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How is Prostate Cancer Diagnosed?

Last updated and reviewed on March 26, 2026.

If your doctor thinks you may have prostate cancer, there are many different tests and procedures that can confirm a diagnosis. 

A single test result is usually not enough to diagnose prostate cancer. Diagnosis relies on a combination of factors, including your symptoms, a physical examination by your doctor, and the results of tests and scans. 

This page lists all of the different tests that may be needed. Some are used to confirm a prostate cancer diagnosis. Others are used to learn more about the cancer, such as genetic changes, that can help guide treatment. Some of these tests may also be used to monitor how well the treatment is working. You may not have all of the tests on this list.

Talk to your care team if you have questions about the type of tests you received and what the results mean for your diagnosis. 

What tests are used to diagnose prostate cancer?

Prostate-Specific Antigen (PSA) Blood Test

The first step is usually a PSA blood test. PSA is a protein made by the prostate gland. A small amount of blood is drawn and tested.

• If your PSA level is normal, your doctor may recommend routine monitoring.
• If your PSA level is higher than expected, it does not automatically mean you have cancer. It could be caused by an enlarged prostate, infection, or inflammation. However, it does mean your doctor will want to look more closely.

Digital Rectal Exam (DRE)

Your doctor may also do a DRE. During this exam, your doctor gently inserts a gloved finger into the rectum to feel the prostate for any lumps, hardness, or unusual changes.

This exam takes only a few seconds. It is not painful for most men, though it may feel slightly uncomfortable. It is most useful when done alongside a PSA test.

Magnetic resonance imaging (MRI) 

If your PSA or physical exam raises concern, the next step is usually an imaging scan of the prostate called magnetic resonance imaging (MRI) . An MRI uses magnets to create detailed pictures of your prostate. It does not use any radiation.

The MRI helps your doctor:

• See if there are any suspicious areas in the prostate.
• Decide whether a biopsy is truly needed.
• Target the exact area if a biopsy is needed.

The MRI results are rated on a scale of 1 to 5 (called PI-RADS). A score of 1 or 2 means cancer is unlikely. A score of 4 or 5 means a suspicious area was found and a biopsy will likely be recommended. A 3 is considered an intermediate result. This is less likely to be cancer, but your doctor may still recommend a biopsy. 

If the MRI looks normal, many men can avoid a biopsy altogether.

Biopsy

If the MRI finds a suspicious area, your doctor will recommend a biopsy. During a biopsy, a small tissue sample from the prostate is taken to check for cancer cells under a microscope.

Here's what to expect:

• The procedure is usually done in a clinic or outpatient setting.
• A numbing medication is used to keep you comfortable.
• A thin needle takes several small samples (called "cores") from the prostate.
• The whole procedure typically takes 15 to 30 minutes.
• You may feel mild soreness or see some blood in your urine for a few days afterward. This is normal.

Sometimes a biopsy is combined with an MRI or a transrectal ultrasound (TRUS). During a TRUS, the ultrasound probe is inserted into the rectum to get pictures of the prostate.

The tissue samples are sent to a lab, where a specialist, called a pathologist, examines them for cancer cells.

Biomarker testing

Biomarker testing of the tumor is also an important part of prostate cancer diagnosis. There are different types of biomarker tests for prostate cancer, including Decipher, Oncotype DX Prostate, Prolaris, and ProMark. The results of these tests will tell you the different genetic changes in the cancer cells. These results are used to: 

• Learn if your cancer is more likely to grow or spread

• Choose the best treatment for you

Tests to find out if prostate cancer has spread

You may also have additional scans and tests to learn if the prostate cancer has spread to other parts of your body. Examples of these tests include: 

• Bone scan. This test uses a radioactive tracer to see if prostate cancer has spread to the bone. If prostate cancer has spread to distant parts of the body, it is most likely to spread to the bones. 

• Computed tomography (CT) scan. CT scans can see if cancer has spread from the prostate to nearby lymph nodes or bones. 

• Positron emission tomography (PET) scan. PET scans are most often used to see if prostate cancer has come back. It is often combined with a CT scan for a scan called PET-CT. This scan is helpful for finding small amounts of cancer. A new version of a PET scan, called a PSMA PET scan, may also be used. 
  

After all of the results of your tests are in, your doctor will determine the stage and grade of the prostate cancer. They will also determine the Gleason Score. This score helps doctors understand how aggressive the cancer is.  The next page in this guide covers staging and Gleason scores.

It is important to remember that a high PSA does not mean you definitely have prostate cancer. More tests are needed to determine the cause of the high PSA. Most men will not need a biopsy if they have a normal MRI.