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, allowing for timely intervention and better prognosis.
What happens during your appointment?
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 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 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.
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.
2. Prostate Biopsy
A prostate biopsy involves taking small samples of prostate tissue for histological examination to confirm the presence of cancer.
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 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 the 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.
Treatment Pathways Following Diagnosis
If prostate cancer 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 MRIs.
- Radical Prostatectomy: Surgical removal of the prostate, often performed robotically.
- Radiotherapy: Targeted radiation to eliminate 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.
Conclusion
Prostate cancer screening is a vital tool in the early detection of the disease, particularly for those at higher risk. While screening can help identify 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 are improving the accuracy of detection, enabling more personalised treatment approaches.
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Learn more about the consultants and surgeons at our Men’s Health clinic.
