There is 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.
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 your first appointment we will repeat this test, along with an examination of your prostate gland via the back passage (your rectum).
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 lethal 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. In addition, the one-stop service developed by the team has reduced patient visits from five to two, and time-to-diagnosis from six weeks to one.
It may be necessary to perform transrectal ultrasound-guided biopsy (TRUS). A biopsy may also be taken during a cystoscopy examination or through the skin behind the testicles (perineum).
During a TRUS biopsy, an ultrasound probe (a machine that uses sound waves to build a picture of the inside of your body) is inserted into your rectum. This allows the doctor or specialist nurse to see exactly where to pass a needle through the wall of your rectum to take small samples of tissue from your prostate.
The procedure can be uncomfortable, so you may be given a local anaesthetic to minimise any discomfort. As with any procedure, there may be complications, including bleeding and infection.
Although it is more reliable than a PSA test, the TRUS biopsy can have problems. It can miss up to one in five cancers, because the location of the cancer is unknown when it is carried out. The doctors can see the prostate using the ultrasound scan, but not the tumour(s) if they are present.
You may need another biopsy if your symptoms persist, or your PSA level continues to rise. Your doctor may request an MRI scan of the prostate before another biopsy.
The samples of tissue from the biopsy are studied in a laboratory. If cancerous cells are found, they can be studied further to see how quickly the cancer will spread. This process is known as "staging and grading" and helps doctors to decide which treatment is the most appropriate.
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.
- A magnetic resonance imaging (MRI) or computerised tomography (CT) scan – these scans build a detailed picture of the inside of your body.
- 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.