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In the modern era, the first step to diagnosing prostate cancer is usually by detecting an elevation in PSA through routine screening. Cancer may also be diagnosed after an abnormal digital rectal examination.
A definitive diagnosis requires taking a biopsy of the prostate and examining the tissue under a microscope for cancer cells.
Biopsies may be performed under ultrasound or MRI guidance.
If cancer cells are detected in your biopsy, the cancer will be given a pathological staging, called a Gleason score. This is a score based on the microscopic appearance of the cancer cells, with the minimum score being 2 and the maximum being 10. A higher Gleason score indicates a higher grade, more aggressive cancer and is associated with a poorer prognosis.
Your cancer will be clinically staged with a bone scan and CT scan to check for metastatic disease.
Based on the aggressiveness of your cancer and other factors, such as your age, other medical conditions you may suffer from and the likelihood that treatment will lead to a better outcome, your doctor may recommend active treatment or active surveillance, a “watchful waiting” approach to managing your prostate cancer.
See more about a positive biopsy result: