Initial tests

Digital rectal examination


Interactive illustration explaining the digital rectal examination

A digital rectal examination (DREDigital rectal examination, physical examination that involves inserting a finger into the patient’s rectum, their back passage.) is done to help diagnose prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

A DREDigital rectal examination, physical examination that involves inserting a finger into the patient’s rectum, their back passage. is a very simple test performed by your doctor.

Your doctor will ask you to lie on an examination table, on your left side with your knees drawn up to your chin. You can also lean over the back of a chair or across a table if that is more comfortable.

The doctor will carefully place a gloved and lubricated finger into your rectum. This allows the doctor to feel the size of the prostate and its back surface for any hard or irregular areas. He can also feel the size of the prostate.

If your prostate is larger than normal but smooth, this may suggest benign prostatic hyperplasiaEnlargement of the prostate, which may cause difficulty in passing urine. (BPHAn abbreviation for benign prostatic hyperplasia, which is enlargement of the prostate that may cause difficulty in passing urine.).

A prostate that feels hard or bumpy is more likely to be cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body..

Many men feel embarrassed about this examination. However, your doctor does this test regularly and will be sensitive to your concerns.


Interactive illustration of where the prostate sits inside the male body

Urine test

A urine test should always be carried out if there are concerns about prostate disease, as it can reveal signs of infectionInvasion by organisms that may be harmful, for example bacteria or parasites., which may affect the true reading of a PSA test.

You will be asked for a sample of your urine. This can be tested using a dipstick to look for signs of infectionInvasion by organisms that may be harmful, for example bacteria or parasites.. The sample will be sent to the laboratory to establish whether infectionInvasion by organisms that may be harmful, for example bacteria or parasites. is present.

PSA test

The prostate makes a substance called prostate specific antigenA substance that prompts the immune system to fight infection with antibodies. (PSA).

It is normal to find some PSA in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid.. When prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. develops, the levels of PSA in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. can increase, sometimes rapidly. However, other conditions can also cause increased levels of PSA, including different types of prostate disease (BPHAn abbreviation for benign prostatic hyperplasia, which is enlargement of the prostate that may cause difficulty in passing urine. and prostatitis) and urinary tract infectionInvasion by organisms that may be harmful, for example bacteria or parasites..

Your doctor may want to rule out a urinary tract infectionInvasion by organisms that may be harmful, for example bacteria or parasites. before carrying out a PSA test. If you have a urinary tract infectionInvasion by organisms that may be harmful, for example bacteria or parasites., you should not have a PSA test done for at least a month after you complete your treatment.

PSA test results

A raised PSA level shows that there is a problem with the prostate. However, the PSA test is not a very specific test for prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. because:

  • Infections and other conditions that are not cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. such as BPHAn abbreviation for benign prostatic hyperplasia, which is enlargement of the prostate that may cause difficulty in passing urine. and prostatitis can cause increased PSA levels
  • It is normal for PSA levels to increase with age
  • Prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. can be found in men with normal PSA levels.

Learn more about the advantages and disadvantages of the PSA test in the hot topic, PSA screening debate.

In general though, the higher the PSA level, and the faster it increases, the more likely it is to be prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

There is some variation in the way that laboratories around the world report the results of the PSA test and how doctors interpret these.

For example, in the UK, the following PSA levels are regarded as normal by Cancer Research UK:

  • 3 nanograms/ml or less between the ages of 50-59
  • 4 nanograms/ml or less between the ages of 60-69
  • 5 nanograms/ml or less above the age of 70.

In the USA, the National Cancer Institute offers the following guidance:

  • 2.5 nanograms/ml or less is a 'low' PSA level
  • Between 2.6 nanograms/ml and 10 nanograms/ml is 'slightly to moderately elevated'
  • Between 10 nanograms/ml and 19.9 nanograms/ml is 'moderately elevated'
  • 20 nanograms/ml or more is 'significantly elevated'.

Urine flow test

This test, also known as uroflowmetry, measures the volume and speed of your urine flow. If it is slow, this may be a sign that your prostate is pressing on the urethra and blocking the flow of urine. The test involves you urinating into a bowl that is attached to a flow meter.

Ultrasound scan

Ultrasound scanning produces images of the internal organs by passing very high-pitched sound waves into the body. The sound waves bounce off the organs and are then converted into an image on a screen.

Using an ultrasound scan The process of using high-frequency sound waves to produce internal images of the body. (also called ultrasonography), your doctor can see how much urine is in your bladderThe organ that stores urine. when it feels full, and whether it empties properly.