Digital Rectal Examination
You will be seen in a clinic by a prostate cancer surgeon. A full history and examination will be indertaken. This will include an examination of your prostate with a DRE ( digital rectal examination) where a finger will be passed into the back passage.
The following will be part of this assessment:
PSA Blood Test
Prostate Specific Antigen (PSA) is a protein made by both normal and cancerous prostate tissue. The PSA blood test measures the level of PSA in your blood.
PSA is measured to help diagnose prostate cancer. This test alone is not a reliable way of diagnosing prostate cancer. This is because some men can have a low PSA level and still have prostate cancer. Other men can have a high level of PSA and not have prostate cancer.
PSA blood testing is still an important way ofdiagnosing prostate cancer, especially in menwho have few or no other symptoms.
PSA blood tests are used in combination with prostate MRI and prostate biopsies.
Prostate MRI
Magnetic resonance imaging (MRI) uses magnets and radio waves to produce both two and three-dimensional pictures of the prostate. The MRI used will be a multiparametric MRI which can take more detailed pictures of the prostate gland.
MRI scans are used to help diagnose prostate cancer. It can also be used to safely rule out cancer in some men, therefore avoiding the need a biopsy.
Prostate Biopsy
Birmingham Prostate Centre offers patients a Local Anaesthetic Transperineal Prostate Biopsy (LATP). The procedure takes 10-15 minutes and involves an ultrasound probe in the back passage which provides an image on a screen.
A needle is placed in the skin between the scrotum and the back passage (perineum) on one side of the body. A finer needle is fed through the first to access tissue of the prostate gland. Multiple biopsies are taken using the ultrasound scan and MRI images to guide the procedure and maximise the chances of targeting any abnormality or cancer which may be present. The process is repeated on the other side.
Most people tolerate this procedure well with minimal pain. If the procedure is uncomfortable however, we can stop and repeat the procedure at a later date under a general anaesthetic.
Advantages of LATP
LATP biopsies have many benefits over the transrectal ultrasound guided (TRUS) biopsy method used by many other prostate clinics.
Firstly, the infection rate is very low following a LATP biopsy (around 1%) compared to a TRUS biopsy which has an infection rate of around 10%.
LATP biopsies allow the surgeon to acquire tissuefrom areas of the prostate that are difficult to reach.
More samples can be taken during the process whilst maintaining a low infection rate. With the ability to also reach hard-to-access areas of the prostate, the result is a much more thorough examination, with less risk of missing cancer.
What are the risks of LATP?
This is generally a safe procedure. However, as with most things, there are risks which include:
- Blood in urine and semen (common and may last up to 6 weeks)
- Blood in stools (common and can last for a couple of days)
- Infection (less than 1%)
- Discomfort from biopsy site (common and settles with paracetamol)
- Temporary need for a catheter to drain the bladder (around 6%)
- Missed cancer (around 10%)
What happens after the biopsy and mpMRI?
The prostate cancer surgeon will arrange a follow-up consultation to discuss the results and the available treatment options.
