Your general practitioner (GP) conducts a blood test, often as part of a suite of blood tests, and/or a physical examination:

Blood test (Prostate Specific Antigen – PSA) – identifies whether there has been an increase in a protein in your blood, that may indicate you need further investigation by a specialist.

Digital Rectal Examination (DRE) – allows your doctor to feel the size of the prostate and check if there are any abnormalities. Occasionally a cancer can be felt this way, but not always. A normal DRE exam does not rule out prostate cancer.

Even if positive, neither of these tests make the diagnosis. In fact, most men with a high PSA test result do not have prostate cancer. More tests are required (see below).

If these tests are positive, your doctor may request to repeat them and refer you to a urologist (a doctor who specialises in the urinary and reproductive area) who may suggest:

Free Total PSA ratio
If you have a moderately raised PSA score and your doctor is not sure whether you need a biopsy, you may have another test to measure the “free PSA” in your blood – that is, the PSA molecules that are not attached to other blood proteins. A decreased level of free PSA can indicate prostate cancer.

Prostate Health Index (PHI)
A combination of three blood tests that measure different forms of PSA protein. When reviewed together they may provide a risk assessment for prostate cancer.

A urine test which measures the level of the PCA3 gene and which, when looked at in conjunction with the PSA test, can help your doctor decide whether you need a biopsy.

This is the only way a firm diagnosis of prostate cancer can be made. Your specialist removes small samples of tissue from your prostate using a very thin, hollow needle, guided by an ultrasound. The prostate is either reached through the rectum (transrectal) or the perineum (transperineal), which is the area between the anus and scrotum. A biopsy is usually done as an out-patient procedure and your doctor will likely advise a course of antibiotics afterwards to reduce the chance of infection. The tissue is sent to a pathologist to identify whether the cells are malignant (i.e. cancerous) or benign (i.e. non-cancerous).

Scanning is emerging in detecting clinically significant prostate cancer and commencing early intervention if necessary.
The results of all these tests are looked at together, giving an overall picture of the prostate cancer diagnosis. It is only then that the correct treatment options can be discussed with you. For more information about treatment options, please see another booklet in this series: Treatment.