Prostate cancer tests

Usually you begin by seeing your family doctor (GP) who will examine you and ask about your general health. There are several tests that may be used to diagnose prostate cancer.

PSA is a protein produced by both normal and cancerous prostate cells. A high level of PSA can be a sign of cancer. But your PSA level can also be raised in prostate conditions that are not cancer (are benign) or if you have an infection. To check for PSA (prostate specific antigen), your doctor takes a sample of your blood. Your doctor may want to rule out a urine infection before carrying out a test. If you've had a urine infection, you shouldn't have a PSA test for at least a month after your treatment finishes. PSA is usually measured in nanograms per millilitre of blood (ng/ml).

There is no one PSA reading that is considered normal. The reading varies from man to man and the normal level increases as you get older. But the following values are a rough guide

• 3 ng/ml or less is considered to be in the normal range for a man under 60 years old
• 4 ng/ml or less is normal for a man aged 60 to 69
• 5 ng/ml or less is normal if you are aged over 70.

A reading higher than these values, but less than 10 ng/ml is usually due to a benign enlarged prostate. A reading higher than 10 ng/ml may also be caused by benign prostate disease, but the higher the level of PSA, the more likely it is to be cancer. Sometimes a cancer may be diagnosed in a man with a PSA reading within the normal range. But usually, the higher the reading, the more likely it is to be cancer. Some men have PSA levels in the hundreds (or even thousands) when they are diagnosed. The higher the level of PSA at diagnosis, the more likely the cancer is to spread quickly. There is information about the PSA blood test in the screening for prostate cancer section.

PSA blood tests are also used to monitor how well prostate cancer treatment works or to decide whether you need treatment. If your PSA is stable, it is a sign that a cancer is not growing or spreading. Successful treatment shrinks cancer and so the PSA level in the blood then falls.

UK Prostate Link can direct you to general information about the PSA test for prostate cancer.

Your doctor puts a gloved finger into your back passage (rectum) to feel your prostate gland and check for abnormal signs, such as a lumpy, hard prostate. Doctors call this test a digital rectal examination (DRE).

You may also have a rectal ultrasound scan to examine the prostate gland. You will need to make sure you have had a bowel movement beforehand so your rectum is empty when you go for your appointment. A small ultrasound device is put into your back passage. It produces sound waves to create a clear picture of the prostate gland. This test is uncomfortable, but shouldn't hurt. It does not take long.

If the doctor finds a lump or hardening of your prostate during your rectal examination, your specialist may take a sample of cells (a biopsy) to examine under a microscope. The biopsy is most often done through your back passage (rectum) using a transrectal ultrasound scanner. But you can also have a biopsy taken through the skin behind your testicles (the perineum) or while you are having a cystoscopy examination.

You have the biopsy in the outpatient department. When you arrive at the hospital, a nurse will meet you. The nurse will ask you some questions and make sure you understand what will happen. Before the biopsy, you may have blood taken for a repeat PSA test. You will have antibiotics to take to help stop infection developing after the biopsy. You can have antibiotics in 3 different ways

• As tablets or capsules
• By injection into a vein
• Directly into the rectum in a suppository.

Before you have the biopsy, the doctor will show you the ultrasound machine and the very fine needle used to take the tissue samples. The needle is attached to a firing mechanism and the doctor will show you this and demonstrate the noise it makes so you know what to expect. The doctor will explain the whole procedure before they start and you can ask any questions you need to.

The doctor will take a series of small tissue samples from the prostate. First, you lie down on your left side. Your specialist will inject local anaesthetic into your back passage (rectum), to numb the area and make the procedure as painless as possible. The doctor then puts the ultrasound probe into your rectum to examine your prostate. To get the samples of prostate tissue, the fine needle is pushed along the ultrasound probe and into the prostate gland. This is a little uncomfortable, and may be painful but does not take long. You will feel a slight jolt each time the needle is fired. This may happen up to 12 times, as the doctor takes the different tissue samples.

After the test, you have a rest and a drink. You can then go home. It is very important to drink a lot of fluids for the next 24 hours. Your prostate gland will bleed slightly. And there is a risk of urine infection. Drinking plenty of fluid flushes out the blood and helps to stop any infection from developing. You will see a small amount of blood in your urine and semen after the test. This may carry on for a few weeks, but is nothing to worry about. But you should contact your doctor if you think you are getting an infection. 

You should phone your doctor immediately or go to casualty if you have

• Shivering or shaking
• A high temperature
• A lot of difficulty passing urine
• A need to pass urine very often
• A lot of blood in your urine or bowel movement

You will need antibiotics straight away if you have a urine infection.

If a prostate biopsy is negative but your doctor still thinks there may be a small prostate cancer present, they may suggest that you have a transperineal template biopsy. This procedure can sometimes find a prostate cancer that has been missed by other types of biopsy. You have it under local anaesthetic or general anaesthetic and have a tube (catheter) in place to drain urine. You have antibiotics beforehand. 

To do the biopsy the doctor puts a template with holes approximately 5 mm apart over the area of skin behind the testicles (the perineum). Under transrectal ultrasound guidance the doctor puts a biopsy needle in through the different holes in the template, to take samples from particular areas of the prostate.

This test is usually called an IVU or IVP (intravenous pyelogram). It is not done very often to diagnose prostate cancer. Your doctor may suggest one if you have had a lot of difficulty passing urine, and they suspect that you have a blockage or a kidney problem. It shows up abnormalities in

• The kidneys
• The urinary system

You have an IVU in the X-ray department and it takes about an hour. The doctor injects a dye into a vein, usually in your arm. The dye travels through your bloodstream to your kidneys. The doctor can watch the dye go from your kidneys to the bladder on an X-ray screen. It is possible to have an allergic reaction to the dye but this is not common. Your doctor will be aware of this and will watch for any signs of a reaction. You should tell your doctor about any allergies you have before the injection, and also if you are diabetic.

The dye sometimes makes you feel hot and flushed for a few minutes. But this feeling slowly disappears and you can usually go home as soon as the test is over.

If your GP finds anything that could be due to a cancer they will refer you to hospital for further tests. The tests are described on the next page. They are used to diagnose prostate cancer or to find out whether it has spread. You won't need to have all of the tests. Your doctor will discuss the tests you'll have and will explain what they are for.

Waiting for test results or for further tests can be a very worrying time. You may have contact details for a specialist nurse and you can contact them for information if you need to. It may help to talk to a close friend or relative about how you feel. You can also contact the Cancer Research UK nurses.

Our prostate cancer organisations page gives details of people who can help and support you. You can also find details of counselling organisations in our counselling section. Our prostate cancer reading list has information about books and leaflets about prostate cancer and its treatment.