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)
