Diagnosis

If you have a symptom or test result that suggests cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor will ask about your personal and family medical history. You will have a physical exam. You may have lab tests. Your visit may include a digital rectal exam, a urine test to check for blood or infection, and a blood test to measure PSA level.

You also may have other exams:

• Transrectal ultrasound: The doctor inserts a probe into the man's rectum to check for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.
• Cystoscopy: The doctor uses a thin, lighted tube to look into the urethra and bladder.
• Transrectal biopsy: A biopsy is the removal of tissue to look for cancer cells. It is the only sure way to diagnose prostate cancer. The doctor inserts a needle through the rectum into the prostate. The doctor takes small tissue samples from many areas of the prostate. Ultrasound may be used to guide the needle. A pathologist checks for cancer cells in the tissue.

If Cancer Is Not Found

If the physical exam and test results do not suggest cancer, your doctor may suggest medicine to reduce symptoms caused by an enlarged prostate. Surgery also can relieve these symptoms. The surgery most often used in such cases is transurethral resection of the prostate (TURP or TUR). In TURP, an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine. You should talk to your doctor about the best treatment option.

If Cancer Is Found

If cancer is present, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow. Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread.

One system of grading prostate cancer uses G1 through G4. Another way of grading is with the Gleason score. The pathologist gives each area of cancer a grade of 1 through 5. The pathologist adds the two most common grades together to make a Gleason score. Or the pathologist may add the most common grade and the highest (most abnormal) grade to get the score. Gleason scores can range from 2 to 10.
Staging

To plan your treatment, your doctor needs to know the extent (stage) of the disease. The stage is based on the size of the tumor, whether the cancer has spread outside the prostate and, if so, where it has spread.

You may have blood tests to see if the cancer has spread. Some men also may need imaging tests:

• Bone scan: The doctor injects a small amount of a radioactive substance into a blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones on a computer screen or on film. The pictures may show cancer that has spread to the bones.
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of areas inside your body. Doctors often use CT scans to see the pelvis or abdomen.
• MRI: A strong magnet linked to a computer is used to make detailed pictures of areas inside your body.

These are the stages of prostate cancer:

• Stage I: The cancer cannot be felt during a digital rectal exam. It is found by chance when surgery is done for another reason, usually for BPH. The cancer is only in the prostate.
• Stage II: The cancer is more advanced, but it has not spread outside the prostate.
• Stage III: The cancer has spread outside the prostate. It may be in the seminal vesicles. It has not spread to the lymph nodes.
• Stage IV: The cancer may be in nearby muscles and organs (beyond the seminal vesicles). It may have spread to the lymph nodes. It may have spread to other parts of the body.
• Recurrent cancer is cancer that has come back (recurred) after a time when it could not be detected. It may recur in or near the prostate. Or it may recur in any other part of the body, such as the bones.

The more advanced the disease, the lower the probability of local control and the higher the probability of systemic relapse.  There are many prognostic models based on a combination of the initial T stage, Gleason score, and baseline PSA.  

The Cancer Monthly database currently has the results (survival, side effects, etc.) for 40 recent therapies for prostate cancer including biological therapy, immunotherapy, chemotherapy, gene therapy, hormone therapy, radiation therapy and alternative therapy.