How Is Prostate Cancer Diagnosed?
Key takeaways:
A prostate cancer diagnosis involves multiple steps, including a physical exam, blood work, and a prostate biopsy.
The tools for prostate cancer diagnosis aren’t perfect — so some people need additional testing.
The path to prostate cancer diagnosis isn’t always straightforward. It can help to reach out to your support system during this time of uncertainty.
Prostate cancer is very common and affects 1 in 8 men. But even though it’s common, diagnosing prostate cancer isn’t easy. That’s because the tools for screening and diagnosing prostate cancer aren’t perfect.
If you’ve recently been screened for prostate cancer and had concerning results, here’s everything you need to know about your next steps.
What are the steps of a prostate cancer diagnosis?
There are several steps to getting a prostate cancer diagnosis. These include an exam and discussion with your healthcare team, blood work, and a prostate biopsy.
Most people get evaluated for prostate cancer for one of two reasons:
They have symptoms of prostate cancer — like trouble urinating.
They decide to get screened for prostate cancer, and the results are concerning for cancer.
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The steps to diagnose prostate cancer are almost the same in both cases. They include an exam and discussion with a healthcare professional, blood work, and a prostate biopsy.
Let’s take a closer look at each step in the diagnosis path and what can happen with results.
Prostate-specific antigen blood test
The PSA test is a blood test. It’s the most common screening test for prostate cancer. The prostate makes a protein called prostate-specific antigen (PSA). While all males have some PSA in their blood, people with cancer typically have a higher PSA level. That’s because prostate cancer cells usually make more PSA than regular prostate cells.
If you have symptoms of prostate cancer or are being screened for prostate cancer, you will need a PSA test.
If your PSA level is high, it could mean that you have prostate cancer. The chance of having prostate cancer goes up as your PSA level goes up. But your PSA level also goes up as you get older. Inflammation in the prostate from noncancerous conditions can also increase PSA levels.
Normal PSA levels
If your PSA level is less than 4 ng/mL, the chance of having prostate cancer is low — about 15% of people with PSA levels less than 4 ng/mL have prostate cancer.
If your PSA level is between 4 ng/mL and 10 ng/mL, there’s a 25% chance of prostate cancer.
If your PSA level is higher than 10 ng/mL, there’s a 50% chance of prostate cancer.
Learn more about prostate cancer: Our prostate cancer guide can help you get started.
Not all prostate cancers are the same: Here’s what you should know about the different types of prostate cancer.
What is stage 4 prostate cancer? Symptoms and treatment options for metastatic prostate cancer.
Unfortunately, the PSA isn’t a perfect test. A PSA can be high for many reasons, not just prostate cancer.
If you got a PSA level because you have symptoms of prostate cancer, a healthcare professional will put together all the information available to decide if you should have a prostate biopsy, a prostate MRI and/or another specialized test like a phi or 4K score.
If you got a PSA level for screening, depending on your level, your healthcare team might want to repeat the levels over time. If your PSA level continues to go up, they will probably recommend a biopsy, imaging, or further tests to evaluate your risk of prostate cancer. If you are at higher risk for developing prostate cancer, your healthcare team might suggest going straight to a biopsy.
Digital rectal exam
A physical exam, including a digital rectal exam, is another important step. During the physical exam, your healthcare professional will ask you about symptoms of prostate cancer such as trouble urinating or blood in the urine or semen.
Your physical exam may include a digital rectal exam (DRE). During a DRE, a healthcare professional inserts a gloved finger into your rectum to feel the prostate. They might be able to feel a tumor. Or they may feel an enlarged or an inflamed prostate. Both of these conditions can cause the same symptoms as prostate cancer.
Prostate biopsy
A prostate biopsy is the main tool to diagnose prostate cancer. You may need a prostate biopsy if you have a high PSA level or concerning findings during a digital rectal exam.
A prostate biopsy is a short procedure that’s done with anesthesia — so you don’t feel pain. Getting ready for your prostate biopsy takes only a few steps, and the procedure is very short.
During a prostate biopsy, a urologist will remove several small samples of tissue from your prostate. A pathologist will look for cancer cells from your samples using a microscope.
Gleason grading system for prostate cancer
Gleason score and grade group describes what the cells from your prostate biopsy look like under a microscope.
Determining the Gleason score and grade group is an important part of prostate cancer staging. These numbers describe how prostate cancer is likely to behave over time. This helps healthcare teams choose the best combination of treatments.
Imaging studies
If your prostate biopsy showed cancer cells, you might need imaging studies like a magnetic resonance imaging (MRI), a bone scan, CT scan, or a positron emission tomography (PET) scan. These studies help your team see exactly where your cancer is and whether it has spread.
