Skip to main content

Investigations – Prostate

PSA

PSA stands for Prostate Specific Antigen. PSA is a protein made by prostate cells. It typically leaks into your blood from the prostate but is not directly a result of prostate cancer. As men get older the prostate tends to enlarge and this can cause a rise in PSA.

There are various causes for a rise in PSA including:

  • Prostate Cancer
  • Infection (UTI, Prostatitis)
  • Trauma (surgery, urethral catheterisation, DRE, Biopsy)
  • Irritation i.e. Acute urinary retention
  • Enlarging prostate (benign prostatic enlargement)
  • Increasing age

Your Clinician at South Coast Urology will be able to assess things in your particular case and offer a plan for further assessment. Sometimes this involves the use of risk calculators such as the SWOP risk calculator.

Lower Urinary Tract Symptoms (LUTS) Investigations

A flow rate is a fairly simple test to assess bladder function. It is most commonly performed when assessing men to predict whether their bladder is blocked by the prostate or narrowing of the water pipe. You would be asked to arrive at the clinic with a reasonably full bladder. Once you feel ready to pass urine you will be asked to void (wee) into a special funnel that measures the volume passed and the rate at which it came. The test is only valid if you pass over 150mls, hence the need for the full bladder. If you are early for the appointment and desperate for the toilet, don’t hesitate to speak with the receptionist or nurse who will be able to get you to do the test before seeing your surgeon. After voiding, a mini ultrasound (bladder scan) is used on your tummy to assess how well the bladder has emptied.

Prostate cancer investigations often crossover with benign prostate investigations

Digital Rectal Examination (DRE)

A DRE requires the patient to lie on their left side on the examination couch with knees drawn up towards the chin. The doctor or nurse will then use a lubricated and gloved finger to feel the prostate via the rectum (back passage). The prostate can be felt through the rectal wall and will be examined for approximate size and consistency. A DRE should not be painful but may be uncomfortable and embarrassing.

Multiparametric MRI of Prostate

Clinicians at South Coast Urology use the most up-to-date MRI techniques in conjunction with our radiology colleagues. Our MRI scans are reported by expert uro-radiologists giving us the reassurance of their experience. Using multiparametric MRI helps to identify areas of textural change within the prostate that may signify an underlying prostate cancer. Often these scans are scored using a PIRADS or LIKERT system out of five. If your MRI has a score of 3, 4 or 5 it is likely you will be offered a biopsy.

Other Imaging

Ultrasound is the simplest imaging test. ‘Jelly’ is placed on the side and front of your tummy which allows the radiologist to slide a probe over your skin. It uses sound waves to generate an image. There is no radiation used and therefore it is safe, even for pregnant ladies. It can miss some stones.

Bladder Scan is a simple automatic ultrasound machine that can be used in the clinic to assess whether the bladder is completely empty

CT scanning gives much more detail but does utilise radiation.  Usually intravenous contrast is given to provide very detailed images of your anatomy. If cancer is suspected then it is helpful to define the extent of the disease and to assess if there has been any spread to other organs. This scan takes between 10 & 30 minutes. The patient lies on a narrow bed that is moved through a large white ring (often likened to a large polo mint!)

Nuclear Medicine scans are used increasingly. PET-CT is similar to a CT but looks at which lesions are metabolically active. The anatomical detail is less but they are often used in conjunction with other scans. Bone scans are occasionally used to assess if a cancer has spread to the bones

Local Anaesthetic Transperineal Prostate Biopsy (PrecisionPoint)

The local anaesthetic transperineal approach has revolutionized the methodology for obtaining prostate biopsies. It takes full advantage of the transperineal path to more thoroughly sample all regions of the prostate including those difficult to access with the transrectal approach e.g. the anterior prostate. Since the technique is free hand, the practitioner can easily target the desired locations with certainty and through a single puncture of the skin. Furthermore the technique minimizes the potential for infection, since passage of the biopsy needle avoids the rectal wall contaminants entirely.

A biopsy is necessary to confirm the nature of any imaging changes and work out if there is a cancer what kind it is.

Download the BAUS information leaflet here: Transperineal prostate biopsies

General Anaesthetic Transperineal Template Biopsy of the Prostate

Similar to the local anaesthetic technique this procedure is done under a general anaesthetic. This allows similar access to the prostate via a transperineal route.

Download the BAUS information leaflet here: Transperineal prostate biopsies

General Anaesthetic Transperineal Fusion Biopsy of the Prostate

Similar to other biopsy techniques this is done transperineally. Fusion biopsies tend to be reserved for small lesions in large prostate or where there is concern that MRI changes haven’t been adequately sampled. This state of the art technique uses real time ultrasound images merged with preoperative MRI scans to more accurately target the areas of concern seen. Your SCU clinician will be able to discuss the pros and cons of this approach.

Treatments