You may be reading this because you’re thinking about getting screened for prostate cancer. Maybe you’re waiting for test results. Or, perhaps you or someone you care about just learned they have prostate cancer.
This guide will help you understand how prostate cancer is diagnosed and what your diagnosis means. Learning as much as you can may help you feel ready to talk with doctors about your care.
PSA blood tests help find early signs of prostate cancer. But only a biopsy can diagnosis the disease. You may need more tests to learn as much as possible about your diagnosis.
A prostate cancer diagnosis most often will describe where the cancer started, its type, and if it has spread. We use this information to create a care plan just for you.
Metastatic prostate cancer is cancer that has spread from the prostate to other places. It’s also called late-stage prostate cancer, advanced prostate cancer, or stage 4 prostate cancer.
The most common way to find prostate cancer is through a routine cancer screening. Most people with early-stage prostate cancer do not have symptoms.
Prostate cancer screening can help find it early when it’s easier to treat. Screening guidelines are based on your age and risk (chances) of getting prostate cancer. Talk with your doctor about your risk for getting prostate cancer.
For many people, the first sign of prostate cancer is an abnormal (not normal) result on a screening test. The most common screening test for prostate cancer is the prostate-specific antigen (PSA) test. You may have a digital rectal exam (DRE).
Medical oncologist Dr. Devika Rao shares tips on what to expect during your first visit at MSK, and how to get ready.
We want to ensure your first visit is as productive and supportive as possible. Here are some tips on how you can best prepare.
If you have a high PSA level or other possible signs of prostate cancer, you’ll need other tests. They could confirm if it’s prostate cancer.
MSK uses imaging tests, a prostate biopsy, and biomarker tests to help diagnose prostate cancer. These tests show the type of prostate cancer and how advanced it is.
We use a testing tool developed at MSK called MSK-IMPACT®. It looks at about 500 genes for genetic changes and other tumor traits. Our test finds genetic changes in the tumor that other tests can miss. MSK-IMPACT has tested nearly 100,000 of our patients to find the best treatments for them.
A prostate biopsy is the best way to know for sure if you have prostate cancer.
During a prostate biopsy, your doctor removes a few small samples of tissue from the growth in your prostate. Each sample is called a core. We may take 12 to 20 core samples, often from different areas and sides of the prostate.
A pathologist will use a microscope to examine the samples. A pathologist is a doctor who uses a microscope to diagnose disease. They’ll look for cancer cells.
A biopsy provides information about the type of cancer cells. This helps doctors choose which treatment is best for you. Some prostate cancers have different treatments.
Most prostate biopsies at MSK are done on an outpatient basis. You’ll come in for the procedure during the day and then go home.
Your doctor will recommend the best biopsy method for you. They can explain why they chose that type of prostate biopsy.
During a core needle biopsy, we first use an injection (shot) to numb the biopsy site. We then use a hollow needle to remove a thin piece of tissue.
A magnetic resonance imaging (MRI) scan gives us a very good view of the prostate. We use an MRI scan to guide the prostate biopsy procedure. It lets us see the type, size, and location of tumors. The MRI helps us see areas that do not look normal.
For most biopsies, we remove 12 to 14 tissue samples. We may do more testing to better understand the tumor and choose the best treatment.
You may have a transperineal prostate biopsy or a transrectal prostate biopsy.
A transperineal (TRANZ-PAYR-ih-NEE-ul) biopsy is the most common type of biopsy for prostate cancer.
You may have either a:
Your doctor will use ultrasound imaging to help them take tissue from the right areas of your prostate. Ultrasound is an imaging scan that uses sound waves to make pictures of the inside of your body.
Your doctor puts a thin needle into your prostate through the area between the scrotum and anus, called the perineum (PAYR-ih-NEE-um).
You may have either a:
Your doctor will gently put a probe into your rectum. They’ll put an anesthetic (numbing) lubricant on it to help it slide in easily.
