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Doctors use three main tests to diagnose prostate cancer.

Early cancers are usually picked up by a blood test, called a PSA test, which is sometimes performed as part of a routine health check.

• The PSA test measures the amount of a substance called prostate-specific antigen (or PSA) in your blood. The prostate produces PSA to keep your semen in a liquid, fluid state. When cancer is present, more PSA seeps from your prostate into your blood.
• Your test result will show the level of PSA in a measurement of nanograms (ng) per milliliter (mL) of blood. If your levels of PSA are between 4 ng/mL and 10 ng/mL, you have a 20 percent to 50 percent chance of having cancer. If your PSA levels are above 10 ng/mL, it is highly likely that you have cancer. If you do have cancer, then the higher your level of PSA, the larger your tumor and the more likely it is to have spread.

However, not all doctors agree that it's a good idea to have a PSA test. This is because research hasn't shown that men who are screened are less likely to die from prostate cancer than those who aren't.¹ Also, PSA tests aren't fail-safe, and studies have found that men can have significant distress for up to a year if a test falsely shows they may have cancer.¹ A panel of doctors that reviewed all the studies has concluded that there isn't yet enough good research on PSA screening to say whether men should or shouldn't be screened for prostate cancer.²

If you are considering having the test, here are some points to keep in mind.³

• A PSA test cannot tell you for certain if you have prostate cancer. It can tell you only what your chance of having prostate cancer is.
• An abnormal test result (above 4 ng/mL) does not automatically mean you have cancer. In fact, two-thirds of people with these results turn out not to have cancer. Other prostate problems that are not cancerous, such as an enlarged prostate, also can raise your PSA level. See Prostate, enlarged for more.
• A PSA level less than 4 ng/mL does not guarantee that you do not have prostate cancer. Approximately 20 percent to 30 percent of men with prostate cancer have PSA levels below 4 ng/mL. This may be because their cancer is too small to affect their PSA level.

If you've already had treatment for prostate cancer, your doctor may recommend that you have regular PSA tests to check that the cancer has not come back or grown.

Another test that doctors use to check for prostate cancer is called the digital rectal exam (DRE). If your tumor is bigger than half an inch (around 1.5 centimeters), your doctor may be able to feel it through the wall of your rectum.

Wearing a medical glove and using a lubricating gel to make the exam more comfortable, your doctor will put a finger into your rectum to feel for a lump. This doesn't hurt, but some men find it embarrassing.

A biopsy is the main test doctors use to find out for certain if you have cancer. The doctor uses a special needle to remove very small pieces of tissue from your prostate to look at under a microscope. The needle is either gently pushed through the wall of your rectum into the prostate or it is inserted into the skin between your scrotum (the sac that holds your testicles) and your anus (the opening through which you empty your bowels). The needle is guided by a special device called an ultrasound probe.

A biopsy is not usually painful, but you may feel a sharp prick, even if you are given a local anesthetic (painkiller) to numb the area.

The more abnormal the cancer cells look compared with healthy prostate cells, the more likely the cancer is fast-growing (aggressive) and able to spread.

Most of the time, doctors will know if your cancer has spread by looking at a combination of your PSA level and your biopsy results. If they need more information about your cancer, doctors can use special techniques to look at other parts of your body, including your lymph nodes and your bones. They may use ultrasound scans, X-rays or body scans (computed tomography and magnetic resonance imaging) to check whether cancer is anywhere else in your body.

From the results of your tests, you doctor will be able to tell you:

• How big your prostate tumor is
• How likely it is that your prostate cancer has spread to your lymph nodes
• Whether your prostate cancer has spread to other parts of your body
• What type of prostate cancer cells you have and how fast they are likely to grow and spread.

Doctors use number and letter classification systems to describe how far your cancer has spread. This is called staging. There are several systems, but the most common is called the TNM system. See our explanation of the TNM system to find out what the different classifications mean.

Doctors use something called the Gleason score to describe how your cancer looks under a microscope. This is called your cancer grade. A tumor that has a low-grade score is likely to be slow-growing, while one with a high-grade score is more aggressive and likely to spread. If your cancer has been given a grade, read our explanation of the Gleason score to learn more about what it means.

Your doctor may combine your TNM classification and Gleason score to tell you the overall stage of your cancer. Knowing this stage can help you and your doctor consider what may happen to you, and it can help you decide on the best course of treatment.

There are four stages of prostate cancer. Stage 1 is the earliest, stage 4 is the most advanced. See Defining your cancer's overall stage to learn more.^{4 5 6}

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.