There are several tests that can help doctors investigate prostate problems and assess whether prostate cancer may be present. No single test can diagnose prostate cancer on its own, so results are considered alongside factors such as your symptoms, age, family history and other risk factors.
PSA blood test
PSA stands for prostate-specific antigen, a protein produced by the prostate. A PSA test measures the amount of PSA in your blood.
A raised PSA level does not necessarily mean that you have prostate cancer. PSA can also be raised for other reasons, including benign enlargement of the prostate and prostatitis. Some people with prostate cancer do not have a raised PSA.
If you are considering a PSA test, your GP can discuss its possible benefits and limitations with you. Read NHS information about the PSA test.
Digital rectal examination (DRE)
A doctor or other healthcare professional may examine your prostate by gently inserting a lubricated, gloved finger into the rectum. This allows them to feel the size and shape of the prostate and check for abnormalities. A DRE cannot by itself confirm or rule out prostate cancer.
MRI scan
If you are referred to a specialist because prostate cancer is suspected, you will usually have an MRI scan of the prostate. A multiparametric MRI (mpMRI) creates detailed images that can help doctors identify suspicious areas and decide whether a biopsy is needed.
Not everyone who has an MRI will need a biopsy. Read NHS information about tests and next steps for prostate cancer.
For historical context on research into MRI and biomarkers, see our archived ReIMAGINE presentation by Professor Mark Emberton. It was recorded in 2020, so current clinical guidance should take priority.
Prostate biopsy
If your MRI or other test results suggest that further investigation is needed, your specialist may recommend a prostate biopsy. Small samples of prostate tissue are taken and examined under a microscope to look for cancer cells.
The biopsy may be targeted towards areas identified on the MRI. Biopsies can be performed using different approaches, including through the skin between the scrotum and anus (a transperineal biopsy). Your specialist team will explain why a biopsy is being recommended, how it will be performed, and its possible benefits and risks before you decide whether to proceed.
Read NICE guidance on prostate cancer assessment and diagnosis.
What happens next?
If prostate cancer is found, further tests may sometimes be needed to establish its extent and help your specialist team recommend the most appropriate treatment or monitoring.
If cancer is not found but there is still concern about your prostate, your doctor may recommend continued monitoring or further investigations.
If you are worried about prostate symptoms or your risk of prostate cancer, speak to your GP rather than relying on symptoms alone. Prostate cancer often causes no symptoms in its early stages.
This information is intended to help you understand prostate investigations and does not replace advice from your GP, urologist or specialist cancer team.