Prostate Cancer

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Tests to Diagnose and Monitor the Condition

The tests most commonly used tests to investigate men with symptoms suggestive of prostate cancer are rectal examination and the Prostate-Specific Antigen (PSA) blood test. To perform a rectal examination, the doctor inserts a gloved, lubricated finger into the rectum (back passage) and feels the prostate gland with his or her finger for localised hardness or nodules. For the PSA test, blood is taken and sent to a clinical laboratory. There the blood is examined for an increased level of the blood marker which is associated with prostate inflammation or cancer.

Whilst the PSA level is raised in up to eighty percent of prostate cancers, an abnormal result does not necessarily mean a diagnosis of cancer. In fact, two-thirds of men with a raised serum PSA level do not have prostate cancer, although other abnormalities requiring treatment may be the cause of a raised PSA results. Rectal examination and PSA measurement can also assist in the early detection of benign prostatic hypertrophy (BPH). The current UK NHS policy about the use of PSA to screen men without symptoms for prostate cancer is explained under Screening/Adults 50+.

Should you have symptoms of prostate disease, be sure to let your GP know. If your PSA and/or rectal examination have normal results, your doctor can recommend when re-testing is appropriate. If your results are abnormal, your doctor may recommend further tests, such as a transrectal ultrasound-guided biopsy. This procedure allows a doctor to take a sample from the prostate for further study. It may be necessary to stop taking certain medicines up to ten days before the test. Ultrasound examination helps the doctor to assess the size of the prostate gland.  A few weeks after the time of the biopsy you may also be asked to have an examination of your urinary flow rate and assessment of how much urine is retained in the bladder after urination. If your PSA level is only mildly elevated then your doctor may recommend re-testing after a certain period of time e.g. six months to a year.

Once a diagnosis of prostate cancer is made, doctors may use a variety of tests to monitor the cancer, determine treatment options, and evaluate the effectiveness of a chosen course of treatment. In addition to using rectal examination and PSA for this purpose, tests using X-ray, ultrasound, magnetic resonance imaging (MRI) and tissue sampling may be used.

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