3 Prostate Cancer Tests You Need to Know About

Prostate Health: What You Should Know

Written by Alex Reid
Posted November 4, 2013

Men, let's talk about something serious for a second...

It's a scary thought to be diagnosed with cancer of any kind.

And for many of us, the tests involved in detecting prostate cancer in particular can be equally frightening.

Because the prostate is not easy to reach from the outside of the body, two of the primary tests involve inserting a finger or probe into the rectum — not exactly the most comfortable thought (or feeling) in the world.

It may surprise you to know there is a lot of controversy surrounding the effectiveness of prostate screening.

Here's what you need to know about prostate cancer, as well as the three main detection tests, to better help you and your doctor make an informed decision...

Prostate Cancer Basics

The prostate is a small gland located behind the bladder. Its main job is to produce the fluids for ejaculation.

Prostate enlargement is a natural side effect of aging; unfortunately, the risk of developing prostate cancer increases with age as well. Most prostate cancers are found in men older than 65,1 though most are diagnosed around age 70.2 It's rare in men below 40.

African American men are at a higher risk than the rest of the population.3

Your risk also increases if you have an immediate male family member that has been diagnosed with prostate cancer.

While some men may not present symptoms for prostate cancer, there are some warning signs you should be aware of4:

  • Difficulty in starting urination

  • Weak or interrupted flow of urine

  • Frequent urination, especially at night

  • Difficulty in emptying the bladder completely

  • Pain or burning during urination

  • Blood in the urine or semen

  • Pain in the back, hips, or pelvis that doesn’t go away

  • Painful ejaculation

A very important distinction in prostate cancer is the two “types” of cancer: slow-growing and fast-growing.

The fast-growing cancer is an aggressive type that is more dangerous than slow-growing cancer. It requires immediate medical treatment; otherwise the cancer can spread to other organs (“metastasize” in medical terms) and result in death.

The slow-growing prostate cancer is exactly what it sounds like: It grows so slowly that many of the men diagnosed often die of other complications before they would succumb to the cancer, due to the advanced age at which most men develop the cancer.

This is important because the treatments involved for getting rid of prostate cancer can have some very serious side effects. These include:

  • Impotence

  • Incontinence

  • Complications from surgery, chemo, and/or radiation therapy

  • Psychological trauma from dealing with cancer treatment

For those with slow-growing, low-risk tumors, the consequences of cancer treatment may far outweigh the consequences of living with the cancer.

Prostate Screening Tests: What They Can and Can't Tell You

There are three main tests used to screen for prostate cancer.

1) Prostate Specific Antigen (PSA)

This test measures the amount of PSAs in ejaculate fluid. PSAs are found naturally in semen, and they increase with the size of the prostate, which can be a key indicator of cancer.

“According to published reports, men who have a prostate gland that feels normal on examination and a PSA less than four have a 15% chance of having prostate cancer. Those with a PSA between four and 10 have a 25% chance of having prostate cancer and if the PSA is higher than 10, the risk increases to 67%."5

However, the PSA test is notorious for producing “false positive” cancer diagnosis. Because PSAs are elevated for prostate enlargement from any cause, including non-cancer causes like normal aging, the test oven leads to a misdiagnosis.

That's why it's important patients don't rely on the PSA test as their only diagnostic tool.

There are also cases of men with low-PSA levels developing cancer, so the test is not 100% foolproof.

2) Digital Rectal Exam (DRE)

This is the one that make most men squirm. Basically put, your doctor will insert a gloved, lubed finger into the rectum to check the prostate for abnormal texture and hardness.

As 85% of prostate cancers develop in the rear of the prostate near the rectum, this test has been used for decades by medical professionals to diagnosis prostate issues.

However, the effectiveness of the DRE is another debated item: While it can be used to confirm later stages of tumor growth or those that develop close to the rectum, it can miss many small tumors growing in other parts of the prostate.

The skill and experience of the doctor doing the exam can also make a huge difference in the diagnosis (or lack thereof) made, so it pays to do your research beforehand.

3) Further tests

If the doctor finds any abnormalities in the first two tests, he or she may ask you to take tests to discover the extent of the problems. These include a prostate ultrasound (a finger-sized probe that is inserted into the rectum to give a better image of the prostate), a CAT scan (a type of X-ray imaging), or an MRI (magnetic imaging).

These will give the doctor a better idea of whether or not cancer is the proper diagnosis.

(Note: They are more expensive than the PSA and DRE, which is why they're not used in the initial testing.)

A Positive Test for Prostate Cancer

The doctor will do the tests necessary to determine whether the cancer is of the slow- or fast-growing type.

If it's the aggressive type, he or she will likely recommend common cancer treatments, such as chemotherapy, radiation therapy, and even physical removal of the tumor or the entire prostate.

The slow-growing type involves a bit more patient discretion. As I mentioned above, the side effects of cancer treatment can often be more harmful than letting the cancer go untreated.

One of the most common responses to slow-growing prostate cancer diagnosis is “active waiting.” This involves simply carrying on with your life as normal — no surgeries or cancer treatments.

Your doctor may advise you to make some lifestyle changes, such as diet or exercise. You'll be advised to go in for regular testing to actively monitor the growth of the tumor; if it increases in size to be of concern, then the doctor may advise you to go in for more aggressive treatments.

While it can be hard to balance a healthy prostate with psychological comfort, the decision to get tested isn't one to take lightly.

Your doctor can provide you with more information, including the identification of certain risk factors that may increase your chances of developing prostate cancer.

Yours in health,


Ken Swearengen


[1] http://www.mayoclinic.com/health/prostate-cancer/HQ01273/NSECTIONGROUP=2 

[2] http://www.mayoclinic.com/health/prostate-cancer/HQ01273/NSECTIONGROUP=2 

[3] http://www.webmd.com/prostate-cancer/guide/prostate-cancer-risk-factors 

[4] http://www.cdc.gov/cancer/dcpc/resources/features/ProstateCancer/ 

[5] http://www.webmd.com/prostate-cancer/guide/psa