### Instruction:  Disease name:

    Prostate cancer

: Diagnosis

Your doctor will ask about your symptoms, your medical history, and whether prostate cancer runs in your family. Your doctor will want to know whether you have ever been diagnosed with an inflamed or enlarged prostate. These conditions are not cancerous. However, the symptoms of these conditions can be the same as symptoms of prostate cancer. Your doctor will examine you and do a digital rectal exam (DRE) to feel the prostate gland. During a DRE, the doctor inserts a gloved, lubricated finger into the rectum. The doctor can feel part of the prostate through the rectal wall. Swelling, lumps, firm spots, or enlargement may indicate prostate cancer. Most cases of prostate cancer are detected by screening for the disease with a PSA test. PSA is a protein made by the prostate that can be detected in blood. Prostate cancer can cause higher amounts of PSA to leak out of the prostate into the blood. Tell your doctor if you take any medications to treat an enlarged prostate. Certain prostate medications, such as finasteride (Proscar) and dutasteride (Avodart), can affect PSA test results. Although doctors use the PSA test to detect prostate cancer, it does not give a definitive diagnosis. That's because other conditions, such as an enlarged prostate, can raise PSA levels. In fact, most men with a mildly elevated PSA do not have prostate cancer. Also, some men with a normal PSA actually do have cancer. Because an elevated PSA level may prompt you to seek treatment, which can cause urinary and sexual side effects, many doctors and organizations don't recommend routine PSA screening. Instead, they suggest that men age 50 and older talk with their doctors about the risks and benefits of screening. African American men should talk with their doctors about PSA screening beginning at age 40 to 45. Even though PSA screening is the most common way prostate cancers are detected, the test very often finds cancers that do not need to be treated. Most medical organizations recommend having a discussion with your doctor before getting the test performed on a routine basis. Discussing whether to get a PSA test with your doctor is called "shared decision-making." If your PSA level is high, or if your DRE shows a possible problem, your doctor may order more tests, such as an MRI or a prostate biopsy. While MRI can be helpful in diagnosing prostate cancer, most often a biopsy is still needed, although some practices will avoid doing the biopsy if the MRI test shows no signs of cancer. For the biopsy, a needle is used to remove small pieces of tissue from the top, middle, and bottom parts of the prostate. Your doctor also may want to take tissue samples from any areas that felt abnormal during the DRE. A specialist called a pathologist then checks the tissue samples for cancer under a microscope. If your biopsy shows prostate cancer, the pathologist will assign a Gleason grade to the two most common cells types in your tumor. The sum of the two grades is the Gleason score. The Gleason score describes how abnormal the cancer cells look compared to normal prostate cells. The score provides a rough estimate of how fast the cancer is growing and how likely it is to spread. A Gleason score includes the sum of two numbers that are scored as either 3, 4, or 5. The sum of the two numbers is the Gleason score.