If you have symptoms that could be caused by prostate cancer, you should visit a GP.
There's no single, definitive test for prostate cancer. The GP will discuss the pros and cons of the various tests with you to try to avoid unnecessary anxiety.
The GP is likely to:
- ask for a urine sample to check for infection
- take a blood sample to test your level of prostate-specific antigen (PSA) – called PSA testing
- examine your prostate by inserting a gloved finger into your bottom – called digital rectal examination
The GP will assess your risk of having prostate cancer based on a number of factors, including your PSA levels and the results of your prostate examination, as well as your age, family history and ethnic group.
If you're at risk, you should be referred to hospital to discuss the options of further tests.
If you have a raised PSA level, your doctor may refer you to hospital for an MRI scan of your prostate. If the scan shows a problem, it can be targeted later with a biopsy.
There are a few types of biopsy that may be used in hospital, including the following.
A transperineal biopsy
This is where a needle is inserted into the prostate through the skin behind the scrotum. It's usually done under a general anaesthetic (while you're asleep). It has the advantage of a reduced risk of infection.
A transrectal biopsy
During this 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 where to pass the needle to take small samples of tissue from your prostate.
This procedure can be uncomfortable and sometimes painful, so you may be given a local anaesthetic to numb the area and minimise any discomfort. As with any procedure, there may be complications, including bleeding and infection.
A biopsy may also be taken during a cystoscopy examination.
Issues with biopsies
Although a biopsy is more reliable than a PSA test, there can still be issues, such as:
- missing the cancer – doctors can see the prostate using the ultrasound scan but might not always spot a tumour
- needing another biopsy if your symptoms persist or your PSA level continues to rise – you may be offered another MRI scan first
- finding small, low-risk cancers that do not need treatment but may cause you anxiety – and there is a possible related risk that you choose to undergo surgery or radiotherapy of little to no benefit that cause side effects, such as incontinence and erectile dysfunction (impotence)
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 is called "staging and grading" and helps doctors to decide which treatment is the most appropriate.
- Cancer Research UK: stages, types and grades of prostate cancer
- Macmillan: staging and grading of prostate cancer
If there's a significant chance the cancer has spread from your prostate to other parts of the body, further tests may be recommended.
- an MRI scan, CT scan or PET scan – these scans build a detailed picture of the inside of your body
- an isotope bone scan, which can tell if the cancer has spread to your bones – a small amount of radiation dye is injected into the vein and then collects in parts of the bone where there are any abnormalities