How is prostate cancer diagnosed?

Initial assessment

If a doctor suspects that you may have prostate cancer, he or she will usually:

• Examine
  the prostate gland. They do this by inserting a gloved finger through
  the anus into the rectum to feel the back of the prostate gland. An
  enlarged-feeling gland, particularly if it is not smooth to feel, may
  indicate prostate cancer. However, a normal-feeling prostate does not
  rule out prostate cancer.
• Do a blood test to measure the level of prostate specific antigen
  (PSA). PSA is a chemical which is made by both normal and cancerous
  prostate cells. Basically, the higher the level of PSA, the more likely
  that you have cancer of the prostate. However, a mild to moderately
  raised PSA can occur in conditions other than prostate cancer. (If you
  have confirmed prostate cancer, the PSA blood test is also used to
  monitor treatment. If treatment is working and cancer cells are killed
  then the level of PSA falls.)
• A PCA3 test may be offered. This is a new urine test which provides
  a more effective means of detecting prostate cancer than the PSA test.
  PCA3 is a chemical made particularly by prostate cancer cells. Up to
  100 times more PCA3 is present in prostate cancer cells than
  non-cancerous cells. A certain level of PCA3 in the urine is a good
  indication that prostate cancer is present. This test is combined with
  a rectal examination. A normal feeling prostate combined with a
  negative PCA3 test can be reassuring and may help avoid the need for
  prostate biopsies. However, it is not yet available in all clinics in
  the UK.

Biopsy - to confirm the diagnosis

A biopsy
is when a small sample of tissue is removed from a part of the body.
The sample is then examined under the microscope to look for abnormal
cells. A biopsy can usually confirm the presence of prostate cancer.

A
biopsy is not always necessary to confirm a diagnosis of prostate
cancer. Your doctor will be able to discuss the reasons for you to have
a biopsy, if appropriate, with you in more detail.

A small
biopsy of the prostate is taken by using a fine needle. This is usually
done with the aid of a special ultrasound scanner. The probe of the
scanner is about the size and shape of a finger. It is passed through
the anus into the rectum to lie behind the prostate. This finds the
exact position of the prostate. The doctor then pushes a fine needle
into the back of the prostate from within the rectum to obtain the
biopsy. Several samples are usually taken from different parts of the
prostate.

To biopsy the prostate can be uncomfortable. Therefore, local anaesthetic is used to reduce the pain as much as possible.