By Ephram Smith

Introduction: If you or a loved one is going through testing for prostate cancer, it can feel overwhelming. There are many different tests, and each one has a purpose. As a healthcare advocate with years of experience supporting patients, I want to explain these common tests in a simple, friendly way. In this guide, we’ll walk through each test – what it is, why it’s done, and what you can expect. My goal is to make these medical tests less scary by using plain language and sharing practical tips and experiences.

PSA Blood Test

The PSA test is often one of the first steps in checking for prostate problems. PSA stands for Prostate-Specific Antigen, which is a protein made by the prostate gland (Prostate-Specific Antigen (PSA) Test: MedlinePlus Medical Test). This gland is part of the male reproductive system and sits just below the bladder. A small amount of PSA is normally in your blood, but a higher level of PSA can be a sign that something is going on with the prostate (Prostate-Specific Antigen (PSA) Test: MedlinePlus Medical Test). To do the test, the doctor or nurse draws a small sample of your blood – just like any routine blood test. It’s quick and not painful, aside from a tiny pinch from the needle.

What a high PSA might mean: If your PSA level comes back higher than normal, it doesn’t automatically mean you have cancer. PSA can go up for different reasons. Prostate cancer can cause a high PSA, but so can other common issues like an enlarged prostate (which many men get as they age) or an infection in the prostate (Prostate-Specific Antigen (PSA) Test: MedlinePlus Medical Test). Even things like recent ejaculation or riding a bicycle before the test might raise PSA a bit for a short time (Prostate Cancer Screening Tests | American Cancer Society). That’s why doctors sometimes advise not to have sex or heavy exercise a day or two before a PSA test – it can help avoid confusing results (Prostate Cancer Screening Tests | American Cancer Society).

If your PSA is high, the doctor will likely suggest further tests to find out why. A PSA test by itself can’t tell exactly what’s wrong (Prostate-Specific Antigen (PSA) Test: MedlinePlus Medical Test). Think of PSA as a warning light in a car – it tells you something might need checking, but you need other tests to know the exact problem. Usually, if PSA is high or rising over time, the next step might be imaging tests or a prostate biopsy (we’ll explain those soon). In fact, a prostate biopsy is the only sure way to diagnose prostate cancer by looking at prostate cells under a microscope (Prostate-Specific Antigen (PSA) Test: MedlinePlus Medical Test). So while PSA is a very useful screening tool, it’s just one piece of the puzzle. Many men with high PSA don’t have cancer – and some men with cancer have normal PSA. Doctors will consider your PSA result along with other factors (like a physical exam or family history) to decide on next steps.

A practical tip: When you get a PSA test, you usually get the results in a few days. Waiting for results can be stressful. It might help to remember that PSA levels can be influenced by many things. Try not to panic if one test is high. Often doctors will repeat the test to confirm it, or do additional testing. Keep in mind that PSA is just a number – what matters is figuring out why it’s high, and there’s a plan for that. Stay in communication with your healthcare provider about what the results mean and what to do next.

Digital Rectal Exam (DRE)

The digital rectal exam, or DRE, is a quick physical exam of the prostate. “Digital” in this case means finger (a digit), not a computer. In a DRE, the doctor inserts a gloved, lubricated finger into the rectum to feel the surface of the prostate gland ( Digital rectal exam – Mayo Clinic ). The prostate is just in front of the rectum, so the doctor can reach it with their finger and check for any bumps, hard areas, or unusual shapes. This exam only takes a minute or two. It might be a little uncomfortable or embarrassing, but it shouldn’t be painful, and it’s over very quickly (Digital rectal examination (DRE) | Prostate Cancer UK).

Many men feel nervous about the DRE – that’s completely normal. It’s not exactly anyone’s favorite experience. One tip from both doctors and patients is to take slow, deep breaths and try to relax your muscles during the exam. Tensing up can make it more uncomfortable. The doctor will usually ask you to lie on your side and bring your knees up, or sometimes to bend over a table, whichever position lets them reach the prostate easily (Digital rectal examination (DRE) | Prostate Cancer UK). They use plenty of lubricant to minimize discomfort (Digital rectal examination (DRE) | Prostate Cancer UK).

