Prostate Cancer Tests and Diagnosis

Hearing that you might have prostate cancer can be hard. You might have questions, concerns or be confused about what will happen next. Learning how prostate cancer is diagnosed can help you feel more prepared and confident as you go forward.

At Banner MD Anderson Cancer Center, finding out if you have prostate cancer is a step-by-step process. Catching it early usually means you have more treatment options and better outcomes. The diagnosis usually involves more than one test, using advanced scans and precise tools to give your care team a clear view of what’s going on.

How prostate cancer is found

Prostate cancer does not always cause symptoms, especially in the early stages. Testing may be suggested for different reasons, such as:

• Problems with urination, like a weak stream or blood in urine or semen
• High PSA levels found in a blood test
• Unusual results during a digital rectal exam (DRE)
• Risk factors like a family history, inherited genetic changes or being Black/African American
• Unexpected findings on imaging done for other health issues

Your health care provider will consider your age, overall health and personal risk factors when deciding if testing is the right next step.

What to expect during the diagnostic process

A prostate cancer diagnosis usually isn’t based on just one test. Instead, it involves a careful evaluation that might include:

• Looking at your medical and family history
• Talking about your symptoms and concerns
• Shared decision-making about next steps
• A step-by-step testing path, like blood tests, imaging and a biopsy

Your care team will tell you what each test checks for, why it’s needed, and how the results help decide what happens next.

Common tests used to diagnose prostate cancer

PSA blood test

The prostate-specific antigen (PSA) test checks the amount of PSA in your blood. The prostate makes PSA and higher levels can mean prostate cancer.

Most men who do not have prostate cancer have PSA levels below 4 ng/mL. Men with PSA levels between four and 10 (called the borderline range) have about a one in four chance of having prostate cancer. If the PSA is over 10, the chance goes up to over 50%.

PSA levels can also go up for other reasons, such as:

• Enlarged prostate
• Infection or inflammation of the prostate
• Recent ejaculation or prostate procedures

Providers often look at more than just one PSA test. They may include:

• PSA velocity (how fast PSA rises over time)
• PSA density (PSA level compared to the size)
• Free PSA (how PSA in the blood

Sometimes, repeat PSA tests are done to see if results change. If PSA levels stay high or show concern, your provider might suggest an MRI to get a closer look.

Learn more about advanced evaluation through Banner’s PSA Clinic.

Digital rectal exam (DRE)

During a digital rectal exam, your provider gently feels the prostate through your rectum. They check for lumps or bumps, hard or firm areas and any changes in shape or symmetry. The DRE complements PSA testing. Some prostate cancers can be found during the exam even if the PSA levels are not high.

MRI of the prostate

A multiparametric MRI (mpMRI) makes detailed images of the prostate and nearby tissues.

Doctors use a PIRADS score to report MRI results. This score shows how suspicious the area looks:

• PIRADS 1-2: Unlikely to be cancer
• PIRADS 3: Maybe cancer, unsure
• PIRADS 4-5: More likely to be cancer

MRI helps to:

• Find problem areas
• Avoid unnecessary biopsies
• Guide targeted biopsies if cancer is suspected

Ultrasound and imaging tools

Transrectal ultrasound (TRUS) uses sound waves to create images of the prostate. While ultrasound alone cannot diagnose cancer, it is often used during biopsies.

Many clinics use a specialized biopsy called a fusion biopsy. It combines MRI and real-time ultrasound images to help specialists better visualize and target suspicious areas on MRI.

Prostate biopsy

A biopsy is the only way to confirm prostate cancer.

There are two main types of biopsies:

• Systemic biopsy, which takes samples from different parts of the prostate
• MRI-targeted biopsy, which looks at areas that seem unusual on imaging

Biopsies can be done using:

• A transrectal approach
• A transperineal approach, which might lower the chance of infection

During the biopsy, small tissue samples are taken and examined by a pathologist. Most people can go home the same day. It is common to have temporary soreness and mild bleeding in urine or semen. Your care team will tell you how to recover and what warning signs to watch for.

Additional tests for staging

If prostate cancer is diagnosed, additional imaging may be used to see if it has spread beyond the prostate. 

• CT scan: This scan looks at nearby organs and lymph nodes to check for cancer spread.
• Bone scan: This scan checks if the cancer has spread to the bones, which can happen in more advanced cases.
• PET scans, like PSMA PET: These scans find very small areas of prostate cancer that other scans might miss. They help guide accurate staging and precise treatment.

Understanding your diagnosis

When you are diagnosed with prostate cancer, your care team looks at more than just whether there is cancer. Two things help explain what the cancer may behave: grade and stage.

Grade and stage help specialists understand how serious the cancer is, how far it has spread and what treatment might work best for you.

Prostate cancer grade

Grade describes what prostate cancer cells look like under a microscope after a biopsy. Cancer specialists use the Gleason score and Grade Group (1-5) to describe grade. 

• Gleason 6 (Grade Group 1): Low grade
• Gleason 7-8 (Grade Group 2-3): Intermediate grade
• Gleason 9-10 (Grade Group 4-5): High grade (which means the cancer is more aggressive) 

Prostate cancer stage

Stage describes where the cancer is located and whether it has spread. Specialists use the TNM system:

• T (Tumor): Size of the tumor and whether it extends beyond the prostate
• N (Nodes): Whether cancer has spread to the lymph nodes
• M (Metastasis): Whether cancer has spread to distant areas, such as bones

After TNM staging, prostate cancer is grouped into stages from Stage I to Stage IV:

• Stage I (1): Cancer is small and slow growing; found only in the prostate
• Stage II (2): Cancer is still confined to the prostate; may be more aggressive
• Stage III (3): Cancer has spread outside the prostate; the survival rate is still high
• Stage IV (4): Cancer has spread to lymph nodes, bones or other organs; requires advanced and often combination treatment

How grading and staging influence treatment

Grade and stage help guide treatment decisions. Some low-grade, early-stage cancers may be monitored with active surveillance. Higher-grade or advanced cancers often need treatment sooner. 

Your Banner MD Anderson team will explain your results, review your options with you and help you make informed decisions.

How Banner MD Anderson supports your diagnosis

As a patient, your diagnosis is supported by a full care team, including:

• Multidisciplinary review by specialists in urology, medical oncology, radiation oncology, radiology and pathology
• Nurse navigation to help coordinate testing, appointments and next steps
• Genetic counseling when an inherited cancer risk is suspected
• Clear next steps and early access to prostate cancer specialists

Your care plan is built around you, your diagnosis and your goals. 

Where to go next

• Learn more about prostate cancer basics
• Review screening and risk factors
• Explore prostate cancer treatment options  

Request an appointment