If the tests you had at the GP surgery
suggest you have a prostate problem, they may refer you to
the hospital for further tests.
Hospital tests you may have
include:
Biopsy
This is sometimes called a trans-rectal ultrasound (TRUS) guided
prostate biopsy. It involves taking small pieces of prostate tissue
to be looked at under the microscope. The aim of a biopsy is to
find any cancer that might cause symptoms or affect your life
expectancy.
Having a high PSA level alone does not automatically mean that
you need a biopsy. Your specialist should discuss the advantages
and disadvantages of having a biopsy and any concerns you may have
before you decide whether to have the test.
If your cancer has already spread outside the prostate, you may
not need a biopsy. You may be offered scans, such as a bone scan. Your doctor or
nurse will discuss this with you.
What are the advantages and disadvantages of a
biopsy?
Advantages
- It is the most accurate way of finding out if you have prostate
cancer.
- It can tell you how much cancer is present in the samples
taken.
- It can help you and your doctor or nurse decide which treatment
options may be suitable for you.
Disadvantages
- A biopsy can only show whether there was cancer in the samples
taken. The biopsy only takes tissue from a small area of the
prostate, so it is possible that cancer in other parts of the
prostate might be missed.
- A biopsy can pick up slow growing cancer that would not cause
problems in your lifetime. But treatments have side effects, which
for some men, may be worse than the effects of the cancer
itself.
- The biopsy can have side effects, such as blood in your urine,
faeces or semen, and a risk of infection.
What does a biopsy involve?
Before the biopsy tell your doctor or nurse if you are taking
any medicines, particularly drugs to prevent blood clots, including
warfarin, aspirin, clopidogrel or dipyridamole.
You will be given antibiotics to help prevent infection, which
you will need to continue taking when you go home. You will have a
local anaesthetic injection into your back passage to numb the area
and reduce any discomfort.
You will have a trans-rectal ultrasound scan (TRUS) at the same
time to guide the biopsy needles. The ultrasound probe is put into
your back passage (rectum) using a gel to make it more comfortable.
A needle is placed down the probe and through the wall of the back
passage into the prostate. Ten to 12 small samples of tissue are
removed from the prostate.
The biopsy will take 10 to 15 minutes. You may need to wait for
about half an hour after the biopsy or until you have passed urine
before going home.
Some men find the biopsy painful, but others have only slight
discomfort. If you have any pain afterwards, tell your nurse or
doctor. They may give you a mild painkiller.
What are the possible side effects of
biopsy?
Short-term bleeding
- You may see a bit of blood in your urine or stools for up to
two weeks.
- You may find blood in your semen for up to six weeks. If it
takes longer than this to clear up, or gets worse see a doctor
straight away.
Infection
- There is a small risk of getting a urine infection after the
biopsy. A course of antibiotics will help clear this up.
- A very small number of men may get a more serious infection.
This can affect about one in 50 men (two per cent). Make sure you
take all the antibiotics you have been given to help prevent
this.
- A high temperature, pain or burning when you pass urine, or
difficulty passing urine can be signs of an infection. This can
happen even if you have been taking antibiotics. If you have these
symptoms go to your nearest accident and emergency (A&E)
department straight away.
Urine retention
- Some men are unable to pass urine after a biopsy. This is
called urine retention. If this happens contact your doctor or
nurse at the hospital urgently, or visit the accident and emergency
(A&E) department.
What is a template or saturation biopsy?
These types of biopsy involve taking more tissue samples than a
TRUS guided biopsy. You will usually have about 32 samples taken
from different areas of the prostate. This is normally done under
general anaesthetic.
Your doctor will put the biopsy needles through the area of skin
between the testicles and the back passage (perineum), into your
prostate. You will have a trans-rectal ultrasound scan to guide the
needles.
There is more chance of finding prostate cancer using one of
these biopsies because more of the prostate is looked at. However,
it may also find slow growing cancer. Ask your doctor to explain
more about these types of biopsy.
What do my biospy results mean?
A doctor who looks at cells using a microscope (pathologist)
will look for any cancer in your biopsy samples.
A pathology report is sent to your doctor explaining what the
pathologist has found. Some men also receive a copy of their
pathology report. If cancer was found, the pathology report will
have information about:
- how many samples contain cancer
- how much cancer is in each sample
- your Gleason score.
If cancer is found
If your biopsy samples contain cancer, it is graded to show how
active the cancer is. This is called Gleason grading. Read more
about your test results, and what support is available.
If no cancer is found
If no cancer is found this is obviously reassuring. Strictly
speaking this means "no cancer found" rather than "no cancer
present". There could be a small cancer that the needles did not
hit.
Your doctor may suggest that you have further PSA tests and DREs. If they still suspect that cancer is present
they may suggest having another biopsy. You may be offered either
another TRUS biopsy, or a template or saturation biopsy.
