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Medically Approved by Dr Aqua Asif (Jun 18th 2025)
Written by Neil Patel
Prostate cancer is one of the most common cancers affecting men, particularly as they age. While there’s currently no national screening programme in the UK, early detection through appropriate testing can significantly improve treatment options and outcomes. Understanding the different diagnostic approaches available can help you make informed decisions about your health.
Understanding prostate cancer and early detection
Prostate cancer often develops slowly and may not cause noticeable symptoms in its early stages. This is why discussions about early detection are important – finding cancer before symptoms develop can often lead to more treatment options and better outcomes.
Common symptoms and risk factors
Early prostate cancer typically causes no symptoms at all – this is why discussions about testing are important even in men who feel completely well. Urinary symptoms such as difficulty starting urination, changes in urinary flow, or increased frequency (particularly at night) are much more commonly caused by benign prostatic hyperplasia (BPH) – a non-cancerous enlargement of the prostate that affects most men as they age.
When prostate cancer does cause symptoms, it’s often in more advanced stages and may include persistent bone pain, unexplained weight loss, or significant changes in urinary or bowel function. However, by this stage, treatment options may be more limited.
Key risk factors include advancing age (particularly over 50), family history of prostate or breast cancer, and certain ethnic backgrounds, with men of African Caribbean ancestry having approximately double the risk compared to men of European ancestry.
Importance of early diagnosis
When prostate cancer is detected early, patients typically have more treatment options available. For men diagnosed with localised cancer, treatments like focal therapy aim to target only the affected area while preserving healthy tissue. Research suggests this approach may help reduce the risk of side effects such as incontinence or erectile dysfunction compared to more extensive treatments.
Current approaches to prostate cancer testing
Rather than a single definitive test, doctors typically use a combination of assessments to evaluate prostate cancer risk and guide further investigations. Current NICE guidelines have established evidence-based pathways that prioritise certain tests based on their proven effectiveness.
Prostate-specific antigen (PSA) blood test
PSA is a protein made by the prostate, and a higher amount in your blood may signal a problem. Elevated levels can be caused by cancer, but also by non-cancerous issues like infection or an enlarged prostate. Because of this, further testing is usually needed to determine what’s really going on.
Digital rectal examination (DRE)
A digital rectal examination (DRE) involves a doctor feeling the prostate through the rectum to check for any lumps or hard areas. While this is a straightforward examination, research indicates it has limited accuracy for detecting prostate cancer. It’s typically used alongside other assessments rather than as a standalone test.
Multiparametric MRI (mpMRI)
Multiparametric MRI provides detailed images of the prostate and surrounding tissues. Current NICE guidelines recommend mpMRI as a first-line investigation for men with suspected prostate cancer. It is commonly used when a PSA result is raised to guide whether a biopsy is needed. Many specialists consider mpMRI the best scan for prostate cancer currently available for initial assessment.
Prostate biopsy procedures
When imaging or other tests suggest cancer may be present, a biopsy involves taking small tissue samples for microscopic examination. This remains the definitive way to diagnose prostate cancer. Modern approaches use MRI guidance to target suspicious areas, which research shows significantly improves accuracy compared to random sampling methods.
Emerging diagnostic approaches
Several newer tests are being developed that may improve prostate cancer detection while reducing unnecessary procedures.
Blood-based testing
Beyond standard PSA, several enhanced blood tests are now available that may provide additional information. These include the Prostate Health Index (PHI) and 4Kscore, which combine multiple biomarkers and show improved accuracy compared to PSA alone, potentially reducing unnecessary biopsies.
Advanced urine tests
Urine biomarker tests, such as PCA3, look for a gene that is more active in prostate cancer cells. A positive result suggests a higher likelihood of cancer and can help guide whether a biopsy is needed. This kind of testing is especially helpful for those with uncertain PSA levels and a relevant family history.
Genetic risk assessment
For men with strong family histories, genetic testing can identify inherited cancer predisposition genes like BRCA2. While not used for general screening, this information can help inform personalised risk assessment.
