Diagnosing prostate cancer: what to expect

If you’re concerned about prostate cancer, there are tests that can be carried out by your medical specialist to check for any signs of the disease.

Speaking with your GP is the first step if you’d like to explore getting checked and discover whether having further tests is right for you.

Testing for prostate cancer may involve different tests, including having a blood test and/or a rectal exam, followed by an MRI scan. In this article, we explain all of the different types of tests that can be carried out, and what to expect with each one.

Visiting your GP

When you visit your GP, you’re bound to have lots of questions, so it’s helpful to write them down or to take someone else with you who can help you ask everything you want to.

It’s also helpful to be prepared with a description of the symptoms you’re experiencing, when you experience them, how often and how long you’ve had them. Your GP will also ask if you have a family history of cancer, so it’s worth knowing if you have a close relative who’s had cancer of any kind.

Once you’ve had a chat with your GP, you can then decide if you’d like to be tested for prostate cancer. If you do, then your GP will have a number of tests they can perform.

Urine test

Visiting your GP with prostate symptoms will often mean that your GP will ask you to produce a urine sample. This is so that your urine can be tested for signs of an infection.

Depending on your GP surgery, your doctor may test your urine sample there and then using a dipstick test, or it may be sent away for analysis at a laboratory. Your results will normally take a few days to come back and your doctor will treat you for an infection if you have one.

You may or may not also have other tests for prostate cancer at the same time. If you don’t have a urine infection and you haven’t had any tests for prostate cancer, then you will be offered further tests.

Rectal examination

Depending on your symptoms, your doctor may think it’s necessary to perform a digital rectal examination (DRE).

This will involve your doctor feeling inside your rectum using a gloved finger, to feel for any abnormalities. Prostate abnormalities include an enlarged prostate or a prostate that feels hard or lumpy.

You will be lying on your left side with your knees pulled up to your chest. You will be asked to remove your lower clothing and underwear, but your bottom half will be covered with a paper towel.

You shouldn’t feel any pain, but you may feel some slight discomfort or embarrassment. Your doctor will use some lubricating gel to make the procedure less uncomfortable. They may apply some pressure to your prostate gland which shouldn’t feel uncomfortable but may give you an urge to pass urine.

You will be offered the choice of having someone else in the room with you, either someone you have brought with you, or another doctor or nurse.

Prostate Specific Antigen (PSA) blood test

A PSA blood test is a common test for prostate cancer. Depending on your GP surgery, you may be able to book an appointment to have your blood taken there, or you may need to make an appointment at a nearby clinic. You may also have a local walk-in clinic where you can have a blood test the same day.

Your blood will be tested for the presence of a protein that’s produced by the prostate and the results will take a few days. The prostate produces this protein whether it’s healthy or has become cancerous, so most men will have a certain amount of this protein in their blood.

However, if a PSA blood test result is very high, referred to as a raised PSA level, it may be an indicator that you have prostate cancer. Having a raised PSA level doesn’t necessarily mean that you have prostate cancer though, and could be a sign of an infection, prostatitis (inflammation of the prostate) or an enlarged prostate.

As many as three in four men with a raised PSA level do not have prostate cancer. For this reason, a raised PSA level is not usually used on its own to diagnose prostate cancer.

A PSA blood test can sometimes also miss prostate cancer, which is why your doctor will also perform a digital rectal exam and urine test to collate a series of results.

Getting a definitive diagnosis of prostate cancer

As the PSA test can be unreliable, there is no national screening programme that tests men for prostate cancer. So if you think you have symptoms of prostate cancer, or are worried that you might be at risk, it’s important to speak to your GP about being tested.

If you have a PSA blood test and your PSA level is raised, your doctor will discuss your options with you.

The results of a urine test, digital rectal examination and the PSA blood test are often used together by doctors to assess a person’s risk of having or developing prostate cancer, along with factors such as age, family history and general health and wellbeing. When all of these factors are considered together, it gives doctors a clearer idea of the possibility of prostate cancer.

If your results and factors combined suggest that you may possibly have prostate cancer, you will be referred to a specialist hospital doctor called a urologist. Your urologist will then perform some further tests.

MRI scans, ultrasounds and biopsies

An MRI scan uses magnetic resonance imaging to look at the prostate more closely. It takes between 30-50 minutes. You will be lying down inside the MRI scanner. Often, an injection will be given into the bloodstream. This can help the doctors analysing the MRI scan to spot cancers.

The scan can be noisy, and you will often be given headphones to wear if you want to. You will be asked to wear a hospital gown, and you will keep your underwear on.

The National Institute for Health and Care Excellence (NICE) recommends that an MRI scan is done before considering any invasive tests, such as a biopsy.

Prostate biopsy

If your specialist thinks it necessary, they will offer a biopsy to remove some tissue from the prostate using a long, thin needle. The samples are then sent to be looked at by specialist doctors in the laboratory under a powerful microscope.

Transrectal ultrasound guided biopsy

A transrectal ultrasound guided biopsy (TRUS) is usually performed under a local anaesthetic where your back passage is numbed but you remain awake. It is performed using an ultrasound probe that helps your doctor get a better view of your prostate.

The ultrasound probe is gently inserted into your rectum using a lubricating gel, while you’re lying on your left hand side with your knees bent up towards your chest. A long, thin needle is then passed through the ultrasound probe in order to take a sample of cells. You may feel short, sharp pains during the procedure. The procedure takes around 20 minutes.

You will be able to return home the same day and you may notice some bleeding from your back passage and in your urine and semen for a few weeks, but this is completely normal.

Transperineal biopsy

A transperineal biopsy is  performed either under a general anaesthetic, meaning that you’re asleep throughout the procedure, or local anaesthetic, using an injection to numb the area.

Your doctor will insert a long, thin needle through the skin between your scrotum and rectum (the perineal skin), into your prostate. They will also insert an ultrasound probe into your rectum to give a good view of your prostate. They will use results from your MRI scan to target the area of your prostate that looks abnormal, and usually take some other samples too.

Your doctor will discuss which type of biopsy method is best for you.

Using biopsy results to diagnose prostate cancer

Biopsy results are then used to say whether there is cancer or not. The PSA blood test and MRI scan can help to define whether it is a cancer in a low, intermediate or high-risk category. Sometimes other scans are needed to look for cancer outside of the prostate.

If you’re diagnosed with prostate cancer, your specialist doctor will discuss your treatment options with you.

More information

• If you don’t have access to a GP, you can make an appointment with a same day private GP here at King Edward VII’s Hospital.
• Our Urology Department is one of the UK’s leading centres for urology and has some of the best prostate cancer diagnostic and treatment equipment.