There’s a lot of fear around prostate cancer diagnosis, but diagnosis is the first step in treating and managing the disease. Here are the various procedures available to move towards an accurate diagnosis:

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Digital Rectal Exam

Once you’ve visited your doctor and they have a clear idea of your symptoms, they will likely perform a digital rectal examination, in order to feel the prostate through the wall of the rectum. This allows your doctor to determine whether there are any lumps or abnormalities in the prostate. A digital rectal examination is conducted by inserting a lubricated, gloved finger into the rectum.

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Other initial tests

During your first visit to the doctor you can also expect to give a urine sample in order to check for blood in the urine. Your doctor will also want to measure your Prostate Specific Antigen (PSA) level. This is done via a blood test.

Both the digital rectal examination and PSA test allow your doctor to identify whether there’s a problem with the prostate. If a problem is detected, further tests will need to be carried out to determine if cancer is present.

Common Diagnosis Test

Transrectal Ultrasound (TRUS)

This involves the insertion of a probe into the rectum. Ultrasound waves are bounced off the prostate and used to form a picture called a sonogram. The sonogram will show up any abnormal areas on the prostate. This test is only used for sizing and guiding of the biopsy, and not for diagnosis of cancer.

Transrectal Biopsy

This involves taking a sample of tissue from the prostate, using a needle and guided by the TRUS. The sample is viewed through a microscope by a pathologist, who will look for the presence of cancer cells. The tissue sample is obtained by the insertion of a thin needle through the rectum and into the prostate.

Prostate Specific Antigen (PSA)

Any time there’s talk of prostate cancer, you’ll probably hear people using the term ‘PSA’. When you first visit the doctor, they will take a blood test, which will show the level of Prostate Specific Antigen (PSA) in your blood. This result, along with other examinations, will be used to find and diagnose prostate cancer. PSA is a protein made by the prostate that helps keep semen in liquid form. A small amount of PSA enters the bloodstream and will show up on a blood test. PSA can be produced by both non-cancer and cancer in the prostate. Cancer cells usually produce more PSA than normal cells and therefore more PSA may enter the bloodstream in patients with prostate cancer and a higher level will be seen on a blood test.

Why could my PSA levels be raised?

Apart from prostate cancer there can be other reasons for a raised PSA level in the blood. These include:

  • An enlarged prostate (benign prostatic hyperplasia)
  • An inflamed prostate
  • A bladder infection (cystitis)
  • A recent prostate biopsy (it’s advised to wait for a few weeks before doing a PSA test)
  • A recent digital rectal examination (doctors will take your blood before this examination)
  • Recent bicycle riding (though this has not been properly proven)
  • Recent ejaculation (24-48 hours prior to the PSA test)
  1. Men’s Foundation. Prostate cancer. https://mensfoundation.co.za/mens-health/prostate-cancer/. Accessed on 22 October 2021.
  2. Cansa.org. Fact Sheet on Prostate Cancer. https://cansa.org.za/files/2021/04/Fact-Sheet-on-Prostate-Cancer-NCR-2017-web-March-2021.pdf. Accessed on 22 October 2021.
  3. Memorial Sloan Kettering Cancer Center. Prostate Cancer Diagnosis. https://www.mskcc.org/cancer-care/types/prostate/diagnosis. Accessed on 22 October 2021.
  4. National Cancer Institute. Stages of Prostate Cancer. https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq#_120. Accessed on 22 October 2021.


IFPA. Psoriasis is a serious disease deserving global attention. Available at: https://ifpa-pso.com/wp-content/uploads/2017/01/Brochure-Psoriasis-is-a-serious-disease-deserving-global-attention.pdf Accessed: June 2020.
Rapp SR, et al. J Am Acad Dermatol 1999;41:401–7.
NHS. Living with psoriasis. Available at: https://www.nhs.uk/conditions/psoriasis/living-with/ Accessed: June 2020.
Griffiths CEM and Barker JNWN. Lancet 2007;370:263-71.
Reich A, et al. Acta Derm Venereol 2010;90:257-63.
Heller MM, et al. Skin Ther Letter 2011;16.
Moon H-S, et al. Dermatol Ther 2013;3:117-30.
NHS. Clinical depression. Available at: https://www.nhs.uk/conditions/clinical-depression/symptoms/ Accessed: June 2020.
Pulse Today. Almost half of GP consultations ‘now include a mental health issue’. Available at: http://www.pulsetoday.co.uk/clinical/clinical-specialties/mental-health/almost-half-of-gp-consultations-now-include-a-mental-health-issue/20036839.article Accessed: June 2020.
NHS. CBT. Available at: https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/ Accessed: June 2020.
Markowitz JC and Weissman MM. World Psych 2004;3(3):136-9.
NHS. Counselling. Available at: https://www.nhs.uk/conditions/counselling/ Accessed: June 2020.