It’s okay to feel a bit awkward about a DRE. However, it provides important information. By feeling the prostate, the doctor might find a hard lump or an area that doesn’t feel normal, which could be a sign of cancer or another prostate issue. The test isn’t perfect – it can’t find all problems (since it only checks the back surface of the prostate) (Digital rectal examination (DRE) | Prostate Cancer UK). Some men with prostate cancer have a normal-feeling prostate, and some with an odd feeling prostate turn out not to have cancer. Even so, the DRE can sometimes catch things that the PSA blood test might miss. It’s often done together with a PSA test during a check-up.

Patient perspective: I’ve heard men say the anticipation of a DRE is worse than the exam itself. One patient I worked with, let’s call him Jim, was very anxious about it. After finally doing the exam, he was surprised and said, “Oh, that was it? That wasn’t as bad as I imagined.” It helped him to joke a bit with his doctor and to focus on the fact that it was only a few seconds of discomfort. In fact, one prostate cancer survivor famously said: “For a few seconds of discomfort, I can live with it… Yeah it’s uncomfortable, but it could save your life.” (Digital rectal examination (DRE) | Prostate Cancer UK). In other words, a DRE is quick, and if it helps catch cancer early, it’s well worth it.

Prostate Biopsy (Prostate cancer – Diagnosis and treatment – Mayo Clinic)

Figure: Illustration of a transrectal prostate biopsy. The doctor uses an ultrasound probe (in the rectum) to guide a needle that takes small tissue samples from the prostate gland.

A prostate biopsy is a test where small pieces of tissue are taken from your prostate to check for cancer cells under a microscope (Prostate biopsy: Procedure, preparation, recovery, and results). It sounds intimidating, but let’s break down what happens and why. A biopsy is usually recommended if earlier tests (like a PSA or DRE) show something suspicious. It’s the only way to know for sure if a man has prostate cancer (Prostate biopsy: Procedure, preparation, recovery, and results).

How it’s done: Most commonly, a prostate biopsy is done with the help of an ultrasound, in a procedure called a transrectal ultrasound-guided biopsy. You will lie on your side on an exam table, with your knees pulled up toward your chest (Prostate Biopsy & Ultrasound: Procedure Details, Risks & Benefits). The doctor will insert a small ultrasound probe into the rectum – it’s about the width of a finger. This probe uses sound waves to create a picture of the prostate on a screen, helping the doctor see where to aim the biopsy needle (Prostate Biopsy & Ultrasound: Procedure Details, Risks & Benefits). Before taking any samples, the doctor usually numbs the area to reduce pain (for example, by injecting a local anesthetic around the prostate) (Prostate Biopsy & Ultrasound: Procedure Details, Risks & Benefits).

Once you’re numbed, the doctor uses a special biopsy needle device (often called a biopsy gun). With guidance from the ultrasound image, the needle is quickly inserted through the rectal wall into the prostate to take a tiny tissue sample, then pulled out. Each sample happens in a split second (you might hear a click). They will take multiple samples (often around 10-12 cores from different parts of the prostate). You might feel a brief sharp pinch or pressure for each sample, but because of the numbing, many men describe it more as an odd pressure sensation rather than a sharp pain. The whole procedure is pretty quick – usually about 10 minutes in total (Prostate Biopsy & Ultrasound: Procedure Details, Risks & Benefits).

After the samples are taken, that’s it – the tissue goes to a lab where a pathologist will look for cancer cells. You’ll be able to go home the same day. It’s often done in a doctor’s office or outpatient clinic. They may have you wait a short while after to make sure you feel okay, especially if any sedation was used (sometimes biopsies are done under light sedation or with just local anesthesia).

What to expect after: It’s normal to have some mild soreness in the area for a couple of days. You might also see a bit of blood in your urine or stool for a day or two, and even in your semen for a few weeks afterwards (Prostate Biopsy & Ultrasound: Procedure Details, Risks & Benefits). Seeing blood in your semen (which can make it look reddish or brownish) can be startling, but it’s a common side effect and not harmful (Prostate Biopsy & Ultrasound: Procedure Details, Risks & Benefits). The discoloration in semen can sometimes last up to a couple of months in small amounts (Prostate Biopsy & Ultrasound: Procedure Details, Risks & Benefits), but it will clear up. Make sure to follow any instructions about taking antibiotics (biopsies carry a small risk of infection, so doctors usually give antibiotic pills around the time of the biopsy to prevent this). Also, avoid heavy exercise or heavy lifting for a few days after the biopsy to help your body heal (Prostate Biopsy & Ultrasound: Procedure Details, Risks & Benefits).

