based upon advanced diagnostics
The Prostate Cancer Diagnostic Process: PSA, MRI, Biopsy
When caught early, prostate cancer is readily treatable.
Over the last decade, developments in MRI imaging and biopsy procedures have made it possible for significantly enhanced diagnostic precision.
This combined with extra PSA screening means that prostate cancer can be detected at an earlier stage than before. Early detection and precision diagnosis have laid the basis for minimally invasive focal treatment.
This page explains the ways in which prostate cancer is detected and diagnosed in the UK.
A PSA test measures the levels of prostate specific antigen (PSA) in the blood. PSA is a substance made by the prostate. Levels of PSA in the blood can be higher in men who have prostate cancer.
It is a screening tool used to determine whether or not an investigation for prostate cancer is needed. It can also be used to monitor a man’s general prostate health over time.
DRE (DIGITAL RECTAL EXAM)
A digital rectal exam is a test that is done when a doctor or nurse inserts a gloved, lubricated finger into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities.
The DRE is used to help diagnose prostate cancer and for other prostate problems such as benign prostatic hyperplasia (BPH) or prostatitis.
If the results of early detection tests like the PSA test or the digital rectal exam suggest that you might have prostate cancer, your doctor will conduct further testing. The PSA may be repeated, or you may be sent to a specialist for more tests such as a MRI scan and a prostate biopsy.
An MRI (magnetic resonance imaging) scan is used to identify areas of suspicion within your prostate gland that may need further investigation.
It uses magnets to create an image of your prostate and the surrounding tissues. The image from your scan gives your doctor information about whether there are any cancer cells in your prostate and how likely they are to grow.
The radiologist reviewing your MRI scan will identify areas of suspicion shown in the scan and will assign them a PIRADS score. A PIRADS score of 4 or 5 indicates a need for a biopsy, and a significant number of men with a PIRADS score of 3 will also be biopsied.
What is an mpMRI scan?
A multi-parametric magnetic resonance imaging (mpMRI) scan creates a more detailed picture of your prostate than a standard MRI scan: it does this by combining four different types of image.
In the UK, an mpMRI scan should be carried out for men with an elevated PSA level before any biopsy. The information from the mpMRI pinpoints exactly where any areas of interest are located and allows for more targeted biopsies.
“The big change has been the advent of MRI and its use in prostate imaging. Using mpMRI we are now about 90% accurate in picking up clinically significant tumours. If you compare that to standard TRUS biopsies, which we know to be about 30%, it’s a completely different league.”
Dr Clare Allen, Uro-Radiologist at The Focal Therapy Clinic
A prostate biopsy involves using thin needles to take tiny samples of tissue from the prostate gland. The tissue is then examined under a microscope to check for cancerous cells.
If cancerous cells are found, the biopsy will also show how aggressive the cancer is, whether it has already spread, and how likely it is to spread outside the prostate.
“A high-quality mpMRI scan combined with a targeted biopsy allows us to know the location and grade of your prostate cancer. We can then treat it with minimal damage to surrounding organs and reduced side effects.”
Mr Raj Nigam, Urological Consultant at The Focal Therapy Clinic
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