Prostate diagnosis

PSA, prostate-specific antigen, is a protein-like substance that occurs in abundance in the fluid within the prostate. Testing blood samples to determine the amount of PSA (a ‘PSA test’) is central to the early detection and selection of the most effective treatment for prostate cancer. It’s worth emphasising that a higher than normal PSA level doesn’t necessarily mean you have prostate cancer.

Conversely, a normal PSA value does not conclusively exclude the presence of the disease. Both BPH and prostatitis can result in elevated PSA levels in the blood, and your doctor will cross-check your PSA result with your symptoms, the result of a digital rectal examination and probably the results from a biopsy to make the diagnosis. Other tests, such as your fasting blood sugar and cholesterol level, may be used as indicators of your general health and to rule out diabetes or an abnormal lipid profile (e.g. raised HbA1c or cholesterol). They can also be used to estimate the risk of future problems, such as heart disease or stroke.

You may be asked to provide a urine specimen. We check for bacteria, to see whether you have a urinary tract infection, and we may also test for blood. If prostate cancer has spread into the urethra, which runs through the prostate, it can result in blood being present in the urine, so this provides the urologist with a clue to the nature of your problem.

Other causes of blood in the urine include bladder stones and bladder cancer, so this is a symptom you really shouldn’t ignore.

We’ll also routinely test urine for sugar to check for diabetes.

Your urologist may examine you in general, but will almost certainly perform a digital rectal examination. It’s undeniably an uncomfortable experience and one that some men dread, but the discomfort is, in fact, only mild. For urologists it’s a routine check, but if that doesn’t reassure you, then the consequences of ignoring your condition should. A few moments of minor discomfort are a price worth paying.

Your urologist will put on a glove and apply some lubricant jelly to their finger. They’ll tell you which position to adopt – probably one where you lie on your side with your legs pulled up towards your chest. They will then gently insert their finger into your rectum, passing through the sphincter muscle that keeps the anus closed. Next, they will feel your prostate, noting its size, shape, firmness and how its surface feels – an enlarged but soft prostate suggests benign enlargement of the gland, while a firm nodule may indicate cancer. The examination isn’t painful, just a little uncomfortable. Try to relax until it’s over – just few moments.

An MRI (magnetic resonance imaging) scan uses magnets to create a detailed picture of the prostate and pelvis. The use of a multi-parametric MRI (mpMRI) scan helps to identify if there’s any cancer inside the prostate.

If we suspect you may have cancer, your urologist will need to check by performing a biopsy. This involves taking some tiny samples from the prostate.

Template biopsies are invasive and require a general anaesthetic. However, they offer a very thorough insight into the prostate, and can provide a more accurate diagnosis.

Download a guide to having a transperineal (template) biopsy of the prostate here.