Patient experiences and tips: Many men feel anxious about the biopsy, which is completely understandable. In my experience, talking with the doctor beforehand about how the procedure works can really help ease your mind. If you’re very nervous, ask if there are options for sedation or stronger anesthesia – in some cases, biopsies can be done under a brief general anesthesia or IV sedation so you won’t feel anything (this might depend on your doctor and setting). Most men I’ve supported who have a prostate biopsy say that the idea of the biopsy was worse than the actual procedure. One patient, George, told me he was awake for his biopsy and was surprised that it was “more uncomfortable than painful, and it was over before I knew it.” He likened the sensation to a quick pinch each time the needle fired. Afterward, he took it easy for a day, and he said the worst part was honestly just worrying about it beforehand.

It’s perfectly okay to take a day off to rest after the biopsy. Drink plenty of fluids to help flush out any blood. If you develop a fever, difficulty urinating, or significant bleeding, you should contact your doctor right away – those could be signs of a complication like infection (which is uncommon, but needs prompt attention if it happens).

The waiting period for biopsy results can be tough. It usually takes about a week (sometimes less, sometimes more) to get results. During this time, try to stay busy and lean on support from family or friends. Remember that not all prostate biopsies find cancer – many come back benign (no cancer). And if it does find cancer, knowing for sure means you and your doctors can make the best plan for treatment. Either way, getting the biopsy is a step toward knowing what’s going on, and that knowledge is helpful for deciding next steps.

MRI Scan of the Prostate (MRI (Magnetic Resonance Imaging): What It Is & Results)

Figure: MRI machines used for scanning. Top: A standard closed-bore MRI (a tube-like machine). Bottom: An open MRI machine, which is less confining for the patient. Both use strong magnets to take detailed pictures inside the body.

MRI stands for Magnetic Resonance Imaging. An MRI scan uses a powerful magnet and radio waves to create detailed pictures of the inside of your body, in this case, the prostate and surrounding areas (The Prostate MRI Procedure at ARA: What to Expect & Next Steps). The MRI is very good at showing soft tissues. Unlike an X-ray or CT scan, MRI does not use radiation – just magnetism and radio waves, which are safe. Doctors may order a prostate MRI to get a clearer look at the prostate if there’s suspicion of cancer. In many hospitals, if a man has a high PSA or an abnormal DRE, they might do an MRI before doing a biopsy. The MRI can sometimes spot areas in the prostate that look suspicious for cancer, helping doctors know where to biopsy or even possibly avoiding a biopsy if everything looks normal.

What it’s like: The prostate MRI is painless, but it can be a bit lengthy and noisy. You will lie flat on your back on a sliding table, and then the table moves you inside a large tube-shaped machine (The Prostate MRI Procedure at ARA: What to Expect & Next Steps). The inside of an MRI machine is a tight space (in a closed MRI). If you tend to feel claustrophobic (scared of closed spaces), tell your provider ahead of time – there are ways to help, like medication to relax you, or some places have open MRI machines that are less enclosed. The scan usually takes about 20-40 minutes (The Prostate MRI Procedure at ARA: What to Expect & Next Steps). During that time, you have to lie very still so the pictures come out clear. The machine will make loud knocking or thumping sounds as it takes the images (The Prostate MRI Procedure at ARA: What to Expect & Next Steps). You’ll likely be given earplugs or headphones to protect your ears and to make it more comfortable (The Prostate MRI Procedure at ARA: What to Expect & Next Steps). Some centers even let you listen to music through the headphones. You can also usually talk to the MRI technician through a microphone if you need to; they can see and hear you from the control room the whole time.

In some cases, the MRI might involve a contrast dye injection. This means they put an IV in your arm and inject a special fluid partway through the scan. The dye (often gadolinium-based) helps enhance the images of the prostate. You might feel a cool sensation in your arm when the dye goes in. A few people get a brief headache or feel a bit nauseous from the contrast, but serious reactions are very rare (Multiparametric MRI (mpMRI) scan for prostate cancer | Cancer Research UK) (Multiparametric MRI (mpMRI) scan for prostate cancer | Cancer Research UK). The doctors will ask about any kidney problems or allergies beforehand, just to be safe.

Tips for MRI: Since you’ll be in the machine for a while, get as comfortable as you can on the table before the scan starts. If your back hurts or you have joint pain, let the technician know – they can add a cushion under your knees or adjust your position. If you think you might get anxious, practicing some breathing techniques or even meditation beforehand can help. One of my patients, Sam, was very nervous about his MRI because of the confined space. We discussed his worries and he decided to ask his doctor for a mild sedative to take before the scan. He also brought a playlist of his favorite calming music. During the MRI, he focused on the music and pretended he was just lying in his bed at home. Later, he told me that these steps really helped; he got through the MRI much easier than he expected.

After the MRI, you can go about your day normally. There’s no recovery time (unless you took a sedative, in which case you might be groggy and need a ride home). The results of a prostate MRI usually go to your doctor within a day or two, as a radiologist needs to analyze the images. The MRI might report something called a PI-RADS score for any suspicious areas (this is a rating of how likely an area could be cancer). Your doctor will explain the findings and whether you should have a biopsy or any other follow-up based on the MRI results.

Transrectal Ultrasound (TRUS)

A transrectal ultrasound, often abbreviated TRUS, is an imaging test that uses sound waves to create a picture of the prostate. In fact, we already talked about it as part of the biopsy procedure, because it’s commonly used to guide the biopsy needle. However, sometimes a TRUS might be done on its own as a diagnostic test.

Here’s how it works: the doctor or technician inserts a small ultrasound probe into the rectum (after applying lubricant, of course, to minimize discomfort). The probe sends out sound waves that bounce off the prostate and form an image on a screen. This is very similar to the kind of ultrasound that might be used on a pregnant woman’s belly to see a baby – except the probe is placed rectally to get closer to the prostate gland. The whole thing usually takes only a few minutes.

On its own, a standard TRUS can show the size of the prostate and any obvious abnormalities like big nodules. It’s often used if the prostate is suspected to be enlarged (to help diagnose BPH, which is benign enlargement) or to look for any unusual areas. However, ultrasound isn’t very detailed for seeing prostate cancer – small tumors might not show up clearly. That’s why TRUS by itself isn’t a great standalone test for prostate cancer. It really shines when used to help perform a biopsy (Prostate Biopsy & Ultrasound: Procedure Details, Risks & Benefits). During a biopsy, the ultrasound image guides the doctor to sample the right spots.

What to expect: TRUS feels a lot like a DRE in the sense that something is in the rectum, but in this case it’s a probe rather than a finger. The probe is a bit thicker than a finger in diameter but it’s not huge. The idea of it sounds uncomfortable, but many men tolerate it well because it’s lubricated and the exam is short. You might feel pressure and a brief uncomfortable sensation, especially when the probe first goes in or if the technician adjusts it to get a better view. It shouldn’t be sharply painful. If you’ve already had a DRE, this is similar, just with a device instead of a finger.

There’s typically no special preparation for a transrectal ultrasound. Sometimes they may do a quick cleansing enema beforehand, but often it’s not necessary. If you’re only having TRUS (and not an immediate biopsy), you probably won’t need antibiotics or other meds, since just imaging the prostate has a very low risk of infection (the risk comes mainly when doing a biopsy needle through the rectal wall). After a simple TRUS exam, you can resume normal activities right away. There’s no recovery needed; you might just feel a little weirded out for a short time, which is understandable.

In summary, TRUS is a handy tool to visualize the prostate. On its own it can measure the prostate and detect big changes. It’s most commonly a supporting player for the biopsy, helping the urologist hit the target. The good news is it’s quick and done in the office, and aside from a bit of discomfort during the procedure, it doesn’t have lasting side effects.

Bone Scan (Bone Scan: What It Can Show)

Figure: A patient lying on a table during a bone scan. The large curved device above is a gamma camera, which moves slowly over the body to detect areas where the radioactive tracer has collected in the bones.

A bone scan is an imaging test used to see if prostate cancer has spread to the bones. Prostate cancer, when advanced or aggressive, can move into bones (common places are the spine, hips, or ribs). A bone scan can help doctors check your entire skeleton for any signs of cancer activity. This test is usually ordered for men who have been diagnosed with prostate cancer already (for example, if a biopsy confirmed cancer and the doctor wants to know if it’s spread), or if there are symptoms like bone pain.

How it works: A bone scan is a type of nuclear medicine test. “Nuclear” here means it uses a tiny bit of radioactive material. Don’t let that scare you – the amount of radiation is small and it’s generally safe. Here’s the process: when you arrive for a bone scan, a technologist will inject a substance called a radioactive tracer into a vein, usually in your arm (Bone scan | Tests and scans | Cancer Research UK). This tracer isn’t a dye that you can feel; it’s a material that will travel through your bloodstream and be attracted to bone tissue. It tends to collect more in areas where bone cells are very active (which can happen if cancer is in the bone, but also in areas with arthritis or a healing fracture). After the injection, there’s a waiting period – often about 2 to 3 hours – to give the tracer time to circulate and bind to the bones (Bone scan | Tests and scans | Cancer Research UK). During this waiting time, you can usually leave and come back, or stay in the waiting room. They often encourage you to drink water and empty your bladder often during this time, as it helps clear out any tracer that doesn’t go to the bones.

When it’s time for the scan, you’ll lie down on a scanning table. A special camera called a gamma camera will slowly move above and below your body, taking images of your bones (Bone scan | Tests and scans | Cancer Research UK) (Bone scan | Tests and scans | Cancer Research UK). You just need to lie still; the machine doesn’t touch you and it’s quiet (nothing like an MRI noise). The scan itself is painless and takes about 30-60 minutes (Bone scan | Tests and scans | Cancer Research UK). The camera might move very close to you, but it shouldn’t enclose you completely, so most people don’t feel claustrophobic. Once the imaging is done, you can go home and go about your day. The radioactive tracer will naturally leave your body through urine over the next day or so (Bone scan | Tests and scans | Cancer Research UK). They’ll advise you to drink extra fluids to help flush it out.

What the results mean: The images from a bone scan will show areas of “brightness” or hot spots where a lot of tracer collected (Bone Scan: What It Can Show) (Bone scan | Tests and scans | Cancer Research UK). If prostate cancer has spread to the bone, those spots often light up. But hot spots are not always cancer (Bone scan | Tests and scans | Cancer Research UK). Other conditions like arthritis or old injuries can also show up. So if something is detected, sometimes additional tests (like an X-ray, MRI, or even a bone biopsy) might be needed to confirm what it is. If the bone scan is clear (no hot spots of concern), that’s a good sign that the cancer hasn’t spread to the bones.

Patient tips: For the bone scan, since you have to wait a couple of hours after the injection, bring something to keep yourself occupied – a book, a tablet, music, etc. The injection is just like any shot; it may sting for a second. The radioactive material used is very unlikely to cause any side effects; most people feel totally normal during the wait. After the scan, because you’ll have a bit of radioactive tracer in you, they might tell you to avoid close contact with infants or pregnant women for the rest of the day just as a precaution. And don’t be alarmed by the word “radioactive” – the amount used is small and targeted. I recall a patient joking that he felt like a superhero after his bone scan injection, since he was technically radioactive for a day. He had no symptoms at all from it, and his scan experience was quite relaxed – he even napped briefly on the scanning table.

CT Scan

A CT scan (sometimes called a CAT scan) is another imaging test that may be used in prostate cancer care. CT stands for Computed Tomography. It’s basically a special kind of X-ray that takes many pictures from different angles and a computer compiles them into detailed cross-sectional images of your body (Prostate cancer – Diagnosis and treatment – Mayo Clinic). For prostate cancer, a CT scan is not usually used to look at the prostate itself, because MRI and ultrasound show the prostate better. However, CT scans are very useful for checking areas like the lymph nodes, lungs, or liver to see if cancer has spread there. CT is often done for staging prostate cancer (figuring out how far it has spread) in cases where the cancer is high-risk or if there are symptoms.