Other possible biopsy results
Sometimes when pathologists are looking at biopsy results they
may find other changes to your prostate cells such as PIN or
ASAP.
What is PIN?
Prostatic
intraepithelial neoplasia (PIN) is changes in the cells that
line the prostate gland. PIN is not the same as prostate cancer,
and does not need treatment. If you have PIN you may need to have
follow-up tests at the hospital. Some research suggests that having
PIN can increase your chance of getting prostate cancer in the
future.
What is ASAP?
ASAP is "atypical small acinar proliferation". It means that
your prostate tissue shows possible signs of cancer, but there is
not enough evidence to say for certain whether you have prostate
cancer or not. If you are told you have ASAP, you may need to have
another biopsy.
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Scans
If you are diagnosed with prostate cancer, you may need to have
a scan to find out whether it has spread outside of the prostate.
You may have:
- a computerised tomography (CT) scan
- a magnetic resonance imaging (MRI) scan, or
- a bone scan.
The results will help you and your doctor decide which
treatments may be suitable for you.
You may not need to have these tests if your PSA is low and your
Gleason
score suggests that the cancer is unlikely to have spread.
Computerised tomography (CT) scan
A CT scan can show whether the cancer has spread to the lymph nodes near the prostate. You may have
this if there is a risk of your cancer spreading and you are
considering treatments such as radiotherapy or surgery.
The scanner takes X-rays of your pelvis. A computer uses these to create an image
of the prostate and the surrounding tissues, including the lymph
nodes.
You will be given an injection of a dye. The dye helps the
doctor see the prostate and surrounding organs on the scan. It is
not radioactive.
You should let the X-ray department know well in advance of your
scan appointment if:
- you already know you are allergic to the dye
- you have any other allergies, or
- you are taking the drug metformin for diabetes.
The CT scanner is shaped like a large doughnut. You will lie on
a sliding table, which moves through the hole in the middle of the
machine. The radiographer will leave the room but you will be able
to speak to them through an intercom and they can see you at all
times. The scan takes 10 to 20 minutes and you can go home
afterwards.
Magnetic resonance imaging (MRI) scan
An MRI scan uses magnets to create a detailed picture of your
prostate and surrounding tissues. You may have an MRI if there is a
risk of your cancer spreading and you are considering treatments
such as radiotherapy or surgery.
Some MRI scanners are doughnut-shaped like a CT scanner. Others
are shaped like a long tunnel. If you dislike enclosed spaces, you
should let the scanning department know as soon as possible.
You will lie on a table which passes into the tunnel. The
radiographer may give you an injection of dye during the scan, to
improve the pictures taken.
The scan takes between 30 and 40 minutes. The machine is very
noisy but you will not feel anything. You can speak to the staff
through a microphone and you may be able to listen to music. You
can take a friend or family member into the room with you during
the scan.
Bone scan
A bone scan can show whether any cancer cells have spread from
the prostate to the bone. This is a common place for prostate
cancer to spread to.
You may have a bone scan if there is a chance that your cancer
has spread or to check that it has not spread.
Tell your doctor or nurse if you have any arthritis or have had
a previous bone injury, surgery or fracture. These will also be
picked up on the bone scan.
A small amount of a safe radioactive dye is injected into a vein
in your arm. The dye collects in your bones, which will take around
two to three hours.
You will lie on a table while the machine moves down your body,
taking pictures. This takes around half an hour. The camera will
pick up any "hot spots" where the radioactive substance has
collected. These "hot spots" can show if the cancer has spread to
the bone.
You may need to have X-rays of any "hot spots" to check whether
they are caused by cancer or other damage to the bone, such as
fractures. If there is still doubt, you may need to have an MRI
scan of the bone. Occasionally some men have a bone biopsy but this
is only needed in rare cases.
You may be asked to avoid contact with pregnant women and
children for up to 24 hours after the scan.
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Other tests
Researchers are looking at other tests that may help to diagnose
prostate cancer. These tests are not widely available. More
research is needed before we can be sure how useful they are.
Free and total PSA test
- This test is a different way of looking at the amount of PSA in
your blood. It looks at two different types of PSA called free PSA
and total PSA.
- Some evidence suggests that this test can help tell the
difference between men who have a high PSA because they have an enlarged prostate and men who have a high PSA
because they have prostate cancer.
- The test is only suitable for men who have a PSA level between
4 and 10 ng/ml.
A urine test called a PCA3 test
- Your doctor or nurse will massage your prostate and then take a
urine sample. Cells from the prostate pass into the urine where
they can be examined later with a special genetic-based test.
- This test might be useful in deciding whether some men who have
had a PSA test should have a biopsy. Or for monitoring men who have
already had prostate biopsies and no cancer was found.
- This test is not usually available on the NHS as more research
is still needed.
A type of MRI scan called a "diffusion scan"
- This is to try to identify any abnormal looking areas to target
during the biopsy. Clinical trials are looking at how
useful these scans are in diagnosing prostate cancer.
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