A precise diagnostics of prostate cancer without biopsy is impossible. But the process of early diagnosis usually starts from additional methods, which can suspect the disease.

Early diagnosis of prostate cancer begins with consultation of an urologist or oncologist who performs rectal examination of the prostate (finger method) and analysis of PSA test level.

Rectal examination allows suspecting a disease - a doctor feels an abnormal structure of the gland: induration, enlargement, consistency.

Also suspicions can be confirmed by the results of a PSA blood test and its dynamics.

An increase in the PSA level indicates an inflammatory process or an active lifestyle. That is why it is very important to avoid cycling, physical activities, sex, running 3 days before the PSA test.

PSA is a protein produced by the prostate gland. It is a tumor (organ-specific) marker in the blood serum, is detected for diagnosis and monitoring of prostate cancer and prostate adenoma - benign prostatic hyperplasia (BPH). The concentration of PSA in the blood increases in case of prostate cancer.

Age indexes of the upper level of prostatic specific antigen in the serum:

  • 40-49 years - 2.5 ng/ml
  • 50-59 years - 3.5 ng/ml
  • 60-69 years - 4.5 ng/ml
  • over 70 years - 6.5 ng/ml.
If PSA indexes are higher than 10 ng/ml, a doctor prescribes a biopsy of the prostate gland.

PSA indexes higher than higher mentioned ones up to 10 ng/ml are considered as a “grey area” when it is difficult to determine whether a biopsy of the prostate is necessary (ratio of free PSA to general PSA is important).

Complex diagnostics of prostate cancer

Such additional procedures for examination of prostate cancer may be prescribed:

  • MRI of the small pelvis (doctors use MRI 3 Tesla in most of the cases because it shows neoplasms up to 0.02 mm) - this method detects a tumor and metastases.
  • TRUS - transrectal ultrasound.

Specialists may also apply Fusion-biopsy. It is made under control of ultrasound and visualizes an image more precisely.

Preparation for biopsy

Transrectal biopsy of the prostate is performed using a device consisting of a special pistol and disposable needles. Urologists perform a biopsy of the prostate gland under the control of an ultrasound.

Fusion-biopsy is a new method of diagnosing prostate cancer with a high-precise image. During the examination, an ultrasound image is placed on the MRI images. It allows detecting the most suitable points for taking of the material.

A biopsy is performed on an empty stomach. A patient needs to make an enema in the evening before the examination.

A few days before the planned biopsy, doctors advise patients not to take acetylsalicylic acid (aspirin), anticoagulants and other drugs that affect blood clotting ability.

3-5 days after a biopsy, a patient undergoes antibacterial therapy to prevent inflammatory of the prostate gland.

Types of prostate cancer biopsy

The volume of the prostate gland and PSA level are the main parameters for Vienna nomogram. This nomogram allows choosing the optimal number of injections during a biopsy of the prostate.

Modern diagnostic techniques take 8,12, and 18 (multifocal biopsy) points of prostate biopsy.

A saturation biopsy from 24 points has recently become widespread.

Ask your doctor how many tissue samples during a prostate biopsy does he take?

Evaluation of biopsy results

A Gleason scale (from 1 to 10 points) is used for evaluation of biopsy results. The Gleason scale helps classify adenocarcinoma of the prostate, give a prognosis and choose an appropriate therapy.

The Gleason scale is used for the histological evaluation of the differentiation of prostate cancer. High Gleason score signals a poor prognosis of the disease outcome.

After a biopsy of the prostate, the two main characteristics of the biopsy material are evaluated according to 5-point scale.

Points indicate the degree of differentiation of the gland cells. The simpler the cells (the lower differentiation), the worse prognosis is. Such cells divide quickly and penetrate easier into other tissues and organs, forming new tumor colonies (metastases).

One point means the highest degree of differentiation, and 5 - the lowest one.

The result received of the addition of these estimates is the "Gleason sum" ranging from 2 (1+1) to 10 (5+5) points.

The most dangerous adenocarcinoma has a value of 10, while atypical cells (not prone to metastasis) are evaluated up to 5 points.

The more points on the Gleason scale a tumor receives, the faster it can grow and spread.
  • 2-6 points - tumor cells grow very slowly. If adenocarcinoma is small, it can take years while a tumor becomes a problem. In some cases, a patient can avoid a treatment (only qualified doctor can make such a decision).
  • 7 points - a tumor grows and spreads at the average speed. Treatment is necessary for prevention.
  • 8-10 points - cancer grows and spreads quickly. A patient needs urgent treatment in this case.

Most of the prostate cancer cases have from 6 to 10 scores.

Prediction of possible risks and prognosis

Doctors apply Oncotype DX GPS and CTC tests for detection of risks and prognosis for prostate cancer. Oncotype DX GPS is based on a patient’s genome data, and CTC is a blood test which detects circulating tumor cells.

Oncotype DX GPS measures a level of expression of 17 genes to predict aggressiveness of prostate cancer. A result of testing creates genome prostatic scale (according to GPS) from 0 to 100. This result together with other factors helps detect a risk level of prostate cancer before a beginning of treatment.

Stages of complex diagnostics of prostate cancer

Stage 1

Rectal examination

Estimation if the prostate structure

Urologist or oncologist can perform it

Stage 2


PSA general test

Blood test

Stage 3


Under Ultrasound control

Taking of prostate tissue for analysis

Stage 3


Under MRI or Ultrasound control

Taking of prostate tissue biopsy

Stage 4

Evaluation of biopsy results

Histological examination

Gleason scale indexes

Stage 5

Oncotype DX GPS test

Risk evaluation

Genetic examination

Stage 6


Control of treatment

Blood test