Tests for prostate cancer

You usually have a number of tests to check for prostate cancer. These include:

• a digital rectal examination
• a PSA blood test
• scans
• taking a sample of your prostate gland called a biopsy

Tests your GP might do

Most people start by seeing their GP. They can do some tests to help them decide whether you need a referral to a specialist. The tests your GP might arrange include:

• an examination of your prostate gland (digital rectal examination)
• a prostate specific antigen (PSA) blood test

Examination of your prostate gland

Your doctor checks your prostate gland for abnormal signs such as lumps or hard areas. This is also called digital rectal examination (DRE).

To examine your prostate, the doctor puts a gloved finger into your back passage (rectum).

PSA blood test

The PSA test measures the amount of prostate specific antigen (PSA) in your blood. PSA it’s a protein made by both normal and cancerous prostate cells.

It’s normal for all men to have some PSA in their blood. But a PSA level higher than what would be expected for someone of your age can be a sign of prostate cancer.

Tests your specialist might do

Depending on the results of your tests, your GP might refer you to a specialist. You usually see a urologist. This is a doctor who specialises in treating problems of the urinary tract system such as the prostate, bladder and kidneys.

Your specialist usually does more tests. These might include:

• an MRI scan (MRI)
• biopsy
• CT scan
• bone scan

MRI scan

The first scan your specialist does is an MRI scan. This is usually a multiparametric MRI scan (mpMRI). Some people may have a type of MRI scan called biparametric MRI instead.

MRI stands for magnetic resonance imaging. It uses magnetism and radio waves to take pictures of the inside of the body. A mpMRI scan produces a more detailed picture of your prostate gland than a standard MRI scan.

A mpMRI scan helps your doctor:

• check for any abnormality
• decide whether you need a biopsy
• guide where to take the biopsy from
• look at whether a suspected prostate cancer has started to grow outside the prostate
• look at the local lymph nodes  and bones around your pelvis to make sure they are normal

Your doctor might not do a mpMRI if you're unwell or not likely to be able to have a biopsy or future treatment. 

It is important to know that an MRI alone can’t tell for sure whether you have prostate cancer or not. But the results help your doctor decide whether you need further tests.

Understanding your MRI results

A doctor who specialises in imaging scans gives the MRI scan a score based on the results. This score helps your doctor decide on the next step and whether you need to have a biopsy. This is where your doctor takes a sample of your prostate gland.

This score is called the Likert or PI-RAD system. It estimates the risk that an area seen on the MRI scan may be a cancer or not. The score is from 1 to 5.

What happens if you have a Likert score of 1 or 2

Your doctor may not recommend a biopsy if you have a low Likert score. But you can still have one if you want to. Your doctor will explain the possible benefits and risks of having a biopsy.

When recommending whether you need a biopsy or not, your doctor also looks at other factors. These include:

• your age
• other test results such as PSA level and prostate examination
• the size of your prostate and the corrected PSA for its size. This is called the PSA density
• any other health conditions that you might have
• how well you’d cope with prostate cancer treatment and whether it would benefit you

They might decide not to recommend a biopsy if you're unwell or not likely to be able to have treatment. 

If you don't have a biopsy, your doctor may recommend monitoring your PSA level. They will recommend what your PSA level should be. You are usually discharged back to your GP to be monitored. Your GP can refer you back if the PSA levels go up.

What happens if you have a Likert score of 3 or more

This result on its own doesn’t mean that you definitely have prostate cancer. But it’s more likely that you do. Your doctor is likely to recommend for you to have a biopsy.

The MRI scan can also help doctors know where to take the biopsy from. You usually have tissue samples taken from the suspected area of cancer and also from the rest of the prostate. Doctors call these targeted biopsies and systematic biopsies. This is because not all cancers can be seen on an MRI scan.

Biopsy

During a biopsy, your doctor takes samples of tissue from your prostate. They send the samples to a laboratory and a doctor looks at them under a microscope to check for cancer.

There are 2 main ways to have a prostate biopsy:

• transrectal ultrasound scan (TRUS) guided biopsy
• transperineal biopsy

The type of biopsy you have depends on the size of your prostate and where in the prostate is the abnormal area that doctors want to check. It also depends on which hospital you are having a biopsy.   

Transrectal ultrasound scan (TRUS) guided biopsy

Your doctor takes a series of small tissue samples from the prostate to examine under a microscope. You have the biopsy through the back passage (rectum) using a transrectal ultrasound scanner.

A TRUS guided biopsy can be uncomfortable. You usually have a local anaesthetic to numb the area and reduce any pain.

Transperineal biopsy

Your doctor puts a needle into the prostate through the skin between the testicles and the back passage (rectum). They then take a number of samples from the prostate to examine under a microscope.

You may have this biopsy under local or general anaesthetic. Having a general anaesthetic means you are asleep and won’t feel anything.

Understanding your biopsy results

A specialist doctor called a pathologist looks at the prostate samples under a microscope. The results usually take about 2 to 4 weeks.

You might have a negative biopsy. This means that no cancer cells were found. Your doctor might recommend another biopsy even if the first was negative. They'll discuss this with you. This is because in some cases biopsies can miss cancer.

A positive biopsy means that they have found cancer cells. A pathologist then grades each sample of prostate cancer cells based on how quickly they are likely to grow or how aggressive the cells look. You may hear this being called the Gleason score or Grade Group.

Doctors now use the Gleason score and other information to divide prostate cancer into 5 groups. This is called the Cambridge Prognostic Group (CPG).

It can be difficult to understand what the Gleason score, Grade Group and CPG mean in your situation. We have more information about this, and you can ask your doctor and specialist nurse if you have any questions.

What tests do I need after a biopsy?

If you have a biopsy that shows that you have cancer cells in your prostate, then you may have more tests to work out where and how big the cancer is. This is called staging the cancer.

The tests you have next depend on the type of cancer you have. The tests you might have include:

• CT scan
• bone scan

CT scan

CT (or CAT) scan stands for computed (axial) tomography. It is a test that uses x-rays and a computer to create detailed pictures of the inside of your body.

You might have a CT scan to find out whether the cancer is in the prostate only or whether it has spread to other parts of your body.

Bone scan

A bone scan shows up changes or abnormalities in the bones. You might have a bone scan to find out if prostate cancer has spread to the bones.

Treatment

The tests you have helps your doctor find out if you have prostate cancer and how far it has grown. This is the stage of the cancer. 

This is important because doctors recommend your treatment according to the stage of the cancer.

Coping with prostate cancer

Coping with a diagnosis of prostate cancer can be difficult. There is help and support available to help you and your family.