There are a number of tests that your doctor will perform to assess the likelihood of prostate cancer.

If you have any concerns about your prostate, your doctor may perform a digital rectal examination in the surgery.  In this examination, the doctor uses a gloved, lubricated finger inserted in the rectum to feel for irregular enlargement of the prostate lying anterior to the rectum.

If this examination suggests that the prostate is enlarged (common in men over 50) or a hard lump is present, your doctor will probably send you to a specialist in urology for assessment. It is likely that you will be referred to have an ultrasound scan. This is the main tool used to detect potential problems with the prostate gland.

A doctor might also perform an ultrasound if you have had a blood test indicating abnormal levels of a substance called prostate specific antigen (PSA). Abnormal levels of this substance in the blood may indicate the presence of cancer. The doctor is also likely to include a urine test to check for blood and/or infection.

Prostate ultrasound

The pattern of reflected sound waves or echoes produced by an ultrasound scan can show the outline of the prostate, and detect whether it is enlarged or whether an abnormal growth might be present.

An ultrasound can reveal other types of prostate disease as well. For example,
it can show if there is inflammation of the prostate, known as prostatitis.

To prepare for a prostate ultrasound, an enema is taken 2-4 hours before the exam. The patient will also be required not to urinate for one hour before the test.

The ultrasound is done using a technique called the transrectal method and this can be done in an outpatient clinic. A cylinder-shaped ultrasound probe is gently placed in the rectum as the patient lies on his left side with his knees bent. The probe is moved back and forth to obtain images of the entire prostate.

The procedure takes about 15-25 minutes to perform. After the results have been reviewed you will be able to go home.

Does it hurt?

Having a prostate ultrasound does cause some discomfort but it is minimal. There may be some mucus or a small amount of bleeding from the rectum after the ultrasound. There may also be a small amount of blood in the urine and semen for a couple of days.

What happens next?

If a suspicious lump is detected by the ultrasound scan, the doctor will want to take a sample of some of the tissue (a biopsy) to test it to see whether it is a cancer. In this procedure the doctor will remove tissue from the prostate, usually with a needle. This sample can then be looked at under the microscope to check for cancer cells.

Secondary infection at the site of biopsy may occur and is effectivley prevented by antibiotics given at the time the biopsy is carried out.

If a cancer is present, it will be possible to make a judgement about its grade by observing the cancer cells characteristics under the microscope. This is an important indicator for determining how aggressive the cancer is, and ultimately what treatment options are most appropriate. 

There are several different grading systems; the most common used to describe prostate cancers is the Gleason grading system. In general, tumours with higher scores/grades are more likely to grow and spread than tumours with lower scores. Your medical team will also want to determine the stage of the cancer  the extent and location of any spread of the tumour. To do this, further blood and imaging tests may be used such as a CAT scan or MRI scan (see main section).

The result of these tests plus your age, health and feelings about treatments and their side effects will be taken into account to determine a personal treatment plan.

If a cancer is not present but your prostate is enlarged (benign prostatic hyperplasia), some treatment may be recommended to reduce the symptoms.

02/06/2009