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Summary:
This guide explains how doctors check for prostate cancer, walking readers through the screening and diagnostic process from initial risk assessment to definitive diagnosis. It clarifies what to expect, why each test is used, and how early detection supports better outcomes.
- Doctors begin by reviewing age, family history, genetics, lifestyle factors, and other risks linked to prostate cancer.
- A PSA blood test measures prostate-specific antigen levels to determine whether further testing may be needed.
- A digital rectal exam (DRE) allows physicians to feel the prostate for abnormalities like nodules or firmness.
- If results are concerning, advanced imaging such as multiparametric MRI (mpMRI) helps identify suspicious areas.
- An MRI- or ultrasound-guided biopsy provides a more definitive diagnosis and helps determine how aggressive the cancer may be.
Many men can feel anxious or even intimidated about prostate cancer and the screening and diagnostic procedures related to it. Learning how doctors check for prostate cancer can make this process clearer, helping to dispel potential concerns about this process.
Keep reading for a brief review of what prostate cancer is. Then, learn more about how doctors check for prostate cancer, including common screening and diagnostic procedures. Then, find answers to frequently asked questions about prostate cancer, how physicians work to identify it, and what the process means for patients.
What Is Prostate Cancer?
The prostate gland is found in men that sits below the bladder, in front of the rectum, and around the urethra. The prostate’s main function is to contribute fluid to semen. It also helps to move semen out of the urethra and regulate urine flow.
Prostate cancer stems from out-of-control growth of cells in the prostate, as the American Cancer Society reminds us. The exact cause of prostate cancer is not known, but certain risk factors, both genetic and lifestyle-related, can lead to a higher risk of developing prostate cancer.
Prostate cancer is the second-most common form of cancer found in men, and older men are at higher risk of this disease than younger ones. More than half of all prostate cancer cases are found in men aged 65 and older. However, prostate cancer also occurs in men younger than this age group.
Prostate cancer is often, but not always, slow in its initial development and growth. Additionally, prostate cancer can spread to other areas of the body if it is not treated.
Early detection of prostate cancer is important for both slow-growing and more aggressive prostate cancer. Prostate cancer often has no symptoms in its early stages, so regular screenings can help to identify the disease before it has the opportunity to develop and spread. For some patients, early identification can lead to better outcomes.
Earlier identification can also offer patients more options for treatment, potentially including minimally invasive procedures.
How Do Doctors Check for Prostate Cancer?
Initial Patient Assessment
Checking for prostate cancer starts with an initial evaluation of a patient by a physician, including a medical and family history. Urologists typically check patients for prostate cancer, but primary care physicians also conduct screenings.
A physician will either draw on existing records or have a discussion with their patient to review key risk factors for prostate cancer. These include:
- Age. Prostate cancer is more likely to develop in men, including otherwise healthy men, as they age.
- Inherited gene mutations. Certain gene mutations increase the risk of prostate cancer, although they don’t guarantee that an individual will be diagnosed with prostate cancer.
- Family history. The risk of prostate cancer increases when a blood relative has previously been diagnosed with prostate cancer.
- Race and ethnicity. Men with African ancestry have a higher risk of prostate cancer, as compared to many other groups of men.
- Lifestyle factors. Diet, smoking, obesity, and certain other factors can increase the risk of prostate cancer.
PSA Blood Test
The prostate produces a specific and identifiable protein, prostate-specific antigen (PSA). Physicians will perform a blood test to measure PSA level as one of the first steps in testing for prostate cancer.
Most men who do not have prostate cancer have a PSA level of 4 nanograms per milliliter (ng/mL) of blood or less, as the American Cancer Society explains. The 4-10 ng/mL range is considered borderline, and a level of 10 ng/mL or higher indicates it’s more likely than not (a greater than 50% chance) that a patient has prostate cancer.
However, PSA testing is not conclusive. No measurement or level of PSA can guarantee that someone does or does not have prostate cancer. Instead, PSA is a helpful indicator used to determine if further testing is needed.
Digital Rectal Exam
A digital rectal exam (DRE) is another first-line exam used by doctors check for signs of prostate cancer. This is a brief and painless exam. A physician uses a gloved, lubricated finger to feel the prostate gland through the rectum.
