Health encyclopaedia

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Diagnosis of Cancer of the prostate

Men seeing their GP with concerns about prostate cancer will be examined and have a blood test. The prostate is examined with a gloved finger through the rectum. This is not particularly comfortable but it should not cause pain. Cancerous glands feel irregular and hard whereas benign glands feel smooth and soft.

Prostate Specific Antigen (PSA) is measured with a simple blood test. It is a protein produced specifically by the prostate and indicates prostate activity. The level can be raised if the prostate is enlarged, is infected (prostatitis) or cancerous. It is common for men over 50 to have a non-cancerous enlarged prostate (benign prostatic hyperplasia or BPH). An abnormal examination or a high blood test indicates the need for further investigation by a urinary system specialist (urologist).

The urologist will usually repeat the examination and the blood test. If the results show a possibility of cancer a tissue sample will be taken (biopsy). A probe is inserted in the rectum and the prostate looked at with ultrasound waves and any abnormal areas are sampled with a special needle. This can be uncomfortable but should not hurt. Passing blood in the urine and faeces afterwards is normal, and can last 2-3 days. In order to prevent infections the specialist will usually prescribe a short course of antibiotics.

If the biopsy confirms prostate cancer further tests are needed to check whether it has spread elsewhere in the body. An isotope scan is used to look at the bones. This involves an injection in the arm then a series of scans of the whole skeleton over a period of 2-3 hours. A ‘hot spot’ indicates increased bone activity caused by cancer spread.

A computerised tomography scan (CT scan) or a magnetic resonance imaging scan (MRI scan) are used to look at the prostate itself and the surrounding structures in the pelvis including lymph nodes. This is important in deciding the best treatment.

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