Prostate Cancer Screening and Investigations
Prostate cancer is one of the most common cancers in men worldwide. Early detection through appropriate screening and investigations can significantly improve outcomes by identifying cancer at a treatable stage.
Prostate cancer screening aims to detect the disease before symptoms develop, playing a key role in prostate cancer early detection, timely intervention, and effective management.
What happens during your appointment?
When you attend your initial appointment, your consultant surgeon will ask you to discuss your medical history. This involves asking questions about how the injury occurred and what symptoms you are experiencing, including any urinary symptoms. You will also be asked about your general health, any previous operations or illnesses you may have had, any medications you take and whether you have any allergies.
Who Should Be Screened?
Screening for prostate cancer is recommended for men based on risk factors such as:
- Age: Men over 50 are generally considered for screening, while those with a family history or other risk factors may start at 45.
- Family History: Men with a first-degree relative (father or brother) diagnosed with prostate cancer are at higher risk.
- Ethnicity: Black men have a higher risk and are encouraged to consider earlier screening.
- Genetic Predisposition: Men with BRCA1 or BRCA2 gene mutations have an increased risk and may require earlier and more frequent screening.
Screening Tests for Prostate Cancer
1. Prostate-Specific Antigen (PSA) Test
The PSA test measures the level of prostate-specific antigen in the blood. Elevated or raised PSA levels may indicate prostate cancer but can also be caused by benign conditions such as benign prostatic hyperplasia (BPH) and prostatitis.
Pros of PSA Testing:
- Can detect prostate cancer early before symptoms develop.
- A simple blood test that is widely available.
Cons of PSA Testing:
- Elevated PSA does not always indicate cancer, and some cancers may not produce high PSA levels.
- PSA test results can vary and are not definitive on their own.
2. Digital Rectal Examination (DRE)
In this examination, a healthcare professional manually assesses the prostate through the rectum to check for abnormalities such as:
- Hard or irregular areas.
- Enlargement or asymmetry.
DRE is often used in combination with the PSA test for a more comprehensive assessment.
Investigations Following an Abnormal Screening Result
If initial screening tests suggest a potential risk of prostate cancer, further diagnostic investigations may be required to confirm the diagnosis and assess the extent of the disease.
1. Multiparametric MRI (mpMRI)
mpMRI is a highly sensitive imaging technique used to:
- Detect suspicious areas in the prostate.
- Differentiate between aggressive and non-aggressive cancer.
- Guide biopsy procedures to improve accuracy.
A prostate MRI scan may also be recommended to further evaluate findings from the PSA test or DRE.
2. Prostate Biopsy
A prostate biopsy involves taking small samples of tissue from the prostate gland for histological examination to confirm the presence of prostate cancer cells.
Types of Biopsy Procedures:
- Transrectal Ultrasound-Guided Biopsy (TRUS): Performed through the rectum using ultrasound guidance.
- Transperineal Biopsy: Taken through the skin of the perineum, offering reduced risk of infection and higher accuracy.
3. PSA Density and Velocity
Further analysis of PSA levels can provide additional insights, such as:
- PSA Density: The PSA level relative to prostate size (measured via MRI scans or ultrasound).
- PSA Velocity: The rate at which PSA levels increase over time, which may indicate more aggressive disease.
4. Biomarker Tests
Advanced biomarker tests can complement PSA testing to improve diagnostic accuracy, including:
- Prostate Health Index (PHI).
- 4Kscore Test.
- PCA3 Urine Test.
These tests can help stratify prostate cancer risk and guide the need for biopsy.
5. Bone Scan and CT Scan
In cases where prostate cancer is suspected to be advanced, imaging such as a bone scan or CT scan may be performed to check for metastasis and assess the spread of prostate cancer cells.
Treatment Pathways Following Diagnosis
If a prostate cancer diagnosis is confirmed, the management approach depends on the stage and aggressiveness of the disease:
- Active Surveillance: For low-risk cancers, monitoring with regular PSA tests and MRI scans.
- Radical Prostatectomy: Surgical removal of the prostate gland, often performed robotically.
- Radiotherapy: Targeted radiation to eliminate prostate cancer cells.
- Hormone Therapy: Used to reduce testosterone levels that fuel cancer growth.
- Focal Therapies: Minimally invasive treatments such as HIFU (High-Intensity Focused Ultrasound) or cryotherapy.
When to Seek Medical Advice
Men should consider screening and consultation with a urologist if they experience:
- Frequent urination, especially at night.
- Difficulty starting or stopping urination.
- Blood in the urine or semen.
- Pain in the lower back or pelvis.
These urinary symptoms may be associated with changes in the prostate gland, including possible signs of prostate disease.
Conclusion
Prostate cancer screening is a vital tool in the early detection of the disease, particularly for those at higher prostate cancer risk. While screening can help detect prostate cancer at an early stage, it is important to have a thorough discussion with a healthcare provider to weigh the benefits and potential drawbacks of testing. Advances in diagnostic methods such as PSA testing, MRI scans, and biomarker assessments are improving the accuracy of prostate cancer detection and supporting more personalised treatment approaches.
Meet our Clinic Team
Learn more about the consultants and surgeons at our Men’s Health clinic.
