Tests to check for prostate cancer

Tests for prostate cancer might include a digital rectal examination of your prostate, a blood test called a PSA test, taking a sample of your prostate gland (biopsy) and scans. 

These tests check for prostate cancer or find out what is causing your symptoms.

Most people start by seeing their GP. They can do some tests to help them decide whether you need a referral to a specialist. The tests they might do include:

  • a prostate specific antigen (PSA) blood test 
  • an examination of your prostate gland to check for abnormal signs, such as lumpy or hard areas (digital rectal examination)

If your GP refers you to a specialist, you might have more tests. These include:

  • an mpMRI
  • a biopsy

mpMRI

This is a special type of MRI scan. It produces a more detailed picture of your prostate gland than a standard MRI scan does.

This can help your doctor to see:

  • whether you have cancer in your prostate 
  • how likely it is that the cancer will grow (whether it is clinically significant)

Your doctor might not do an mpMRI if you're unwell or not likely to be able to have treatment. 

Understanding your mpMRI results

Your doctor gives you a Likert score based on your mpMRI. Your Likert score helps your doctor decide whether you need to have a sample of your prostate removed (biopsy).

Likert scoreWhat this means
1It’s very unlikely that you have cancer
2It’s unlikely that you have cancer
3It’s difficult to tell from the scan if you have cancer or not
4It’s likely that you have prostate cancer
5It’s very likely that you have prostate cancer

Sometimes a different system called PI-RADS is used. It stands for Prostate Imaging – Reporting and Data System. The PI-RADS system also scores your risk of having prostate cancer from 1 to 5. 

A Likert score of 1 or 2 means it’s unlikely that you have cancer. You may not need to have a biopsy, but you can still have one to check this. Your doctor will explain the pros and cons of having a biopsy and what the chances are of finding something.

Your doctor may also suggest another test called the PSA density. This test looks at measures taken from your PSA blood test and corrects it for how big your prostate is. It can help doctors decide whether you need a biopsy when the MRI result isn't clear.

Your doctor may also look at whether you have other conditions and how well you'd cope with treatment for prostate cancer. They might decide not to do a biopsy if you're unwell or not likely to be able to have treatment. 

If you don't have a biopsy, you will be discharged back to your GP. Your GP can repeat the PSA test and refer you back to the specialist if needed. 

A Likert score of 3 or more means that it’s more likely that you have cancer. 

This result on its own doesn’t diagnose prostate cancer, but it usually means that your doctor will arrange for you to have a biopsy. The MRI helps doctors know where to take the biopsy from. 

Biopsy

During a biopsy, your doctor takes a sample of tissue from your prostate. The samples are then sent to a laboratory and a pathologist looks at them under a microscope to check for cancer.

There are 2 main ways to have a biopsy:

  • trans rectal ultrasound (TRUS) biopsy
  • trans perineal biopsy

Understanding your biopsy results

You might have a negative biopsy. This means that no cancer cells were found. Your doctor might arrange another biopsy even if the first biopsy was negative. They'll discuss this with you. This is because in some cases biopsies can miss cancer. 

If they find cancer cells, a pathologist grades each sample of prostate cancer cells from 3 to 5 based on how quickly they are likely to grow or how aggressive the cells look. You may hear this being called the Gleason grade, Gleason score or Grade Group.

Gleason score or Grade Group

The pathologist works out an overall Gleason score by adding together the 2 most common Gleason grades. This combined score is also now called the Grade Group. 

There are 5 Grade Groups. Grade Group 1 is the least aggressive and Grade Group 5 is the most aggressive. 

It can be difficult to understand what the Gleason score and Grade Group mean in your situation. We have more information about the Gleason score and Grade Groups. And you can ask your doctor and specialist nurse if you have any questions about this. 

What tests do I need after a biopsy?

If you have a biopsy that shows that you have cancer cells in your prostate, then you'll have more tests to work out where and how big the cancer is (the stage).

The tests you might have include a CT scan and a bone scan. 

Last reviewed: 
17 Jan 2020
  • Prostate cancer: diagnosis and management
    The National Institute for Health and Care Excellence (NICE), 2019

  • The use of PI-RADSvs2 in pre-biopsy multi-parametric MRI
    The Royal College of Radiologists, 2018

  • PI-RADS ™ Prostate Imaging – Reporting and Data System version 2
    American College of Radiology, 2015

  • The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma - Definition of Grading Patterns and Proposal for a New Grading System
    J Epstein and others 
    American Journal of Surgical Pathology, 2016. Vol 40, Issue 2, Pages 244-252 

  • National implementation of multi-parametric magnetic resonance imaging for prostate cancer detection – recommendations from a UK consensus meeting
    M Appayya and others
    BJU International Journal, 2018. Vol 122, Pages 13-25

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