If someone who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to he an abnormal PSA level, the doctor may recommend another PSA test in 6 to 8 weeks to confirm the original finding. If the PSA level is still elevated, the doctor may recommend continued observation with repeat PSA tests along with digital rectal exams (DREs) to watch for any changes over time.
If the PSA level continues to rise—especially if it rises quickly—or if a lump is detected during a DRE, the doctor may recommend additional tests. These may include additional blood- or urine-based tests, or imaging tests, such as magnetic resonance imaging (MRI) or high-resolution micro-ultrasound.
Alternatively, the doctor may recommend a prostate biopsy without further testing. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. The biopsy needle may be inserted through the wall of the rectum (transrectal biopsy) or through the perineum (transperineal biopsy). A pathologist then examines the collected tissue under a microscope. Although both biopsy techniques are guided by ultrasound imaging so the doctor can view the prostate during the biopsy procedure, ultrasound cannot be used alone to diagnose prostate cancer. An MRI-guided biopsy may be performed for patients with suspicious areas seen on MRI.