• Prostate Cancer

    Dana-Farber/Brigham and Women's Cancer Care

    How We Diagnose Prostate Cancer

    Beginning with your first appointment at the Lank Center for Genitourinary Oncology at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), you will be matched with specialists and researchers who study genitourinary cancers exclusively. We have one of the largest teams of genitourinary specialists (urology, medical oncology, radiation oncology) in the world focusing exclusively on diagnosing and managing genitourinary cancers.

    Finding the right pathologists and radiologists to manage your prostate cancer diagnosis is key to developing a successful treatment plan. Our radiology and pathology teams are devoted to prostate cancer, evaluating over 2,200 cases each year.

    Testing for prostate cancer

    As men age, the risk of developing prostate cancer increases. Many men will develop prostate cancer, but not all develop a harmful form of the disease. That's why it's important to be tested and treated as early as possible. Early diagnosis can improve your chances for successful treatment and recovery.

    If you would like a second opinion...

    Our diagnostic team provides second opinions and we are happy to consult with you, your primary care physician, or other specialists. We are frequently asked for second opinions from oncologists all over the country. You may want to consider a second opinion:

    • To confirm your diagnosis
    • To have original biopsies or other tissue diagnosis confirmed
    • For details on the type and stage of cancer
    • To better understand your treatment options
    • To learn if you are eligible for clinical trials

    Phone: 877-442-DFCI or 877-442-3324
    Online: Complete the Appointment Request Form  

    Tests to diagnose prostate cancer

    These tests are most commonly used to diagnose prostate cancer:

    • Digital rectal exam (DRE): The most common and simplest screening test for prostate cancer is the digital rectal exam (DRE). The doctor will gently insert a gloved finger into the rectum to determine if the prostate is enlarged or has lumps. This is not a definitive test, but regular exams can help detect changes in the prostate over time. A DRE may also be used to tell if cancer has spread or returned after treatment.
    • Prostate-specific antigen (PSA) test: A test that measures the level of PSA, a substance made by the prostate, in the blood. Higher levels of PSA in the blood may indicate prostate cancer. A PSA test is a helpful screening tool for doctors, as it determines the next step in evaluating a patient. If prostate cancer is diagnosed, PSA levels are then most helpful in planning treatment, judging treatment effectiveness, and monitoring the prostate for growth (also called active surveillance or watchful waiting).

      It is important to note that PSA levels can fluctuate and are not always a marker for prostate cancer. For example, high PSA levels may be a result of infection, inflammation, an enlarged prostate, aging, or ejaculation. Conversely, certain conditions may make PSA levels low, such as certain herbal medicines or supplements, drugs to treat BPH, or obesity.
    • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. The procedure is similar to a CT scan, except the MRI does not deliver radiation.
    • Transrectal ultrasound: A procedure in which a small probe, about the size of a finger, is inserted into the rectum to check the prostate. The probe is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs, which create a picture of echoes (called a sonogram). A transrectal ultrasound may be used during a biopsy procedure.
    • A transrectal or transurethral biopsy: A procedure to remove cells, fluid, or tiny tissue samples from the prostate for viewing under a microscope by a pathologist. The pathologist will check the tissue sample to see if there are cancer cells, and then determine the Gleason score (see Gleason Grading System below).

    Gleason Grading System

    Massimo Loda, MDMassimo Loda, MD, Director, Center for Molecular Oncologic Pathology 

    The Gleason Grading System is an important way to determine the aggressiveness of prostate cancer. If a biopsy reveals prostate cancer cells, the cancer will be classified using the Gleason grading system. This helps doctors develop the best treatment plan and calculate how quickly the cancer is growing.

    Prostate cancer contains several types of cell patterns, and each pattern has been assigned a number (1 through 5) based on the aggressiveness of the cells. Some cell patterns are more aggressive than others, meaning they have a higher numeric value. Gleason scores are determined by combining scores for the most dominant cell type found, plus the most aggressive cell type found. Generally speaking, this is how risk categories for prostate cancer are determined:

    • Gleason scores of 6 and 7 are low grade and indicate the lowest risk of harm
    • Gleason scores of 7 to 8 indicate intermediate risk
    • Gleason scores of 9 to 10 indicate high risk

    Tests to determine the stage of prostate cancer

    If prostate cancer is found after a biopsy, tests may be conducted to determine if the cancer cells have spread beyond the prostate to other parts of the body. The process used to find out if, and how far, the cancer has spread is called staging. It is important to know the stage of the cancer — in other words, how far the cancer has progressed or is likely to progress — in order to plan treatment. The following tests and procedures may be used in the diagnostic and staging process:

    • Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is mapped by a scanner.
    • PET/CT (CAT) scan: A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to trace and create computerized pictures of the solution inside your body. The procedure is painless and has no side effects.
    • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. The procedure is similar to a CT scan, except the MRI does not deliver radiation.
    • Pelvic lymphadenectomy: This is a procedure performed during the time of surgery to remove the lymph nodes in the pelvis. The lymph nodes are then examined under a microscope to see if they contain cancer.

    Stages of prostate cancer

    Prostate cancer is divided into categories — or stages — based on the size and spread of cancer beyond the prostate and into other places in the body (metastasis), such as the lymph nodes, blood, or other organs.

    The clinical stages of prostate cancer are:

    • Stage I: Cancer is found in the prostate only. It generally does not extend beyond one half of one side of the prostate. At this stage the cancer tumor cannot be felt during a digital rectal exam and is not visible by imaging. It is usually found accidentally during other procedures, such as a biopsy, surgery, or PSA test.
    • Stage II: Cancer is more advanced than in stage I, but has not spread beyond the prostate. At stage II the cancer has spread to more than one-half of one side of the prostate. Tumors at this stage are usually not found by a digital rectal exam or made visible by imaging tests.
    • Stage III: Cancer has spread beyond the outer layer of the prostate to nearby tissues. Cancer may be found in the glands that produce semen (seminal vesicles).
    • Stage IV: Cancer has spread beyond the prostate and seminal glands to lymph nodes or nearby tissues in the rectum, bladder, or pelvic wall. Stage IV cancer may be found in other parts of the body, such as the liver or lungs. Metastatic prostate cancer often spreads to the bones.

    While the staging of prostate cancer is an important factor in determining your treatment plan, prostate cancer is generally referred to by risk category, not stage. Risk is determined by how the cancer appears under a microscope, which, in turn, determines its grade or Gleason score. Categories for localized prostate cancer (cancer confined to the prostate) include: low-risk, intermediate-risk and high-risk. Prostate cancer may also be referred to as metastatic or recurrent. Ninety-five percent of prostate cancer cases are diagnosed as intermediate risk.

    Our prostate cancer research

    The DF/BWCC prostate cancer team is at the forefront of prostate cancer research. We are one of the few cancer centers in the nation to be rewarded through Dana-Farber/Harvard Cancer Center with a prestigious, federally-funded prostate cancer SPORE (Specialized Program of Research Excellence) grant. This grant recognizes the achievements of DF/BWCC prostate cancer researchers, and allows us to continue leading investigations into new diagnosis methods and treatments. Each prostate cancer patient benefits from this quality research and the discoveries our team is making.

    In addition, DF/BWCC experts have built an extensive database of over 8,000 genitourinary cancer tissue and blood samples used for prostate cancer research with the belief that this research will translate into clinical benefits for patients. Patients have the opportunity for tumor assessment using OncoPanel, a screening test that carefully identifies known and unknown genetic mutations. That means we can precisely identify genetic mutations and cellular patterns in the DNA of cancer cells, and in some cases recommend treatment tailored just for you.

    Next: How We Treat Prostate Cancer 

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