How Is Prostate Cancer Diagnosed? Exams and Tests
Prostate CancerNavigating Life With Prostate Cancer

Tests to Diagnose Prostate Cancer

Tests to Diagnose Prostate Cancer
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Updated on September 28, 2026
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Roughly 1 in 8 men will be diagnosed with prostate cancer at some point in their lives.

 When caught before it spreads beyond the prostate, the five-year survival rate is excellent — better than 99 percent — so early detection is key.

 Here are the most common prostate cancer tests.

Prostate-Specific Antigen Test

A prostate-specific antigen (PSA) test is a blood test that may be offered to you as routine screening in the context of a checkup by a primary care physician or urologist.

But using the test for routine screening is tricky. Elevated results on a PSA test may occur for reasons other than cancer, such as an enlarged prostate, benign prostatic hyperplasia, or an infection in the prostate called prostatitis.

 Men who receive an elevated result may be referred for further testing. For this reason, the test should only be performed after an informed conversation between the doctor and the patient, with an emphasis on shared decision-making.

The American Urological Association (AUA) and Society of Urologic Oncology (SUO) recommend PSA tests for those at high risk for prostate cancer starting at age 40 to 45. You’re considered at high risk if you are Black, have a family history of prostate cancer, or carry specific genetic mutations, such as BRCA.

If you’re not at high risk, the AUA and SUO recommend a baseline PSA test and prostate cancer screening around the age of 45 to 50, with regular prostate cancer screenings every two to four years for those ages 50 to 69. These screening timelines may be adjusted based on your personal risk, health, or preferences.

The American Cancer Society uses these parameters to evaluate PSA results:

  • A PSA test result below 4 nanograms per milliliter (ng/mL) means that 85 percent of the time, you won’t have prostate cancer.
  • A PSA result between 4 and 10 ng/mL is associated with a 1 in 4 chance of having prostate cancer.
  • If your PSA result is greater than 10 ng/mL, you have a 1 in 2 chance of having prostate cancer.
But doctors have not adopted a uniform system for interpreting PSA. Thresholds for concern and reference ranges vary, and different medical societies may have varying recommendations.

If your PSA test results are elevated, you will likely be advised to have more tests.

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Digital Rectal Exam

A digital rectal exam (DRE) is a physical exam of your prostate gland administered by a physician, usually in response to elevated PSA levels or symptoms suggestive of an issue with the prostate gland. During a DRE, a physician places a gloved finger into the rectum and checks for asymmetric areas or nodules and irregularities in the size, shape, and texture of the prostate gland.

As with the PSA test, suspicious findings on a DRE do not necessarily mean that you have prostate cancer. Rather, the results are considered in combination with the PSA test results and any symptoms the patient may have.

Transrectal and Transperineal Ultrasound Biopsy

If you receive an elevated PSA result or have suspicious findings on a DRE, your physician might recommend that you undergo a prostate biopsy.

There are two methods of tissue collection:

Transrectal Ultrasound (TRUS) Biopsy During this procedure, an ultrasound probe is inserted into the rectum and sound waves are used to create a real-time image of the prostate gland. Guided by ultrasound, biopsy samples are often collected from several areas of the prostate with a hollow needle. The biopsy samples are then analyzed in a pathology laboratory to see if cancer cells are present.

Transperineal Ultrasound (TP) Biopsy For a TP biopsy, the needle goes through the skin between the scrotum and the anus, under the guidance of an ultrasound device.

TP biopsies have a lower risk of post-procedure infections, when compared with TRUS biopsies.

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) may be used to guide a prostate biopsy, either alone or as an MRI/ultrasound fusion biopsy. Multiparametric MRI (mpMRI) — a scan that looks for abnormalities in the prostate — is capable of revealing potentially cancerous areas in more detail than an ultrasound.

The AUA, National Comprehensive Cancer Network, and European Association of Urology all recommend prebiopsy MRI for men with elevated PSA levels. This can help avoid unneeded biopsies (if the MRI shows no abnormalities) or improve the specificity of a biopsy, if performed.

