blood test. PSA is a protein made by the prostate and secreted into the semen. Prostate cancer and certain noncancerous prostate disorders can cause increased amounts of PSA to leak out of the prostate into the blood.
If the PSA level in your blood is higher than normal or your digital rectal exam shows a possible problem, your doctor may order additional tests, such as a prostate needle biopsy. In this procedure, a needle is used to remove small pieces of tissue from the top, middle and bottom parts of the prostate on both the left and the right sides. Your doctor also may want to take tissue samples from any suspicious areas identified by the digital rectal exam or ultrasound. The tissue will be examined by a pathologist, a physician who specializes in the diagnosis of diseased tissues.
If the results of your biopsy confirm that you have prostate cancer, the pathologist also will assign a Gleason score to your tumor. The Gleason score is an indication of how abnormal the cancer cells look under a microscope compared to normal prostate cells. The score provides a rough estimate of how likely the cancer is to grow and spread rapidly. Gleason scores generally indicate the following:
Gleason score (total) of 2 to 4: Low-grade or nonaggressive cancer
Gleason score (total) of 5 to7: Intermediate grade
Gleason score (total) of 8 or higher: High-grade or aggressive cancer