There is currently no UK wide routine screening programme for prostate cancer because, using the tests available today, it has not yet been demonstrated that the benefits outweigh the risks. There is research ongoing and this may change in the future.
If you have been referred to UCLH then you have probably already had a prostate specific antigen (PSA) blood test at your GP surgery. PSA is a protein produced by the prostate gland. Prostate cancer can increase the production of PSA, and so a PSA test looks for raised levels of PSA in the blood that may be a sign of the condition in its early stages.
At UCLH, we use highly accurate magnetic resonance imaging to identify and biopsy more accurately fast-growing prostate cancers that need treatment, whilst allowing men without suspicion of cancers to avoid biopsy. This targeted biopsy is carried out through the skin, not through the back-passage as with traditional biopsies, and virtually eliminates infection.
The new approach means fewer men are biopsied, resulting in less harm to patients and reduced costs.
The prostate gland produces the white fluid that becomes part of the semen. It is located below the bladder and in front of the rectum and is roughly the size of a walnut.
A biopsy involves taking small samples or cores of tissue from the prostate gland with a needle. These samples are then analysed by a histopathologist (doctor who diagnoses and studies disease by looking at samples under a microscope).
The biopsy can find out whether any of the prostate cells have become cancerous or, if there is pre-existing cancer, whether the cancer has changed. It can also diagnose other conditions such as the natural growth of the prostate that occurs with ageing or inflammation of the prostate.
The transperineal technique is an alternative method for sampling the prostate compared with the older transrectal method. It involves taking the biopsy through the skin (perineum), which is the area between the scrotum and the anus. It is usually performed under sedation or local anaesthetic. This technique will target any abnormal areas seen on your MRI scan. Additionally other areas in your prostate may be biopsied. Taking the samples through the skin, which can be thoroughly cleaned, reduces the infection rate compared to taking samples through the back passage. There is no incision made in the skin and no stitches needed; it is simply a needle passing through the skin each time a sample is taken.
A large proportion of prostate cancers do not necessarily need treatment. Depending on the PSA level and biopsy results additional tests may be required. If there is a significant chance the cancer has spread from your prostate to other parts of the body, further tests may be recommended.
These include:
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Computerised tomography (CT) scan or PSMA PET scan – these scans build a detailed picture of the inside of your body.
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An isotope bone scan – this can tell if the cancer has spread to your bones. A small amount of radiation dye is injected into the vein and collects in parts of the bone where there are any abnormalities.
For further information about grading and staging of prostate cancer, please see the links below:
