A DRE (digital rectal exam) and a PSA serum test are routine tests and if the doctor is suspicious from the results of these (possibly augmented by a PCA-3 test) he will order a trans-rectal ultrasound (TRUS) directed biopsy (actually 4-12 biopsies by fine needle) from different areas of the prostate, but particularly any suspicious areas that are seen on the ultrasound.
The specimens from the biopsy are then carefully examined by microscopy and any cancer confirmed and graded (Gleason grading; see introductory section).
