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Prostate cancer is usually diagnosed after a referral from a primary care physician to a urologist. Many prostate cancers do not need immediate treatment. Patients with low-risk disease can be closely followed on "active surveillance" and undergo treatment only if necessary.

Prostate cancer screening begins with a digital rectal exam (an examination of the prostate via a gloved finger in the rectum) and a prostate-specific antigen (PSA) test -- a blood test for the PSA protein used as a "disease marker" to represent prostate cancer.

After screening, your doctor may send you for a prostate biopsy using needles to sample tissue from the prostate, particularly if you have a worrisome finding on the digital rectal exam, or a persistently elevated PSA. Advanced molecular tests and imaging may also be needed to diagnose prostate cancer.

PSA Screening

PSA screening has been shown to improve the chance that prostate cancer is detected at an early stage, and has been clearly shown to improve the chance of a cure. The American Cancer Society recommends that beginning at age 50, men who are at average risk of prostate cancer and have a life expectancy of at least 10 years discuss the benefits and limitations of PSA testing with a physician. This informed decision-making should begin at age 45 for Black men and those with a close relative diagnosed with prostate cancer before the age of 65, and at age 40 for those at even higher risk, including men with a close relative who was diagnosed at an early age and those who are carriers of the BRCA gene mutation.

Traditionally, the aggressiveness of prostate cancer has been graded according to the Gleason score, which is used to help plan treatment and determine prognosis. The Gleason score is calculated by adding together the two grades of cancer cells that make up the largest areas of a biopsied tissue sample. A Gleason score of 6 is low-grade, 7 is intermediate-grade, and 8 to 10 is high-grade cancer.

Active Surveillance

Your doctor may recommend active surveillance if you have a low-risk tumor instead of treating it with surgery or radiation therapy. During active surveillance, you are carefully followed for any suspected progression of prostate cancer. You will obtain follow-up PSA tests every 3 to 6 months and follow-up magnetic resonance imaging (MRI) and biopsies at intervals determined by your doctor. If biopsy results suggest that the cancer is progressing, then immediate treatment is generally advised.

Prostate Biopsy

The most common method used to diagnose prostate cancer is a needle biopsy using ultrasound guidance. Sometimes the biopsy is preceded by a prostate MRI scan to better visualize tumors within the prostate and help guide biopsy needles to the areas that appear to be most suspicious.

Read Part 1 of this series:

For Your Patients: Risk Factors, Signs, and Symptoms of Prostate Cancer

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease