This is a large print version of our fact sheet about how prostate cancer is diagnosed. It is in size 16 font. It describes the tests used to diagnose prostate cancer and explains what the results may show. We can also send you a copy in the post. Call us on 0800 074 8383 or contact us online.

Last updated: February 2014
To be reviewed February 2016


  • Berney DM. The case for modifying the Gleason grading system. BJU Int 2007;100(4): 725-726.
  • Bostwick DG, Cheng L. Precursors of prostate cancer. Histopathology 2012;60(1): 4–27.
  • British Association of Urological Surgeons. Transperineal biopsy of the prostate – procedure specific information for patients 2012. Available from
  • Catalone W J, Partin AW, SLawin KM, Brawer MK, Flanigan RC, Patel A, Richie JP, deKernion JB, Walsh PC, Scardino PT, Lange PH, Subong EN, Parson RE, Gasior GH, Loveland KG, Southwick PC. Use of percentage of free prostate-specific antigen to enhance differentiaion of prostate cancer from benigh prostatic disease: a prospective multicenter clinical trial. JAMA 1998;279: 1542-1547.
  • Clouston D, Bolton D. In situ and intraductal epithelial proliferations of prostate: definitions and treatment implications. Part 2: intraductal carcinoma and ductal adenocarcinoma of prostate. BJU Int 2012;110(4): 22–24.
  • De Nunzio, Trucchi A, Miano R, Stoppacciaro A, Fattahi H, Cicione A, Tubaro A. The number of cores positive for high grade prostatic intraepithelial neoplasia on initial biopsy is associated with prostate cancer on second biopsy. J Urol 2009;181: 1069–1074.
  • Eichler K, Hempel S, Wilby J, Myers L, Bachmann LM, Kleijnen J. Diagnostic value of systematic prostate biopsy methods in the investigation for prostate cancer: a systematic review. J Urol 2006;175(5): 1605-1612.
  • Froehner M, Buck LM, Koch R, Hakenburg OW, Wirth MP. Derivatives of prostate specific antigen as predictors of incidental prostate cancer. BJU Int 2009;104: 25-28.
  • Haffner, J, Lemaitre L, Puech P, Haber GP, Leroy X, Jones JS and Villers A. Role of magnetic resonance imaging before initial biopsy: comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection. BJU International 2011;108: E171–E178.
  • Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, Mason MD, Matveev V, Mottet N, van der Kwast TH, Wiegel T, Zattoni F. Guidelines on prostate cancer. European Association of Urology 2013. Available at
  • Hooker S, Hernandez W, Chen H, Robbins C, Torres JB, Ahaghotu C, Carpten J, Kittles RA. Replication of prostate cancer risk loci on 8q24, 11q13, 17q12, 19q33, and Xp11 in African Americans. Prostate 2010;70(3): 270-276.
  • Kirkham APS, Emberton M and Allen C. How good is MRI at detecting and characterising cancer within the prostate? Eur Urol 2006;50(6): 1163-1174.
  • Lee MC, Moussa AS, Yu C, Kattan MW, Magi-Galluzzi C, Jones JS.. Multifocal high grade prostatic intraepithelial neoplasia is a risk factor for subsequent prostate cancer. J Urol 2010; 184(5): 1958–1962.
  • Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, Rosario DJ, Scattoni V, Lotan Y. Systematic review of complications of prostate biopsy. Eur Urol 2013;64(6): 876-892.
  • Merrimen JL, Jones G, Walker D, Leung CS, Kapusta LR, Srigley JR.. Multifocal high grade prostatic intraepithelial neoplasia is a significant risk factor for prostatic adenocarcinoma. J Urol 2009;182: 485–490.
  • Montironi R, Mazzucchelli R, Lopez-Beltran A, Scarpelli M, Cheng L. Prostatic intraepithelial neoplasia: its morphological and molecular diagnosis and clinical significance. BJU Int 2011;108(9): 1394–1401.
  • National Institute for Health and Care Excellence. Prostate Cancer: Diagnosis and Treatment; Full Guideline 2014. Available from
  • National Institute for Health and Care Excellence. Transperineal template biopsy and mapping of the prostate 2010. Available from
  • Noguerira L, Corradi R, Eastham J. Other biomarkers for detecting prostate cancer. BJUI 2009;105: 166-169.
  • Prostate Cancer Risk Management Programme information for primary care; PSA testing in asymptomatic men. Evidence document January 2010
  • Prostate Cancer Risk Management Programme. Undertaking a transrectal ultrasound guided biopsy of the prostate. 2006. Available from
  • Roehrborn CG. BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU International 2008;101(3): 17-21. Colin SM, Metcalfe C, Donovan J, Lane JA, Davis M, Neal D, Hamdy F, Martin RM. Associations of lower urinary tract symptoms with prostate-specific antigen levels, and screen detected localized and advanced prostate cancer: a case-control study nested within the UK based population ProtecT (Prostate testing for cancer and Treatment) study. BJU Int 2008; 102(10):1400-1406.
  • Rosario DJ, Lane JA, Metcalfe C, Donovan JL, Doble A, Goodwin L, Davis M, Catto JW, Avery K, Neal DE, Hamdy FC. Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study. BMJ 2012;344:d7894
  • Royal College of Radiologists Clinical Oncology Information Network, British Association of Urological Surgeons. Guidelines on the management of prostate cancer; 1999. Available from:
  • Schilling D, de Reijke T, Tombal B, de la Taille A, Hennenlotter J, Stenzl A. Follow-up of men with an elevated PCA3 score and a negative biopsy: does an elevated PCA3 score indeed predict the presence of prostate cancer? BJU Int 2010;105(4):452-455.
  • Schilling D, de Reijke T, Tombal B, de la Taille A, Hennenlotter J, Stenzl A. The Prostate Cancer gene 3 assay: indications for use in clinical practice. BJU Int 2009; 105: 452-455.
  • Symons JL, Huo A, Yuen CL, Haynes AM, Matthews J, Sutherland RL, Brenner P, Stricker PD. Outcomes of transperineal template-guided prostate biopsy in 409 patients. BJU Int 2013;112(5): 585-593.
  • Yacoub JH, Verma S, Moulton JS, Eggener S, Aytekin O. Imaging-guided prostate biopsy: conventional and emerging techniques. Radiographics 2012;32(3): 819–837.
  • Zynger DL, Yang X. High-grade prostatic intraepithelial neoplasia of the prostate: the precursor lesion of prostate cancer. Int J Clin Exp Pathol 2009;2(4): 327–338.

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