What it’s like: Getting a CT scan is fairly quick and painless. The machine looks like a large donut or ring. You lie on a table that slides through this donut-shaped scanner. Unlike an MRI, a CT machine is not enclosed – it’s open on both ends and the scan is much faster (just a few minutes). You do have to lie still, but it’s not for very long. You won’t feel anything during the scan itself, aside from the table moving.

Often, for a prostate cancer CT scan (to check the abdomen and pelvis), you might receive a contrast dye to drink or through an IV. The IV contrast (iodine-based) helps highlight organs and blood vessels, making it easier to spot abnormal lymph nodes or tumors. When they inject IV contrast, some people experience a warm flush sensation and a strange metallic taste in their mouth for a minute or two – this is normal and passes quickly. It might even feel like you peed your pants because of the warmth in the groin area, but don’t worry, you didn’t – it’s just the sensation from the dye! The staff will usually warn you about this so it doesn’t catch you by surprise. If you’re just drinking oral contrast, it might taste a bit chalky or sweet depending on the type, but it’s generally not too bad.

During the CT, the machine may ask you (via a recorded voice) to “hold your breath” for a few seconds while images are taken, then to breathe normally. This helps get clear pictures. The whole procedure for a CT scan often takes maybe 10-15 minutes total, including setup – the scanning part can be under 5 minutes. Afterward, you can resume normal activities. If you got IV contrast, they’ll advise you to drink extra water that day to help your kidneys flush it out.

Why a CT scan? If your doctor orders a CT, they’re likely looking for any spread of the cancer beyond the prostate region. For example, checking if any lymph nodes in the pelvis are enlarged or if there’s any sign of cancer in other organs. CT scans can find enlarged lymph nodes or tumors in other areas with good accuracy (Prostate cancer – Diagnosis and treatment – Mayo Clinic). They are not as good as MRI for seeing the prostate or bones (bone scan or MRI is better for bones), but CT is excellent for a broad survey of the chest, abdomen, and pelvis for metastases. In many cases of early prostate cancer, a CT scan isn’t needed. But for higher risk cases or if a man has a very high PSA or high-grade cancer, CT (along with a bone scan or a newer PET scan) helps complete the picture of what’s going on.

Patient perspective: CT scans usually don’t cause much anxiety, because they’re quick and not claustrophobic. One patient, Lee, told me the CT was the easiest test he had: “I just laid there, the machine whirred for a minute, and it was done. The weirdest part was the contrast warm feeling, but they told me about it beforehand, so I was prepared.” If you have any allergies to iodine or had reactions to contrast before, be sure to tell your doctor, as they can give medication to prevent a reaction or choose a different approach. But most people have no issues. The amount of radiation in a CT is higher than a regular X-ray, but it’s generally safe and used only when necessary. For prostate cancer staging, the benefit of knowing where the cancer is usually outweighs any small risk from the radiation.

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Closing Thoughts: Going through medical tests for prostate cancer can be a nerve-wracking experience. Each test – from a simple blood draw to advanced scans – plays a role in giving doctors (and you) a clearer picture of what’s happening in your body. It’s completely normal to have fears or questions about these tests. In my years as a patient advocate, I’ve seen that understanding the process can turn fear into empowerment. When you know why a test is done and what to expect, it helps make the experience more bearable.

All of these diagnostic tests are tools to help you and your healthcare team make the best decisions. If at any point you’re unsure about a test or what it means, don’t hesitate to ask questions. Healthcare providers want you to be informed and comfortable. Sometimes, even bringing a friend or family member to appointments can give you extra support, whether moral support during a DRE or someone to drive you home after an MRI if you took a sedative.

Most importantly, remember that you’re not alone. Many men have walked this path before. The terminology and machines might sound intimidating, but each of these tests has been used on countless patients and the doctors and nurses performing them will guide you through it. Take it one step at a time. With each test, you gather more information, and with information comes the power to make decisions that are right for your health. Stay hopeful – prostate cancer, especially when caught early, is very treatable, and even when it’s more advanced, there are many effective treatments. The tests we discussed are the first stepping stones on the journey to getting you the care you need.