Diagnosis & staging
The prostate is a gland that produces a milky fluid. This fluid makes up a large portion of semen that men ejaculate.
The prostate is located under the bladder. The urethra, which is the tube that carries urine (pee) from the bladder to the penis, runs through the prostate.
Image of prostate
Note: Available statistics do not have information about the inclusion of transgender and gender diverse participants. It is unknown how these statistics apply to transgender and gender diverse people. Patients are advised to speak with their primary care provider or specialists about their individual considerations and recommendations.
In early-stage prostate cancer, you may have no symptoms.
However, as you age, your prostate can get larger for many reasons. This can make it hard for you to urinate (pee).
The symptoms below do not mean you have prostate cancer but they can be signs of prostate cancer. Talk to your doctor if you have any of these symptoms:
- Trouble starting or stopping urination (peeing).
- Slow urine stream.
- Painful urination or ejaculation.
- Dribbling of urine.
- Need to urinate more than is normal for you.
- Blood in your urine or ejaculate (semen).
- Waking up in the middle of the night with a need to urinate.
In advanced-stage prostate cancer, you may have these symptoms:
- Weight loss.
- Fatigue (extreme tiredness).
- Back pain or sciatica-like pain (sudden, "shooting" pain that goes from your lower back and down your leg).
- Swelling in your legs that does not go away.
If you have any signs or symptoms that you are worried about, please talk to your family doctor or nurse practitioner.
Prostate cancer is usually found during a physical exam by a doctor or nurse practitioner.
Sometimes prostate cancer is found after surgery for an enlarged prostate gland (when your prostate is bigger than normal). Before the surgery, your health care team does not think there is cancer in your prostate. However, cancer is then found after the surgery.
These are tests that can help diagnose prostate cancer:
Digital rectal examination (DRE): a doctor or nurse practitioner puts their finger through your anus (opening to your bum) and into your rectum. Your rectum lies right behind your prostate. This allows the doctor or nurse practitioner to feel for any irregular texture (such as a lump) in your prostate. A lump may be a sign of cancer. Your doctor or nurse practitioner may recommend this exam if you have symptoms of a prostate problem.
PSA blood test: this measures the amount of Prostate Specific Antigen (PSA) in your blood. Normal levels of PSA are between 4 and 7 ng/mL (nanograms per millilitre). You may need a PSA test if your DRE is suspicious for cancer. If you are over 40 years old, you may want to ask your doctor or nurse practitioner if they recommend you get this test.
- If the DRE or PSA blood test is suspicious for cancer, your doctor or nurse practitioner may then refer you to a urologist. A urologist is a doctor who specializes in the urinary system.
Transrectal ultrasound (TRUS): a doctor puts an ultrasound transducer (a probe that uses sound waves to give an image) through your anus into your rectum. This lets the doctor look at your prostate and the tissues around it. An ultrasound is also used during a prostate biopsy to guide the needle that will take small pieces of tissue from your prostate.
Biopsy: a doctor uses an ultrasound transducer to guide a needle to your prostate. The needle will be put into your prostate 10-12 times to take tiny pieces of the prostate. These pieces will be checked for cancer by a specialist (pathologist). Your doctor will give you some local anesthetic (numbing agent) to help with the discomfort during the biopsy.
If any of these tests are suspicious for cancer or find cancer, you may need more tests. These tests are only done if your cancer is high risk (see risk types below).
Bone scan: this is a type of imaging that checks to see if cancer has spread to your bones. You will have this scan if your PSA is more than 10 ng/mL or if your biopsy shows a high risk cancer (a cancer that is growing more quickly and is more likely to spread).
CT (computed tomography) scan: this is a type of imaging that checks to see if your cancer has spread outside of your prostate into tissues or organs in your chest, abdomen or pelvis.
For more information on tests used to diagnose cancer, see BC Cancer Library screening and diagnosis pathfinder.
More than 95% (95 out of 100) of prostate cancers are adenocarcinomas. These are cancers that start in gland cells. In the prostate, gland cells make mucus and prostatic fluid.
The other types of prostate cancer are rare and they start in other cells of the prostate.
Prostate cancer is divided into three risk groups: low risk, intermediate risk and high risk. The risk groups are based on:
Gleason score: This describes the cancer based on how it looks and acts. A pathologist gives a number after looking at the prostate cancer biopsy. The number can be 1, 2, 3 , 4 or 5. The lower the number, the closer the cancer cells look and act like normal cells. The higher the number, the more they look and act like cancer cells The pathologist will give a number for each pattern of cells they see in the biopsy.
The first number is the most common pattern they see. The second number is the second most common pattern they see. The pathologist will add the two scores to give the total Gleason score. Higher scores mean the cancer is higher risk.
For example, if the most common pattern is 3 and the second most common pattern is 4, the Gleason score is 3 + 4 = 7.
If the most common pattern is 4 and the second most common pattern is 3, the Gleason score is 4 + 3 = 7. However, this cancer is a higher risk than the cancer above because the most common pattern (first number) is a higher grade than the second number.
Stage: Staging is based on how much cancer is in the body, where it was first diagnosed, if the cancer has spread and where it has spread to.
The stage of the cancer can help your health care team plan your treatment. It can also tell them how your cancer might respond to treatment and the chance that your cancer may come back (recur).
Stage T1: doctor cannot feel the tumour during a digital rectal exam.
Stage T1a: cancer is found in 5% or less of the tissue removed from the prostate.
Stage T1b: cancer is found in more than 5% of the tissue removed from the prostate.
Stage T2: doctor can feel a nodule (lump) during digital rectal exam. Cancer is only in the prostate.
Stage T2a: tumour is in half or less of one side of the prostate.
Stage T2b: tumour is in more than half of one side of the prostate.
Stage T2c: tumour is in both sides of the prostate.
Stage T3: tumour has grown through the capsule (outside layer) of the prostate.
Stage T3a: tumour has grown outside of the prostate but not grown into the seminal vesicles (glands that make fluid that is added to semen).
Stage T3b: tumour has grown outside of the prostate and into the seminal vesicles.
Stage T4: tumour has grown outside the prostate and into nearby organs such as the bladder, rectum, pelvic muscles or pelvic wall.
Your PSA, Gleason score and stage determine your risk group. Your risk group helps your health care team plan your treatment.
Low risk - must have
all of the following:
- PSA less than or equal to 10 ng/mL
- Gleason score less than or equal to 6
- Stage T1 or T2a
Intermediate risk - Not low or high risk, any of:
- PSA more than 10 ng/mL
- Gleason score is 7
- Stage 2B
of the following:
- PSA more than 20 ng/mL
- Gleason score is higher than or equal to 8
- Stage T3a or higher
For more information on staging, see About Cancer