The probe uses ultrasound to make pictures of your prostate. It also has a high-speed biopsy gun with a small, thin needle. Your doctor will use this to take each biopsy sample. They may take up to 18 samples.
The biopsy most often takes 20 to 30 minutes.
At MSK, your care team may do a biomarker test as part of your diagnosis process. It’s a simple blood test that looks for prostate cancer biomarkers in your blood. You may have this test even if you have a normal biopsy result.
A biomarker is a biological molecule (substance) in your body. Your care team can look for biomarkers in a sample of your blood under a microscope.
Biomarker testing can help us learn if you have prostate cancer, as well as the type. Prostate cancer biomarkers give us information that guides treatment, including:
Learn more about biomarker tests for prostate cancer.
MSK research was the first to find a protein on the cancer cell surface called prostate-specific membrane antigen (PSMA). Since the early 1990s, MSK has developed and tested technology to track spreading prostate cancer cells.
Positron emission tomography (PET) scans are a type of nuclear medicine scan. PET imaging “lights up” a radioactive tracer that bonds to cancer cells. Most staging for prostate cancer is done through imaging called PSMA PET.
PSMA PET scans use a different radioactive tracer that attach to the PSMA protein. Prostate cancer cells show up as bright spots on the PET scan. We often do a CT scan along with the PET scan.
You’ll get a PSMA PET scan at MSK if you either:
At MSK, broad genetic testing of the tumor is a routine part of how we diagnose prostate cancer.
Genomic testing tells us which genetic changes caused the prostate cancer and made the cancer grow. The test results let us target those genes for treatment, a method called targeted therapy.
If we know which mutations you have, we know which treatments will work best on the tumor. Almost all of these genetic changes are only in cancer cells, not in normal cells. They cannot be passed on to your children.
Some genomic tests look at a few genes together to assess how well you’ll respond to treatment. These genomic tests are only done on a tumor after a biopsy confirms there’s cancer.
The most common genetic changes we look for are in the genes BRCA1, BRCA2, and HOXB13. We can find genetic changes such as a BRCA mutation that runs in families.
We also test for less common genetic changes in such genes as ATM, PALB2, and CHEK2. We also test for TP53 and PTEN mutations.
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Our experts are always exploring new ways to diagnose prostate cancer and find it early when it’s easier to treat. Explore prostate cancer news from MSK.
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Learning you have prostate cancer can be overwhelming. You’ll hear many medical terms you've never heard before. We’re here to help you understand what they mean and why they matter.
The information in your diagnosis describes important details about the type of prostate cancer you have. Your doctors use that information to create the best plan of care for you.
Some prostate cancers grow fast, and others very slowly. MSK uses scoring systems to describe prostate cancer based on how the cancer cells look under a microscope.
The less the cancer cells look like normal cells, the more aggressive the cancer.
There are 2 scoring methods:
Your diagnosis will include information on the prostate cancer’s grade. Your care team uses the grade to understand:
A pathologist will assess the grade of the cancer cells. A pathologist is a doctor who uses a microscope to make a diagnosis from cell and tissue samples. The samples are from your biopsy.
The Gleason score system has been used for many years. It’s based on 2 numbers that a pathologist assigns to your cancer cells.
The pathologist chooses the 2 areas of your cell sample with the most cancer cells. Then they give each area a number from 1 to 5.
Lower grade numbers mean the cells look more like normal prostate cells. The cancer cells are less likely to spread if they’re given a 1 or 2. This is low-grade cancer.
Higher numbers, such as a 4 or 5, are high-grade cancer. This means the cancer cells are more aggressive and likely to spread.
Gleason scores add the numbers from the 2 areas of your sample with the most cancer cells. The Gleason score matters, but so does the order of the 2 numbers.
The number listed first is from the sample area with the most cancer cells. Let’s say your Gleason score is a 7.