MRI can also be used for active surveillance of a slow-growing cancer, or to avoid unnecessary biopsies in men who have received an elevated PSA test result but whose previous biopsies have tested negative for cancer. Using MRI alongside these other tests and techniques can do a better job of finding more aggressive prostate cancers and fewer low-risk prostate cancers.

Preparing for Your Prostate Biopsy

To prepare you for the test, your urologist should tell you about the risks and benefits of having a biopsy. The most common complications following a prostate biopsy are having blood in the urine, rectum, or semen, a urinary tract infection, and acute urinary retention. These side effects usually pass quickly.

 Less commonly, erectile dysfunction occurs.

After this discussion with your doctor, you will be asked to sign a consent form. You may also be asked to discontinue some medications, such as anticoagulants, nonsteroidal anti-inflammatory drugs, herbal supplements, and vitamins, for one to several days. On the night before the biopsy is scheduled, your doctor may ask you to do an enema at home. Eating lightly the day before is often recommended. You also may be asked to take an antibiotic the day before or on the day of the biopsy.

When you come in for the procedure, you will be asked to lie still on your side with your knees bent. The doctor will insert a small finger-sized ultrasound probe into your rectum. The probe lets the doctor see images of your prostate gland and helps determine where to inject a local anesthetic. The images the doctor sees also help guide the biopsy needle. Your doctor will take 10 to 18 tiny tissue samples from the prostate gland, which will then be sent to a pathology lab. The entire procedure takes about 10 minutes.

 Your doctor will contact you with results usually within about a week.
After the procedure, your rectum may feel sore. You may see small amounts of blood in your stool, urine, or semen that last for several days or weeks. Antibiotics might be prescribed for several days to prevent infection.


Making Sense of Prostate Biopsy Results

It is likely that your biopsy will show benign prostate tissue. If your biopsy reveals that some cells look abnormal, but may or may not be cancer, your doctor might recommend another biopsy. However, if your biopsy comes back positive, it means that cancer cells were detected.

Your pathology report will include:

  • The type of cancer (for example, adenocarcinoma is the most common type)
  • A Gleason score, which helps doctors predict how fast-growing the prostate cancer is
  • The number of biopsy samples that contain cancer out of the total number sampled
  • A diagnosis of each biopsy sample
  • The percentage of cancer in each sample
  • Whether the cancer is on one or both sides of the prostate gland

Understanding Your Gleason Score

Your Gleason score is the sum of various “grades” the pathologist has given samples taken from the prostate gland. The more aggressive the cancer looks, the higher the grade. The lowest Gleason score you can receive for prostate cancer is a 6, and the highest is a 10. A score of 6 is considered low-grade and unlikely to be aggressive. A score of 7 is a medium grade. A Gleason score of 8 to 10 is aggressive and more likely to grow and spread quickly.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Key Statistics for Prostate Cancer. American Cancer Society. January 13, 2026.
  2. Survival Rates for Prostate Cancer. American Cancer Society. January 13, 2026.
  3. Tests for Prostate Cancer. American Cancer Society. March 21, 2025.
  4. Prostate-Specific Antigen (PSA) Test. National Cancer Institute. January 31, 2025.
  5. Lin DW et al. Updates to Early Detection of Prostate Cancer: AUA/SUO Guideline (2026). American Urological Association. 2026.
  6. Power J. Transperineal Ultrasound-Guided Prostate Biopsy: What the Radiologist Needs to Know. Insights Imaging. April 25, 2022.
  7. Prostate Cancer Screening. National Comprehensive Cancer Network. 2026.
  8. Mehta A et al. Erectile Function Post Prostate Biopsy: A Systematic Review and Meta-Analysis. Urology. January 29, 2021.
  9. Prostate Biopsy. MedlinePlus. October 5, 2025.
  10. Your Prostate Pathology Report: Cancer (Adenocarcinoma). American Cancer Society. July 7, 2023.
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Tawee Tanvetyanon, MD, MPH

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Tawee Tanvetyanon, MD, MPH, is a professor of oncologic sciences and senior member at H. Lee Moffitt Cancer Center and Morsani College of Medicine at the University of South Florid...

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