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Prostate cancer

Diagnosing prostate cancer

Page last updated: June 2024

The information on this webpage was adapted from Understanding Prostate Cancer - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in June 2024.

Expert content reviewers:

This information was developed based on Australian and international clinical practice guidelines, and with the help of a range of health professionals and people affected by prostate cancer:

  • Prof Declan Murphy, Consultant Urologist, Director – Genitourinary Oncology, Peter MacCallum Cancer Centre and The University of Melbourne, VIC
  • Alan Barlee, Consumer
  • Dr Patrick Bowden, Radiation Oncologist, Epworth Hospital, Richmond, VIC
  • Bob Carnaby, Consumer
  • Dr Megan Crumbaker, Medical Oncologist, St Vincent’s Hospital Sydney, NSW
  • Henry McGregor, Health Physiotherapist, Adelaide Men’s Health Physio, SA
  • Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital and Headway Health, NSW
  • Dr Gary Morrison, Shine a Light (LGBTQIA+ Cancer Support Group)
  • Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA;
  • Graham Rees, Consumer
  • Kerry Santoro, Prostate Cancer Specialist Nurse Consultant, Southern Adelaide Local Health Network, SA
  • Prof Phillip Stricker, Chairman, Department of Urology, St Vincent’s Private Hospital, NSW
  • Dr Sylvia van Dyk, Brachytherapy Lead, Peter MacCallum Cancer Centre, VIC.

There is no simple test to find prostate cancer. Two commonly used tests are the PSA blood test and the digital rectal examination.

These tests, used separately or together, only show changes in the prostate. They do not diagnose prostate cancer. If either test shows an abnormality, you will usually have more tests.

Health professionals use Australian clinical guidelines to help decide when to use PSA testing and other early tests for prostate cancer.

Your guide to best cancer care

A lot can happen in a hurry when you’re diagnosed with cancer. The  guide to best cancer care for prostate cancer can help you make sense of what should happen.

It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.

Read the guide

Prostate specific antigen (PSA) blood test

Prostate specific antigen (PSA) is a protein made by both normal prostate cells and cancerous prostate cells. PSA is found in the blood and can be measured with a blood test.

The test results will show the level of PSA in your blood as nanograms of PSA per millilitre (ng/mL) of blood. There isn’t one normal PSA level for everyone.

If your PSA level is above 3 ng/mL (called the threshold), this may be a sign of prostate cancer. But younger people or people who have a family history of prostate cancer may have a lower threshold.

PSA levels can vary from day to day. If your PSA is higher than expected, your GP will usually repeat the test to help work out your risk of prostate cancer. Your PSA level can be raised even when you don’t have cancer.

Other common causes of raised PSA levels include:

  • benign prostate hyperplasia
  • recent sexual activity
  • an infection in the prostate, or
  • a recent digital rectal examination.

Some people with prostate cancer have normal PSA levels for their age range.

Free PSA or free-to-total test

Your doctor may also suggest that you have a free PSA test. This test measures the ratio of free PSA to total PSA in your blood. Free PSA is PSA that is not attached to other blood proteins.

This test may be suggested if your PSA level is 4–10 ng/mL and your doctor is not sure whether you need a biopsy. A low free-to-total PSA ratio may be a sign of prostate cancer.

Digital rectal examination (DRE)

To do a digital rectal examination (DRE), the urologist places a finger into your rectum to feel the back of the prostate. They’ll wear gloves and put gel on their finger to make the examination more comfortable.

You may have further tests if the specialist feels a hardened area or an odd shape. These changes do not always mean you have prostate cancer.

Having a normal DRE also does not rule out prostate cancer, as the finger can’t reach all of the prostate and a DRE is unlikely to feel a small cancer.

GPs no longer regularly do DRE, although it may still happen depending on your PSA results and urinary symptoms. A urologist will usually do a DRE as part of looking at your prostate.

If your PSA is 3–10 ng/mL your doctor may suggest a DRE. If the DRE is normal and you have no symptoms, they may just do a repeat PSA test. If you are at high risk, they may suggest a urine biomarker test or MRI.

MRI scan

An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to build up detailed pictures of the inside of the body.

A specialised type of MRI called mpMRI (multiparametric magnetic resonance imaging) is used if a doctor suspects prostate cancer. It combines the results of a number of MRI images to provide a more detailed image.

Your doctor may suggest you have an MRI to see if you need a biopsy is needed or to guide the biopsy needle to a specific area of the prostate. This may also show if cancer has spread from the prostate to nearby areas.

Before the scan, let your medical team know if you have a pacemaker or any other metallic object in your body, as the magnet can interfere with some pacemakers. Newer pacemakers are often MRI-compatible.

Also tell the doctor if you have any allergies or have had a reaction to contrast (dye) during previous scans, and if you have diabetes or kidney disease.

Having an MRI

Sometimes a dye (called contrast) is injected into a vein before the scan to help make the pictures clearer. You will then lie on an examination table that slides into the scanner, which is a large metal cylinder open at both ends.

The scan is painless, but the scanner makes loud noises and is narrow, which makes some people feel anxious or claustrophobic. If you think you could become distressed, mention this beforehand to your medical team.

You may be given a mild sedative to help you relax, or be able to bring someone into the room with you for support. You will have earplugs or headphones. The MRI scan may take around 30 minutes.


Medicare rebates

Medicare rebates for MRI scans to detect prostate cancer are only available if the MRI is ordered by a specialist and you meet certain conditions. You may have to also pay a gap fee.

A large clinical trial conducted in Australia, the proPSMA trial, showed that for certain men with newly diagnosed prostate cancer, a PSMA PET–CT scan is more accurate than having traditional CT and bone scans.

