How is prostate cancer diagnosed?

Prostate cancer is diagnosed using a number of different tests including a PSA test, digital rectal examination and a prostate biopsy.

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Prostate biopsy

A prostate biopsy involves taking small pieces of prostate tissue to be looked at under the microscope. You will usually have a biopsy called a trans-rectal ultrasound (TRUS) guided prostate biopsy.

A high PSA level alone doesn't automatically mean that you need a biopsy. Your doctor should talk to you about the pros and cons of having a biopsy, and discuss any concerns you may have before you decide whether to have it.

You might not need a biopsy if other tests, such as a bone scan, shows the cancer has spread outside the prostate.

What are the pros and cons of a TRUS biopsy?


  • A biopsy is the most accurate way of finding out if you have prostate cancer and how likely it is to spread.
  • This can help you and your doctor or nurse decide which treatment options may be suitable for you.
  • A biopsy can pick up a faster growing cancer at an early stage – when treatment might prevent it spreading.


  • The biopsy can only show if there was cancer in the samples taken. If your biopsy result is normal it can’t rule out cancer completely – the biopsy takes tissue from small areas of the prostate, so it might miss some cancer.
  • A biopsy can pick up a slow growing cancer that might not cause any symptoms or problems in your lifetime.
  • A biopsy can also have side effects.

What does a TRUS biopsy involve?

A TRUS biopsy involves using thin needles to take around 10 to 12 small pieces of tissue from the prostate.

Before the biopsy you should tell your doctor or nurse if you’re taking any medicines, particularly drugs that thin the blood.

The biopsy is done through the back passage (rectum). You'll have a local anaesthetic injection into your back passage to ease any discomfort.

Your doctor or nurse will put an ultrasound probe into your back passage, using gel to make it more comfortable. The ultrasound probe scans the prostate and an image appears on a screen. A needle is then inserted through the wall of the back passage into the prostate - using the ultrasound image as a guide.

TRUS Biopsy

The biopsy will take 10 to 15 minutes. You might have to wait until you’ve had a pee (passed urine) before going home. You’ll be given antibiotics to help prevent infection. You will also be given antibiotics to take at home – it’s important to follow the instructions and take all of them.

Some men find the biopsy painful, but others have only slight discomfort. If you have any pain, tell your nurse or doctor. You may need mild pain-relieving drugs, such as paracetamol.

If you’re gay or bisexual you might need to be careful when you have sex. If you have anal sex, you should ideally wait around six weeks after a biopsy before you receive anal sex. Ask your doctor or nurse at the hospital for further advice.

What are the side effects of TRUS biopsy?

  • You might see a small amount of blood in your urine or stools for two weeks or in your semen for a couple of months. If it takes longer to clear up, or gets worse, see a doctor straight away.
  • Up to 3 in 50 men (6 per cent) may get a more serious infection.
  • A fever (high temperature), chills, pain or burning when you pee, or difficulty in peeing are signs of an infection. This can happen even if you’ve been taking antibiotics. If you have these symptoms go to your nearest accident and emergency (A&E) department straight away.
  • A small number of men can’t pee after a biopsy (urine retention). If this happens contact your doctor or nurse at the hospital straight away, or go to the A&E department.
  • Some men have discomfort or pain for a few days or weeks afterwards. Speak to your doctor or nurse about pain relief.
  • There’s a small chance of getting a urine infection after the biopsy. Take the antibiotics your doctor gave you.

Other types of prostate biopsy

What is a template biopsy? 

A template biopsy involves taking more tissue samples than a TRUS biopsy - usually around 30 to 50 samples are taken. 

The biopsy needles are inserted through the skin between the scrotum and the back passage (perineum). The biopsy is normally done under general anaesthetic.

With a template biopsy, more of the prostate is looked at, so there’s more chance of finding cancer. But this also means that there’s more chance of finding a slow-growing cancer that might not cause any symptoms or problems in your lifetime.

Template biopsy can have similar side effects to a TRUS biopsy. But there’s less risk of a serious infection with a template biopsy. There is more chance that you will have problems peeing after a template biopsy. Your doctor will make sure you can pee before you go home. If you can’t pee, you might need to have a catheter for a few days. A catheter is a thin tube that’s passed into your bladder to drain urine. 

What is a transperineal biopsy?

Some men can’t have an ultrasound probe or biopsy needles inserted into their back passage because of other medical conditions. They will have the biopsy needles inserted through the area of skin between the scrotum and the back passage (perineum).

What do my biopsy results mean?

The biopsy samples will be looked at under a microscope to check for any cancer cells. Your doctor will be sent a report, called a pathology report, with the results. The results will show:

  • whether any cancer was found
  • how many biopsy samples contain cancer
  • how much cancer is present in each sample.

