How prostate cancer is evaluated

A suspicion is not yet a diagnosis

PSA can be high because of cancer, enlargement, or inflammation. An abnormal rectal exam can also prompt more testing. The National Cancer Institute says that if PSA stays high after a biopsy that did not show cancer, a urine test for PCA3 RNA is sometimes used to help decide whether another biopsy is needed. None of those steps is the diagnosis. Prostate cancer is diagnosed by looking at tissue, usually from a needle biopsy. Complications of biopsy can include fever, pain, blood in the urine or semen, and infection. The U.S. Preventive Services Task Force summarized evidence in which about 1 percent of biopsies led to a hospital stay. Magnetic resonance imaging is being studied as a guide for biopsy. It is not a substitute this page can assign to you.

Grade describes how the cells look

After cancer is found, a pathologist grades how different the cells look from ordinary prostate cells. Clinicians use that grade, along with PSA and the extent of the cancer, to talk about how likely the cancer is to grow or spread. Older explanations focused on the Gleason score. Many reports now also use Grade Groups, which regroup those patterns into a smaller set of categories. Your report, not a general article, is the one that applies to you. Ask the clinician to read the actual numbers and to say what decision they change.

A higher grade is more concerning. It is not a sentence by itself. A lower grade is not a promise that treatment can always wait. Other illnesses, age, and the amount of cancer on the biopsy all enter the conversation.

Stage describes where the cancer is

Stage describes whether cancer is still in the prostate, has grown through the edge of the gland, has reached nearby nodes, or has spread farther. Spread to bone is still prostate cancer, not a new bone cancer. The tests used to look for spread are not routine for every man on the day of diagnosis. Risk, built from PSA, grade, exam, and the amount of cancer, is what usually determines whether a bone scan, a CT scan, or another imaging test adds useful information.

An older video on this domain argued from then-current practice that many men with a low PSA did not need a bone scan. This article does not repeat a numeric cutoff. Cutoffs change, and a number pulled from a video would be easy to misuse. Ask, “Given my PSA, grade, and exam, which scans would change the plan, and which would only add cost and anxiety?”

Management is a decision after the evaluation, not before it

The 2018 Task Force statement names three common paths for cancer found by screening and still localized: surgery to remove the prostate, radiation (external beam, proton beam, or seed implants), and active surveillance. Active surveillance means monitoring some cancers that appear less aggressive instead of treating immediately, with a plan for treatment if the cancer changes. Focal treatments, which aim at only part of the gland, are a different idea and were not one of those three common paths in that statement. This page does not recommend one path. Side effects differ, and so does the chance that a cancer found by screening would never have caused harm. The Task Force estimated that 20 to 50 percent of screen-detected prostate cancers may be overdiagnosed.

If you are comparing a heavily advertised combination of treatments, ask for survival, side effects, and a fair comparison with surveillance and with standard surgery or radiation. A claim of superiority that omits those pieces is an advertisement. It is not an evaluation of your cancer.

What to keep in a folder

Keep the biopsy pathology report, the PSA history, imaging reports, and a written summary of the options you were offered, including the option of not treating immediately if that was appropriate. Bring that folder to a second clinician if you want another explanation. This website cannot be that second clinician.