Comparing test performance and patient experience
Different tests offer varying levels of accuracy, invasiveness, and patient acceptability, which doctors consider when making recommendations.
Understanding test accuracy
Each diagnostic approach has particular strengths and limitations:
- PSA: Widely available and non-invasive, but prone to false positives
- mpMRI: Excellent at visualising suspicious areas in the prostate and avoiding unnecessary biopsies in men with negative scans
- MRI-targeted biopsy: Currently provides the most definitive diagnosis when cancer is suspected
- Other biomarker tests: May help refine risk assessment, particularly in borderline cases
Balancing accuracy with patient comfort
Many men worry about discomfort or complications from invasive testing procedures. mpMRI scans and blood/urine tests offer non-invasive ways to gather important information. Even when a biopsy is needed, newer methods like targeted biopsy can improve comfort while maintaining accuracy.
Determining the right approach for you
Choosing the right test isn’t one-size-fits-all. The most appropriate testing strategy depends on individual circumstances and should always involve discussion with healthcare professionals.
Factors influencing test selection
Doctors weigh several factors before recommending a test or combination of tests. These may include:
- Age and general health status
- Family history and genetic risk factors
- PSA levels and trends over time
- Presence of early symptoms
- Results of previous investigations
- Patient preferences and concerns
Discussing options with your healthcare provider
Having open conversations with your healthcare provider makes a big difference. Our experienced consultants can help explain test results, discuss medical suitability for different approaches, and guide you through the decision-making process.
FAQs
What is the most accurate test for prostate cancer?
A targeted biopsy guided by mpMRI imaging is currently what is the most accurate test for prostate cancer. This approach allows doctors to focus on suspicious areas seen in scans, improving the chances of detecting cancer accurately. When combined with a PSA test and other modern tools, it creates a reliable and well-rounded diagnostic process.
What are the important considerations?
Several factors deserve consideration, including your age, family history, overall health, and personal preferences. It’s worth noting that not all prostate cancers require immediate treatment – some can be safely monitored. Discussing early symptoms, following diet and lifestyle tips, and understanding your individual risk factors can all contribute to informed decision-making about testing.
References
Cornford P, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2024;86(2):148-163.
NICE. Prostate cancer: diagnosis and management. NICE guideline [NG131]. 2019 (updated 2021).
Merriel SWD, et al. Systematic review and meta-analysis of the diagnostic accuracy of prostate-specific antigen (PSA) for the detection of prostate cancer in symptomatic patients. BMC Med. 2022;20(1):54.
Rosario DJ, et al. Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study. BMJ. 2012:344:d7894.
Ahmed HU, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389(10071):815-822.
Kasivisvanathan V, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018;378(19):1767-1777.
Diamand R, et al. Transperineal or Transrectal Magnetic Resonance Imaging-targeted Biopsy for Prostate Cancer Detection. Eur Urol Focus. 2024;10(5):805-811.
Russo GI, et al. A Systematic Review and Meta-analysis of the Diagnostic Accuracy of Prostate Health Index and 4-Kallikrein Panel Score in Predicting Overall and High-grade Prostate Cancer. Clin Genitourin Cancer. 2017;15(4):429-439.e1.
Vedder MM, et al. The added value of percentage of free to total prostate-specific antigen, PCA3, and a kallikrein panel to the ERSPC risk calculator for prostate cancer in prescreened men. Eur Urol. 2014;66(6):1109-15.
Van Neste L, et al. Detection of High-grade Prostate Cancer Using a Urinary Molecular Biomarker-Based Risk Score. Eur Urol. 2016;70(5):740-748.
Leongamornlert D, et al. Frequent germline deleterious mutations in DNA repair genes in familial prostate cancer cases are associated with advanced disease. Br J Cancer. 2014;110(6):1663-72.
This blog post is for informational purposes only and should not replace professional medical advice. Always consult with your healthcare provider about your specific situation and testing options.
