Prostate cancer diagnosis
The first step in diagnosing prostate cancer is for a doctor to perform a rectal examination. They will insert a gloved finger into your back passage to feel if the prostate is enlarged and whether it is smooth or irregular. An irregular, enlarged prostate is a cause for concern and your doctor will refer you to a specialist for further tests.
A series of tests or investigations will be done to confirm or rule out a diagnosis of cancer and to find out whether the cancer has spread to other parts of your body. The tests will also check your general health.
Prostate specific antigen (PSA) test
Prostatic specific antigen (PSA) is a protein produced by the prostate gland which normally leaks into the bloodstream. The PSA test measures the level of PSA in your bloodstream so your doctor will ask for a blood sample.
This test alone does not confirm a diagnosis of prostate cancer as PSA levels may also be raised for other reasons, such as benign enlargement of the prostate; they are usually higher if cancer is present though.
For men with prostate cancer, PSA tests are very helpful in monitoring their prostate cancer and the effects of treatment.
Prostate biopsy
A biopsy is the removal of a small sample of tissue for examination under the microscope. By looking at the cells from your prostate gland, the doctors can confirm the presence of cancer.
A special ultrasound sensor is used to show the exact position of the prostate; a needle is then guided to the gland to take the tissue samples. The procedure may be carried out in the outpatient clinic. It takes about 45 minutes and most men describe it as uncomfortable but not painful.
You will be given a short course of antibiotics immediately before and after the biopsy to reduce the risk of any infection.
You may have slight bleeding or ‘spotting’ in your urine or stool for a couple of days after a biopsy. Don't be concerned about this.
Flow rate
This is a simple test to observe your urine flow. You will be asked to pass urine into a funnel connected to a computer. The computer provides a print-out of any difficulties you may be having.
You must have a full bladder for this test. If you have difficulty controlling your urine, come early for your appointment and have a drink in the hospital cafeteria.
Other tests
You may have other tests, which include a CT scan, MRI scan or bone scan. The information from these tests is used to assess the size of the cancer and how far it has spread. This is called ‘staging’. Your doctors need to know the extent of the cancer to help them decide on the most appropriate treatment for you.