Prostate-specific antigen testing
Prostate-specific antigen (PSA) is a protein produced by the prostate gland. All men have a small amount of PSA in their blood, and it increases with age. Prostate cancer can increase the production of PSA. A prostate-specific antigen (PSA) test looks for raised levels of PSA in the blood — it does not specifically test for cancer.
If your PSA level is above normal for your age, you may have prostate cancer. However, two thirds of men with raised PSA levels do not have cancer, they have another prostate condition.
Many prostate cancers found by PSA testing are slow-growing and not life-threatening, and the PSA test can’t predict which cancers are likely to become a threat to your health.
Talk to your doctor about the potential benefits and harms of PSA testing. For further information, visit the Cancer Council Australia website.
Digital rectal examination
The next step is a digital rectal examination (DRE). This can be done by your doctor.
During a DRE, your doctor will insert a finger into your rectum. The rectum is close to your prostate gland, so your doctor can check to feel if the surface of the gland has changed. This will feel a little uncomfortable but it should not be painful.
Prostate cancer can make the gland hard and bumpy. However, in some cases, if the cancer is too small a DRE may not be able to detect the it.
DRE is also useful in ruling out benign prostatic hyperplasia, as this causes the gland to feel firm and smooth.
Both PSA and DRE are screening tests and cannot diagnose prostate cancer. It’s recommended you talk to your doctor to see if a PSA or a DRE test is right for you.
Your doctor will assess the risk of you possibly having prostate cancer based on a number of factors, including your PSA levels, the results of your DRE and associated risk factors, such as age and family history. If it is felt that you are at risk, you will be referred to a specialist to have do a biopsy of your prostate.
A biopsy is the only firm way to diagnose prostate cancer. Usually in an outpatient procedure, a urologist removes small samples of tissue from your prostate, using very thin, hollow needles with the help of an ultrasound. The prostate is either accessed through the wall of the rectum (transrectal) or the skin between the scrotum and anus (transperineal biopsy). You will probably have a course of antibiotics afterwards to reduce the chance of infection.
You can discuss the reliability of tests available with your doctor or specialist. In some cases further testing may be required if your symptoms persist or your PSA level continues to rise.
If there is a significant chance that the cancer has spread from your prostate to other parts of the body, further tests may be recommended.
Three tests that are commonly used are the magnetic resonance imaging (MRI), computed tomography (CT) scan and bone scans. These scans build up a detailed picture of the inside of your body. They can be used to check if the cancer has spread beyond the prostate to the surrounding tissue.
Sometimes it is helpful to talk to others about your experience. Cancer Council Australia offers support for you and your loved ones via their helpline on 13 11 20.
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Last reviewed: August 2018