In some cases, your healthcare team might recommend a prostate MRI before your biopsy. This is becoming more common and is now recommended by NCCN guidelines. A prostate MRI helps your urologist visualize your tumor(s). This helps your urologist target the right spots for your prostate biopsy.
What factors may affect the accuracy of a diagnosis?
Each step in the diagnosis process can get complicated. The results of each test aren’t always clear-cut. Unfortunately, none of the tests to help diagnose prostate cancer are perfect. And that means sometimes you won’t get a clear answer right away.
Many things affect the accuracy of tests used for prostate cancer diagnosis. Understanding the limitations at each step can be helpful as you navigate this new terrain. Let’s take a look at each piece more closely.
Shortcomings of the digital rectal exam
A DRE is never perfect. That’s because the prostate is deep within the pelvis and difficult to reach. Studies show that some people have smaller prostates or prostates that are deeper in the pelvis, making it harder to fully evaluate the prostate. Depending on the finger length of the healthcare professional performing the exam, they may not be able to reach your prostate. Finally, if a tumor is growing at the edge or underside of the prostate, it can be easily missed.
In short, it’s very easy for a tumor to get missed on a DRE. This is why blood tests and MRIs can be helpful.
On the other hand, if a healthcare professional does feel something on a DRE, it could be a strong sign of cancer. Studies show that when healthcare professionals feel something on a DRE, there’s a 42% chance of cancer. So while a “normal” DRE isn’t very helpful, an “abnormal” DRE means that you should have additional tests to look for prostate cancer.
Shortcomings of the prostate-specific antigen test
As mentioned above, a higher PSA level can mean someone has prostate cancer. But many things can falsely elevate a PSA level — or falsely lower a PSA level. Scientists are working on ways to make the PSA test more accurate. Newer tests may someday replace PSA altogether.
But in the meantime, there are things you can do to make sure your PSA level isn’t falsely high:
Don’t get your PSA drawn if you have a urinary tract infection or right after your DRE.
Don’t exercise right before you get your PSA drawn.
Wait 2 days after you ejaculate to do your PSA test.
Let a healthcare professional know if you’ve recently had a urinary catheter.
Also let a healthcare professional know if you’ve ever had prostate surgery or if you’re taking medications for benign prostatic hypertrophy. These things can falsely lower your PSA levels.
Shortcomings of prostate biopsy
Prostate biopsies have improved over the years, but they’re not perfect. During a biopsy, the urologist takes about 12 samples of tissue. While that sounds like a lot, it’s only a very small amount of tissue. A biopsy might miss a tumor if the samples come from parts of the prostate that don’t have cancer. Even a highly experienced and skilled urologist can miss cancer on a biopsy. In situations where there’s a high concern for prostate cancer — and a prostate biopsy doesn’t show cancer — you might need another biopsy.
Frequently asked questions
Right now, a prostate biopsy is the most accurate and reliable way to diagnose prostate cancer. There’s no way to get a prostate cancer diagnosis without a prostate biopsy.
In most cases, prostate cancer grows very slowly. It may take several years before a tumor is big enough to cause any symptoms, and even longer before it spreads outside of the prostate. But there are forms of prostate cancer that are more aggressive and can spread faster.
After you are diagnosed with prostate cancer, your healthcare team will review the findings of your prostate biopsy, imaging tests and Gleason score. This information will help you and your healthcare team decide on the best prostate cancer treatment for you.
Survival rates are high for prostate cancer that’s diagnosed at early stages. Ninety-nine percent of people with localized prostate cancer are alive 5 years after diagnosis. New treatments are helping people with advanced prostate cancer live longer.
The bottom line
Prostate cancer can be difficult to diagnose. That’s because the tools for prostate cancer diagnosis — a digital rectal exam, a prostate-specific antigen (PSA) test, and a prostate biopsy — aren’t perfect. But used together, they can help you get a prostate cancer diagnosis.
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References
American Cancer Society. (2023). American Cancer Society recommendations for prostate cancer early detection.
American Cancer Society. (2023). Screening tests for prostate cancer.
American Cancer Society. (2025). Survival rates for prostate cancer.
American Cancer Society. (2025). Tests to diagnose and stage prostate cancer.
Centers for Disease Control and Prevention. (2024). Diagnosing prostate cancer.
Centers for Disease Control and Prevention. (2024). Screening for prostate cancer.
Jones, D., et al. (2018). The diagnostic test accuracy of rectal examination for prostate cancer diagnosis in symptomatic patients: A systematic review. BMC Primary Care.
Koulikov, D., et al. (2012). Why I cannot find the prostate? Behind the subjectivity of rectal exam. International Scholarly Research Notices.
Prostate Cancer Foundation. (2023). Gleason score and grade group.