Physicians feel for signs of an abnormal prostate gland, such as firmness, nodules, and asymmetry. Similar to a PSA test, a DRE cannot conclusively diagnose prostate cancer by itself. However, the findings from this exam can help physicians decide whether and how to proceed with further testing.
Advanced Imaging
If a DRE and/or PSA test reveals abnormal findings, physicians may use advanced imaging tools to view the prostate.
These include multiparametric MRI (mpMRI), which uses a specific protocol of imaging sequences to create a detailed model of the prostate. A radiologist reviews the results of the mpMRI to locate suspicious lesions on the prostate, or a lack thereof. The accuracy of mpMRI for diagnosing prostate cancer is notably high, with a negative predictive value of 91-100%.
Advanced imaging, such as mpMRI and ultrasound, is also used to guide the biopsy process, enabling physicians to take targeted samples from suspicious areas rather than random samples.
MRI-Guided or Ultrasound-Guided Biopsy
A biopsy for prostate cancer takes a tissue sample from the prostate, which is then analyzed by a pathologist to determine if cancer cells are present. As Johns Hopkins Medicine points out, biopsies normally offer a conclusive diagnosis. A biopsy also generally allows providers to determine the grade of the cancer – how aggressive it is.
Biopsies can lead to infection or bleeding, with blood found in urine or semen. However, their benefits generally outweigh their risks when there are clear signs that a patient may have prostate cancer.
Advanced imaging is increasingly used to guide the biopsy process, allowing physicians to take samples from specific areas of concern as opposed to the older, traditional approach of random samples.
Frequently Asked Questions About Prostate Cancer Screening and Diagnosis
What are the 5 warning signs of prostate cancer?
Prostate cancer often doesn’t present symptoms in its early stages, meaning warning signs are frequently absent. Doctors check for prostate cancer using regular screenings due in part to the lack of symptoms. As prostate cancer progresses, it can present symptoms such as:
- Difficulty urinating or a weak urine stream.
- Blood in urine or semen.
- Pelvic discomfort.
- Bone pain, in advanced cases.
- Unexplained weight loss or fatigue.
Do doctors still check the prostate with their fingers?
Yes, a digital rectal exam (DRE) is still a common, first-line procedure used by doctors to check for prostate cancer. DREs are not a conclusive test, and their accuracy is limited by the physician’s ability to feel abnormalities in the prostate.
However, as an initial screening procedure and in conjunction with PSA testing, they can still offer value in terms of determining the next steps for screening and testing for prostate cancer.
Can a doctor tell if you have prostate cancer by feeling it?
A physician can perform a first-line prostate cancer screening by using a digital rectal exam (DRE) to check the prostate for abnormalities like nodules, unusual firmness, and asymmetry. However, a physician cannot conclusively diagnose prostate cancer only by using a DRE. Diagnosis of prostate cancer requires a biopsy.
A DRE is an early screening procedure that, along with a prostate-specific antigen (PSA) blood test, can help physicians understand whether more testing for prostate cancer is needed.
At what age should a man get checked for prostate cancer?
Prostate Laser Center recommends that otherwise healthy men consider annual screening for prostate cancer starting at age 45.
This is based on our experience treating patients and our review of the data that led to the United States Preventive Services Task Force (USPSTF) prostate cancer screening recommendation. The USPSTF recommendation suggests that men ages 55-69 make an individual decision about undergoing periodic PSA blood tests as a screening measure and discourages testing for men ages 70 and older.
How do you self-check your prostate?
There is no reliable self-exam for prostate cancer. Only trained clinicians can properly conduct a digital rectal exam (DRE). The same is true for other screening and diagnostic procedures, whether a PSA blood test, an mpMRI of the prostate, or a biopsy.
Minimally Invasive, MRI-Guided Treatment Options for Prostate Cancer
Prostate Laser Center offers minimally invasive, MRI-guided treatment options for prostate cancer to qualifying patients. Our treatment options offer favorable side-effect profiles as compared to certain other common treatments for prostate cancer.
NOTE: The information provided on this website is general medical information and does not establish a physician-patient relationship. Please discuss your particular situation with a qualified medical professional.
