Prostate Cancer Diagnosis and Stages


If you are experiencing symptoms of prostate cancer, our team at Dana-Farber Brigham Cancer Center will ask about your health history, your family’s history of cancer and risk factors. We may perform diagnostic tests to help determine if you have prostate cancer. A diagnosis is often determined through a combination of imaging tests and tissue sampling (biopsy). In addition to the PSA and DRE tests described above, diagnostic tests may include the following, though most patients will not require all tests:

  • Prostate MRI
  • Tests to estimate the likeliness of high-grade prostate cancer, such as 4Kscore, PHI score, PCA3, ExoDx and SelectMDx
  • Ultrasound-guided transperineal or transrectal prostate biopsy, a test where a probe is inserted in the rectum and prostate biopsies are either taken through the rectum (transrectal) or the skin (transperineal). In some instances, images taken from an MRI can be overlaid with those taken from an ultrasound probe (fusion), allowing the surgeon to identify areas of concern and performed targeted prostate biopsies.

Learn more about our center’s overall diagnosis process.

Stages of Prostate Cancer

After receiving a diagnosis of prostate cancer, our team will try to determine your stage of cancer. The stage of cancer describes how much and far the cancer has spread in your body. It is one of the most important things to know when deciding how to best treat your cancer, including whether your cancer can be removed (resected) with surgery. You may need additional diagnostic tests to help our team formally assign a stage to your cancer, which is dependent upon the size and spread of the cancer.

The Gleason Grading System is commonly used to determine the aggressiveness of prostate cancer, ranging from least to most aggressive with a score from 2–10. A higher number, such as 10, means a more advanced cancer.

An additional stage system includes:

  • Stage I: This stage of prostate cancer is nonaggressive and only found in a small area of the prostate.
  • Stage II:This stage of prostate cancer may either be small but aggressive or larger and involving both sides of the prostate gland.
  • Stage III:This stage of prostate cancer has spread beyond the prostate to seminal vesicles or nearby tissues.
  • Stage IV:This stage of prostate cancer has spread beyond the prostate to nearby tissues in the rectum, bladder or pelvic wall; nearby organs or lymph nodes; or other parts of the body, such as the bones, liver or lungs.

Learn more about the stages of prostate cancer.

Post-Diagnostic Evaluation

After your healthcare team identifies your stage of prostate cancer, they may also want to use any of the following post-diagnostic tests to learn more about your cancer:

  • Computed tomography (CT or CAT) scan, a test which uses a combination of X-rays and software to create images of your prostate and nearby organs. It will help to discover if your cancer has spread into lymph nodes or other organs.
  • Prostate-specific membrane antigen (PSMA) PET scan is an imaging test where radioactive tracers attach to PSMA, a protein found on most prostate cancer cells. This scan is especially helpful to determine if or where your prostate cancer has spread.
  • Magnetic resonance imaging (MRI), a test which uses magnets and radio waves to create detailed images of your prostate and nearby organs and tissues.
  • Lymph node biopsy, a test that examines if your prostate cancer has spread to nearby lymph nodes; small pieces of tissue are tested under a microscope.

Learn more about tests you may receive after your diagnosis.

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