Prostate Cancer Early Detection

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What if the test results aren`t normal?

If the results of early detection tests – the prostate-specific antigen (PSA) blood test and/or digital rectal exam (DRE) – suggest that you might have prostate cancer, your doctor will do other tests, such as a transrectal ultrasound and a prostate biopsy to find out.

Transrectal ultrasound (TRUS)

Transrectal ultrasound (TRUS) uses sound waves to make an image of the prostate on a video screen. For this test, a small probe that gives off sound waves is placed in the rectum. The sound waves enter the prostate and create echoes that are picked up by the probe. A computer turns the pattern of echoes into a black and white image of the prostate.

The procedure often takes less than 10 minutes and is done in a doctor's office or outpatient clinic. The ultrasound probe is about the width of a finger and is lubricated before it is placed in your rectum. You will feel some pressure when the TRUS probe is placed in your rectum, but it is usually not painful. The area may be numbed before the procedure.

TRUS is not used as a screening test for prostate cancer because it can't always tell the difference between normal tissue and cancer. Instead, it is most often used to look for prostate cancer, such as when a man has symptoms or to follow-up a PSA level is high or an abnormal digital rectal exam (DRE). During a prostate biopsy, TRUS is used to guide the biopsy needles into the right area of the prostate.

TRUS is useful in other situations as well. It can be used to measure the size of the prostate gland, which can help determine the PSA density and may also affect which treatment options a man has.

Prostate biopsy

A biopsy is a procedure in which a sample of body tissue is removed and then looked at under a microscope. A core needle biopsy is the main method used to diagnose prostate cancer. It is usually done by a urologist, a surgeon who treats cancers of the genital and urinary tract, which includes the prostate gland.

Using transrectal ultrasound to "see" the prostate gland, the doctor quickly inserts a thin, hollow needle through the wall of the rectum into the prostate gland. When the needle is pulled out, it removes a small cylinder (core) of prostate tissue. This is repeated from 8 to18 times, but most urologists will take about 12 samples.

Though the procedure sounds painful, it may only cause a brief uncomfortable sensation because it is done with a special spring-loaded biopsy instrument. The device inserts and removes the needle in a fraction of a second. Most doctors who do the biopsy will numb the area first with local anesthetic, which also lowers the chance that the procedure will be painful. You might want to ask your doctor if he or she plans to do this.

The biopsy itself takes about 10 minutes and is usually done in the doctor's office. You will likely be given antibiotics to take before the biopsy and possibly for a day or 2 after to reduce the risk of infection.

For a few days after the procedure, you may feel some soreness in the area and will probably notice blood in your urine. You may also have some light bleeding from your rectum, especially if you have hemorrhoids. Many men also see some blood in their semen or have rust colored semen. This can last for several weeks after the biopsy, depending on how frequently you ejaculate.

Your biopsy samples will be sent to a lab, where a pathologist (a doctor who specializes in diagnosing disease in tissue samples) will look at them under a microscope to see if they contain cancer cells. If cancer is present, the pathologist will also assign it a grade. This is often expressed as a Gleason score (or Gleason sum). Although in theory, this can range from 2 to 10, Gleason scores below 6 are rare. The higher your Gleason score, the more likely it is that your cancer will grow and spread quickly.

Getting the biopsy results usually takes at least 1 to 3 days, but it can take longer.

Even taking many samples, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false negative result. If your doctor still strongly suspects prostate cancer (due to a very high PSA level, for example) a repeat biopsy may be needed to help be sure.

Prostate biopsy results are sometimes called suspicious. The pathologist may use terms such as prostatic intraepithelial neoplasia (PIN), atypical small acinar proliferation (ASAP, or just atypia), or proliferative inflammatory atrophy (PIA). Suspicious results mean that the cells do not look quite normal, but they don't look like cancer, either. If your biopsy results come back suspicious, your doctor may want to repeat the biopsy.

More information about the possible results of prostate biopsies can be found in our document Prostate Cancer or in the “Prostate Pathology” section of our website.


Last Medical Review: 08/28/2013
Last Revised: 02/25/2014