Gleason scores go from 2 to 10. Most people have a Gleason score of 6 to 10.
Gleason score of 6 or lower: The tumor is low grade, grows slowly, and is less likely to spread. Active surveillance may be an option for prostate cancer with a low Gleason score.
Gleason score of 7: The tumor is intermediate (IN-ter-MEE-dee-ut) grade and may grow slowly or steadily.
Gleason score of 8 to 10: The tumor is higher grade and more likely to spread.
Grade Groups are a newer method to describe prostate cancer. It’s based on the Gleason score but can be easier to understand. MSK prostate cancer experts use Grade Groups.
Grade Group scores range from 1 to 5. The lower the score, the more the cancer cells look like normal cells. They’re less likely to grow, and they spread slowly.
There are 5 Grade Groups.
Grade Group 1: Your Gleason score is 6.
Grade Group 2: Your Gleason score is 3 + 4 = 7.
Grade group 3: Your Gleason score is 4 + 3 = 7.
Grade group 4: Your Gleason score is 8.
Grade group 5: Your Gleason score is 9 or 10.
When you learn you have prostate cancer, you’ll have many questions for your cancer doctor at your first visit. Talking about treatment options with your doctor can help you feel better prepared to make decisions about your care.
There are a few types of prostate cancer. We’re experienced in treating them all, from the most common to the most rare. This information describes each type of prostate cancer and explains how we classify (sort) them.
Adenocarcinoma (A-deh-noh-KAR-sih-NOH-muh) is any cancer that starts in gland tissue.
Adenocarcinomas are the most common type of prostate cancer. Nearly everyone with prostate cancer has this type.
Acinar adenocarcinoma starts in acini cells, which are round, fluid-filled sacs that line the walls of the prostate gland. They help make semen fluid. Out of every 100 people with prostate cancer, 95 have acinar adenocarcinoma.
Ductal adenocarcinoma starts in the cells that line ducts in the prostate. It can grow and spread faster outside the prostate than acinar adenocarcinoma, and be harder to treat.
Neuroendocrine (NOOR-oh-EN-doh-krin) prostate cancer (NEPC) can start when some prostate cancer treatment stops working. Most often, it happens after adenocarcinoma treatment.
NEPC happens in about 15 out of every 100 people who get hormone therapy to treat prostate cancer.
There’s no treatment for NEPC and most people do not survive 18 months after diagnosis. MSK is working on a new approach to diagnosing and treating neuroendocrine cancers.
Types of prostate neuroendocrine carcinoma:
Nearly everyone with prostate cancer has an adenocarcinoma. Other types of prostate cancers are rare. They affect only a handful out of every 100 people with prostate cancer. They include:
Medical misinformation is harmful. It’s often framed as offering a “miracle cure” or something that “doctors don’t want you to know.” MSK experts explain how to find online cancer information you can trust. Much medical misinformation is about alternative medicine, often confused with integrative medicine.
A cancer stage tells us how advanced the cancer is. It describes traits such as the tumor’s size, location, and whether it has spread.
There are 4 stages of prostate cancer, from 1 to 4 (I to IV). The lower the number, the less the cancer has spread. Your doctor may add a letter (A, B, or C) to these stages to give even more information.
Staging helps your doctor choose the best treatment options for you. The stage also helps them predict the outcome (result) of your treatment. Based on the stage, you also may be able to join a clinical trial.
There are 2 T groups for prostate cancer. The clinical T group (cT) is how much your doctor thinks the cancer has grown. It’s based on exams, prostate biopsy results, and imaging tests.
The other group is the pathological T group (pT). Your doctor can confirm your pT if you have surgery to remove all of your prostate.
This group is often more accurate than the cT. The pT is based on information from examining the prostate in a lab.
N0 means cancer is not in lymph nodes. N1, N2, or N3 means it’s spread to nodes.
M0 means cancer has not spread. M1 means it’s spread to distant organs, muscles, or bones.
