PATIENT ALERT:  Masks are now optional in our VOA offices. If you are immunocompromised or feeling ill, masking is strongly encouraged. Thank you. CLICK HERE for more details​​​​​​.

Prostate Cancer

Prostate Cancer Testing & Diagnosis

Your doctor can check for prostate cancer before you have any symptoms. During an office visit, your doctor will ask about your personal and family medical history. You’ll have a physical exam. You may also have one or both of the following tests:

  • Digital rectal exam: Your doctor inserts a lubricated, gloved finger into the rectum and feels your prostate through the rectal wall. Your prostate is checked for hard or lumpy areas. This is sometimes used as a screening method along with the PSA test.
  • Blood test for prostate-specific antigen (PSA): A lab checks the level of PSA in your blood sample. The prostate makes PSA. A high PSA level is commonly caused by BPH or prostatitis (inflammation of the prostate). Prostate cancer may also cause a high PSA level. See the NCI fact sheet The Prostate-Specific Antigen (PSA) Test: Questions and Answers.

Most men start screening for prostate cancer at age 50, but talk to your primary care doctor about your family history and your risk factors. Some men start screening earlier. 

Related Read: When Should Men Get a Prostate Cancer Screening?

The digital rectal exam and PSA test can detect a problem in the prostate. However, they can’t show whether the problem is cancer or a less serious condition. If you have abnormal test results, your doctor may suggest other tests to make a diagnosis. For example, your visit may include other lab tests, such as a urine test to check for blood or infection. Your doctor may order other procedures:

  • Transrectal ultrasound: The doctor inserts a probe into the rectum to check your prostate for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.
  • Transrectal biopsy: A biopsy is the removal of tissue to look for cancer cells. It’s the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.

If Prostate Cancer Is Found

If cancer cells are found, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow. Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. 

One system of grading is the Gleason score. Gleason scores range from 2 to 10. To come up with the Gleason score, the pathologist uses a microscope to look at the patterns of cells in the prostate tissue. The most common pattern is given a grade of 1 (most like normal cells) to 5 (most abnormal). If there is a second most common pattern, the pathologist gives it a grade of 1 to 5, and adds the two most common grades together to make the Gleason score. If only one pattern is seen, the pathologist counts it twice. For example, 5 + 5 = 10. A high Gleason score (such as 10) means a high-grade prostate tumor. High-grade tumors are more likely than low-grade tumors to grow quickly and spread.

Related Read: Understanding the Prostate Biopsy Gleason Score

Another system of grading prostate cancer uses grade groups 1 through 5 (G1 to G5). Of the five grades of prostate cancer, Stage 1 is low grade and slower to grow, while Stage 5 is high grade, grows rapidly, and is more likely to spread. The grade is related to the Gleason score determined during the biopsy. 

  • Grade 1: Gleason score of 6 or less
  • Grade 2: Gleason score of 3+4=7
  • Grade 3: Gleason score of 4+3=7
  • Grade 4: Gleason score of 8
  • Grade 5: Gleason score of 9 or 10

G4 is more likely than G1, G2, or G3 to grow quickly and spread.

The stage of prostate cancer is determined in a slightly different way than some other types of cancer. Staging considers the tumor size, lymph node involvement, and whether it's spread to other areas of the body, as well as the prostate cancer's grade group and PSA levels. Doctors use tumor grade along with your age and other factors to suggest prostate cancer treatment options.

Related Read: How to Understand a Prostate Cancer Pathology Report

What to Expect If You've Been Diagnosed with Prostate Cancer

If test results show that prostate cancer has been detected, the next step is to consult with a prostate cancer specialist to discuss all of your treatment options. For many men, treatment is not always necessary right away. Learn more about prostate cancer treatments. The oncologists at Virginia Oncology Associates are here to guide newly diagnosed prostate cancer patients through this journey. We work with you to create personalized treatment plans for prostate cancer based on your specific situation. Our cancer centers are located throughout Hampton Roads and Eastern North Carolina.

Listen to our podcast episode about prostate cancer dectection and the latest on treatment options.

Early detection and self-advocacy are the keys to combating prostate cancer. In this episode of Cancer Care Connections, medical oncologist and president of Virginia Oncology Associates, Dr. Mark Fleming shares his insights and personal experience with prostate cancer. He also discusses the importance of the PSA test, which plays a critical role in early diagnosis of prostate cancer