You might be sent a copy of the pathology report. If you have trouble understanding any of it, ask your doctor to explain it, or speak to our Specialist Nurses over the phone or speak to a nurse online.

If cancer is found

If your biopsy shows there is cancer present, you may hear your doctor talk about your Gleason grade and Gleason score. This can give an idea of how likely the cancer is to grow and spread outside the prostate. Read more about your test results, and what support is available.

If no cancer is found

If no cancer is found this is obviously reassuring. However, this means ‘no cancer has been found’ rather than ‘no cancer is present’. There could be some cancer that was missed by the biopsy needles.

Your doctor may suggest keeping an eye on your prostate with PSA testsDREs or an MRI scan. If your doctor still suspects that cancer is present you may be offered another biopsy. You may be offered either another TRUS biopsy or a template biopsy.

What else might the biopsy results show?

Sometimes the biopsy finds other changes to your prostate cells, called PIN or ASAP

Will I need to have a scan?

If you’re diagnosed with prostate cancer, you might need to have a scan to find out whether it has spread outside the prostate. You may have:

  • an MRI scan
  • a CT scan, or
  • a bone scan.

The results should help you and your doctor decide which treatments might be suitable for you.

You might not need to have these scans if your PSA is low and your Gleason score suggests that the cancer is unlikely to have spread.

MRI scan 

You might have an MRI (magnetic resonance imaging) scan to find out if the cancer has spread and you’re thinking about treatments such as radiotherapy or surgery.

The MRI scan uses magnets, so you will need to take off any jewellery or metal items when you have the scan. Let the radiographer know if you have metal implants such as a pacemaker for your heart.

You will lie on a table which will move slowly into the scanner. Some MRI scanners are doughnut-shaped. Others are shaped like a long tunnel. If you have a fear of enclosed spaces (claustrophobia), tell your radiographer.

The scan takes 30 to 40 minutes. The machine is very noisy but you won’t feel anything.

The radiographer will leave the room but you’ll be able to speak to them through an intercom, and they can see you at all times. You may be able to listen to music through headphones.

CT scan

A CT (computerised tomography) scan can show whether the cancer has spread beyond the prostate for example to the lymph nodes or nearby bones. You might have this scan if you’re thinking about treatments such as radiotherapy or surgery

The CT scanner is shaped like a large doughnut. You will lie on a table which moves slowly through the hole in the middle of the scanner. The radiographer will leave the room but you’ll be able to speak to them through an intercom, and they can see you at all times. You will need to keep still, and you might be asked to hold your breath for short periods. The scan takes 10 to 20 minutes.

Bone scan

You might have a bone scan if there’s a chance your cancer has spread outside the prostate to the bones. This is a common place for prostate cancer to spread to.

Tell your doctor or nurse if you have arthritis or have ever had any broken bones or fractures, or surgery to the bones, as these will also show up on the scan.

You might be asked to drink plenty of fluids before and after the scan. A small amount of a safe radioactive dye is injected into a vein in your arm, and you’ll have the scan two to three hours later. If there is any cancer in the bones, the dye will collect in these areas and show up on the scan.

You will lie on a table while the scanner moves very slowly down your body taking pictures. This takes around half an hour. The camera will pick up any ‘hot spots’ where the radioactive dye has collected. These ‘hot spots’ can show if the cancer has spread to the bone.

The doctor will look at the results of the scan carefully to see whether any cancer is present. You may need to have X-rays of any ‘hot spots’ to check if they are definitely cancer. If it’s still not clear, you may need to have an MRI scan.

You may be asked to avoid contact with children and pregnant women for up to 24 hours after the scan. 

Other tests

Researchers are looking at other tests that may help to diagnose prostate cancer. These tests are not widely available and more research is needed before we can be sure how useful they are.

Free and total PSA test

This test measures the amount of two different types of PSA in the blood. It can help tell whether you have a high PSA level because of prostate cancer, or because of a non-cancerous prostate problem. But doctors don’t yet agree on what levels of the different types of PSA show that a man has prostate cancer, so it’s not used that often. The test is only suitable for men who have a PSA level between 4 and 10ng/ml.

A urine test called a PCA3 test

Your doctor or nurse will massage your prostate then ask you to give a urine sample. Cells from the prostate pass into the urine where they can be looked at with a special test that looks at your genes. This test might help specialists decide which men should have a biopsy, or it might be useful for monitoring men who’ve already had a biopsy. At the moment the PCA3 test is only available in a few private hospitals and clinics, as we still need more research about how good it is.


Updated: February 2014 | Due for Review February 2016

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