A Medicare rebate was introduced in 2022, meaning about 75% of all newly diagnosed prostate cancer patients in Australia will be offered a PSMA PET–CT instead of a CT and bone scan.

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Depending on the results of the MRI scan, your urologist may recommend you have a biopsy to remove some samples of tissue from the prostate.

They will explain the risks and benefits of having a prostate biopsy and give you time to decide if you want to have one. With specialised MRI scans available, your doctor may suggest you do not need a biopsy.

There are two main ways to perform a prostate biopsy, both of which are normally done under general anaesthetic:

  • a transperineal (TPUS or TPB) biopsy – a small ultrasound probe is inserted into your rectum. An image of the prostate appears on a screen and helps guide a needle which is inserted through the skin between the anus and the scrotum
  • a transrectal (TRUS) biopsy – the needle is inserted into the prostate via the rectum.

During either procedure, the doctor may take a number of samples from different areas of the prostate and also remove a sample from any suspicious areas seen on the MRI. 

Side effects

Depending on the type of biopsy you have, after the procedure you may see a small amount of blood in your urine or bowel movements (poo) for a few days, and blood in your semen for a couple of months.

After a TPUS biopsy, the risk of infection is extremely low. There is a greater risk of infection with a TRUS biopsy, but the risk is still low.

Your doctor may suggest taking antibiotics before or after a biopsy if they think you may be at risk of infection. The biopsy samples are sent to a laboratory, where a specialist doctor called a pathologist looks for cancer cells in the tissue.

Waiting for the results can be stressful. For support, call Cancer Council 13 11 20.

Further tests

If the MRI or other biopsy results show prostate cancer, other tests may be done to work out whether the cancer has spread. 

PET-CT scan

A PET (positron emission tomography) scan combined with a CT scan is a specialised imaging test. A PET–CT scan may be used to help detect cancers, or to find cancer that has spread or come back.

The scan usually looks for a substance produced by prostate cancer cells called prostate specific membrane antigen (PSMA).

Before the scan you will be injected with a small amount of a radioactive solution that makes PSMA show up on the scan.

A Medicare rebate is available for newly diagnosed patients with intermediate or high-risk prostate cancer.

Bone scan

This scan can show if prostate cancer has spread to your bones. A tiny amount of radioactive dye is injected into a vein. You wait for a few hours while the dye moves through your bloodstream to your bones.

The dye collects in areas of abnormal bone growth. Your body will then be scanned with a machine that detects the dye. A larger amount of dye will usually show up in any areas of bone with cancer cells.

The scan is painless and the radioactive dye passes out of your body in a few hours.

CT scan

A CT (computerised tomography) scan uses x-rays to create detailed pictures of the inside of the body. A CT scan of the abdomen (belly) can show whether cancer has spread to lymph nodes in that area.

A dye is injected into a vein to help make the scan pictures clearer. You will lie still on a table that moves slowly through the large, round doughnutshaped scanner.

The scan itself takes a few minutes and is painless, but the preparation takes 10–30 minutes.


Stage, grade and risk category

Working out the stage, grade and risk category of prostate cancer is complex, so ask your doctor to explain how it applies to you.

You can also speak to our trusted cancer nurses on 13 11 20 for support.

13 11 20 cancer support

Staging prostate cancer

Tests help your doctors work out if you have prostate cancer and whether it has spread. This is called staging, and it helps your doctors recommend the best treatment for you.

The most common staging system for prostate cancer is the TNM system. In this system, letters and numbers are used to describe the cancer, with higher numbers indicating larger size or spread.

Your doctor may also describe the cancer as:

  • localised (early) – the cancer is contained inside the prostate
  • locally advanced – the cancer is larger and has spread outside the prostate to nearby tissues or nearby organs such as the bladder, rectum or pelvic wall
  • advanced (metastatic) – the cancer has spread to distant parts of the body such as the lymph nodes or bone. This is called prostate cancer even if the tumour is in a different part of the body.

Grading prostate cancer

The biopsy results will show the grade of the cancer. Grading describes how the cancer cells look under a microscope compared to normal cells.

For many years, the Gleason scoring system has been used to grade the tissue taken during a biopsy. If you have prostate cancer, you will have a Gleason score between 6 (slightly abnormal) and 10 (more abnormal).

A newer system has been introduced to simplify the grading and make it easier to understand.

Known as the International Society of Urological Pathologists (ISUP) Grade Group system, this grades prostate cancer from 1 (least aggressive) to 5 (most aggressive).

Risk of progression

Based on the size and grade of the cancer, and your PSA level before the biopsy, localised (early) prostate cancer will be classified as:

  • low risk – the cancer is slow growing and not aggressive. Gleason score is 6 or less, ISUP Grade Group is 1.
  • intermediate risk – the cancer is likely to grow faster and be mildly to moderately aggressive. Gleason score is 7, ISUP Grade Group is 2-3.
  • high risk – the cancer is likely to grow quickly and be more aggressive. Gleason score is 8-10, ISUP Grade Group is 4-5.

This is known as the risk of progression. The risk category helps guide treatment. 


Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease. To work out your prognosis, your doctor will consider:

  • test results
  • type of prostate cancer
  • the stage, grade and risk category
  • how well you respond to treatment
  • factors such as your age, fitness and medical history.

Prostate cancer often grows slowly, and even the more aggressive cases of prostate cancer tend to grow more slowly than other types of cancer.

Some low-risk prostate cancers grow so slowly that they never cause any symptoms or spread, others don’t grow at all.

Compared with other cancers, prostate cancer has one of the highest five-year survival rates if diagnosed early. 

Understanding Prostate Cancer

Download our Understanding Prostate Cancer booklet to learn more.

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