Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Diagnosing Prostate Cancer

Diagnosing Prostate Cancer

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Symptoms of Prostate Cancer
Prostate cancer may cause one or more of the following symptoms:

  • Inability to pass urine
  • Difficulty starting or stopping the urine flow
  • Needing to urinate often, especially at night
  • Weak urine flow
  • Urine flow that starts and stops
  • Pain or burning during urination
  • Difficulty having an erection
  • Blood in your urine or semen
  • Frequent pain in the lower back, hips or upper thighs

Keep in mind that these symptoms can also indicate conditions other than prostate cancer. If you’re experiencing any of these symptoms, contact your doctor as soon as possible so that the cause can be diagnosed and treated promptly.

Testing for Prostate Cancer
For men over age 50, a digital rectal exam should be a part of your annual checkup. The doctor inserts a gloved, lubricated finger into the lower part of your rectum to feel the prostate for lumps or any other abnormalities.

Another screening test for prostate cancer is the prostate-specific antigen (PSA) test. This test measures the blood levels of PSA, a substance made mostly by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. There is no consensus in the medical community on the effectiveness of the PSA test to screen for prostate cancer, so discuss it with your doctor if you think you may be at risk for the disease.

Diagnostic Tests for Prostate Cancer
If a digital rectal exam or PSA test indicates the possibility of prostate cancer, your doctor may recommend one or more of the following tests:

  • Transrectal Ultrasound: The doctor inserts an ultrasound probe into your rectum to check the prostate for abnormalities. The probe passes sound waves off the prostate (much like sonar in submarines), and a computer uses the echoes to create a picture called a sonogram.
  • Transrectal Biopsy: This is the only certain way to diagnose prostate cancer. The doctor inserts a needle through the ultrasound probe into the prostate and removes tissue samples from several different areas of the gland. A pathologist then checks the samples for the presence of cancer cells.


Grading and Staging Prostate Cancer
If prostate cancer is diagnosed, the next step is to determine the grade (aggressiveness) and the extent, or stage, of the disease so that your doctor can discuss appropriate treatment options with you.


The grade of your cancer is a number that is assigned by a physician called a pathologist.  The pathologist looks at the tissue that was taken from your prostate and from which the diagnosis of prostate cancer was made.  The cancer is graded using a system called the Gleason Grading System.  This is the grading sys­tem that goes from 1 to 5.  Grade is a method, or a measurement, of how aggressive the cancer is.  It will help you and your physician determine, to some degree, what kind of therapy is best for you.  Grade 1 is the least aggressive cancer, and grade 5 is the most aggressive.

Prostate cancer is a bit unusual compared to other cancers.  Most cancers have a single identifiable grade associated with them.  Prostate cancer, on the other hand, may have two or three different grades within the same specimen or the same area of the cancer.

This created a dilemma in the past as to what stage to call the cancer. Dr. Gleason came up with a scoring system.  In this system, the two most common grades are identified and added together to come up with a score, or a sum.  For instance, one could have a primary grade of 3 and a secondary grade of 2, which adds up to a Gleason score of 5.

It is possible to have only one grade throughout and, in this circumstance, the primary and secondary grades are the same; for instance, Gleason 3+3=6.  It is important to know the primary and secondary numbers.  Therefore, urologists commonly say, “You are a Gleason 3+3=6.”  They will not just say, “You have a Gleason score of 6.”  This is because 4+2=6 and 1+5=6 — both of which are very different cancers than 3+3=6.  It is important to know both numbers that contributed to your Gleason score.



Staging is a method that allows us to tell how far advanced the cancer is at the time of diagnosis.  Most cancers we find are clinically localized to the prostate, meaning that the cancer has not metastasized, or spread, beyond the prostate. 

Stage T1c: Most cancers are identified at this stage. The cancer is not palpable and was only identified because a patient presented with an elevated PSA. 

Stage T2a: The tumor is small and localized to one side. 

Stage T2c: The cancer is either a big tumor or palpable on both sides.

Stage T3: The tumor is palpable beyond the limits of the prostate. 

Stage T4: The cancer has metastasized clearly outside the prostate and has gone to a pelvic sidewall or into the base of the bladder.


Learn more about prostate cancer:

For more information about prostate cancer treatment at the Methodist Cancer Center or to make an appointment, call us at 713-790-2700.