One of the most frequently used tools to diagnose prostate conditions is a blood test to check the level of prostate-specific antigen (PSA). If the PSA level is too high, this suggests that the cells in the prostate are behaving unusually. This could be because of a tumour in the prostate, but also because of an infection or a benign enlargement of the prostate.
Your doctor will do a rectal examination with a finger to feel the size, shape, and consistency of the prostate (Fig. 1). This test is known as digital rectal examination (DRE).
In some cases your doctor may recommend to make a scan of the lower urinary tract. Different types of scans are available, such as ultrasound, CT scan, MRI scan, and bone scan.
None of these tools will provide a definite answer on whether or not you have prostate cancer. Your doctor will use the test results, together with your age and your family history, to estimate the risk of you having prostate cancer.
If the risk is high, you may need a biopsy of prostate tissue. This test is done to confirm if you have a tumour or not. During a biopsy, between 8 and 12 samples of prostate tissue are taken. If you take medication to prevent blood clotting, discuss with your doctor if you need to stop taking it before the procedure. Before the biopsy your doctor will give you antibiotics and make sure your rectum and colon are cleaned to prevent infection.
You will receive local anaesthesia. Then the doctor inserts a needle through your rectum and into the prostate. The samples are taken from different parts of the prostate gland. If you have had a scan, the biopsy may be directed more to the area of the prostate that showed a possible tumour. The tissue samples are analysed by the pathologistin order to help determine future treatment.
After a prostate biopsy you may have some blood in your urine or semen. If you develop a fever, you need to contact your doctor immediately.
Although a biopsy is a reliable diagnostic tool, it may be possible that a tumour in the prostate is missed.