Your GP doctor may request a PSA
(Prostate Specific antigen) blood test if there are any urinary symptoms, erection troubles, unexplained symptoms like weight loss, bone pain, as a part of general health check up or on your request. It is advisable to avoid ejaculation/intercourse for 72 hours prior to the blood test, and it should not be taken if you have very recently had a urine infection. Simple prostate examination by a finger in the back passage should not affect the result. If the PSA is higher than normal for the particular age group, your doctor will discuss referral to us for further assessment. Sometimes GP
s repeat the blood test after a few weeks to see if it is still high.
Some Facts about PSA and prostate cancer:
PSA is a protein measured in blood to look for prostate cancer.
Even without a prostate cancer, PSA can be high in conditions like enlarged prostate, inflammation with or without infection, or even previous surgery in that area. (It is not clear if bicycling artificially raises the PSA value or not).
There is 20 to 30% chance of prostate cancer with PSA between 3 to 10 and 50% chance with PSA 10 to 20. Your chances may be higher if you have had close relatives affected, and also men of Afro-Caribbean ethnicity have a higher risk of being affected.
As people grow older, the chances of finding prostate cancer also increases. It is very important to remember though that despite this, the majority of prostate cancers are not life limiting, and therefore careful evaluation is required to tell if treatment is needed or not.
PSA Referral Pathway:
Once your GP has referred, you will be sent an appointment for assessment in the hospital. This may well be on a "rapid access pathway", meaning that if you fall into certain criteria where cancer has to be ruled out, then appointments will be arranged very quickly, and your helpful cooperation with this is required. You may well be asked to attend for a scan before you are seen as this can help speed things along and give us as much information as possible to guide you at the first appointment.
In that clinic (PSA Clinic) you will be given questionnaires to fill regarding your symptoms and your general health and sexual function, and any risk factors you may have including family history of prostate cancer. You will be asked to provide a urine sample for testing, and will be asked to do a flow rate (passing urine in a WC shaped machine inside a toilet which records the urine flow). After this we will do a small ultrasound scan to see how much urine is left behind in the bladder. So you will be advised to bring urine sample with you and to come in with a comfortably full bladder to clinic for the flow test. Physical examination includes examination of the genitalia and DRE (finger examination of the back passage) to assess the prostate. (Presently due to COVID it is telephone appointment)
Your symptoms will be discussed and lifestyle advice or medications may be offered as necessary. The causes of the raised PSA will be discussed and you will be offered investigations to look for prostate cancer such as MP MRI (Multi parametric MRI) scan of the prostate and possibly biopsies. The MRI Scan is requested prior to the clinic and sometimes you might have had the scan before the appointment (in that case the results will be discussed in the clinic). If the scan is afterwards we will review it and contact you afterwards. The MRI scan can pick up around 85% of significant prostate cancers, and using this and other factors we will tell you whether a biopsy is advised.
If biopsy is advised, an appointment will follow. Biopsies for prostate usually are of two types:
1. TRUS (Transrectal ultrasound guided) biopsies of prostate – It involves Ultrasound probe through the back passage and taking biopsies with needle under local anaesthesia. As it is through the back passage which has got bacteria, you will be prescribed antibiotics to prevent infection. You will need to stop any blood thinners for the required amount of time before the biopsies (which varies between the medicines). More information available in the following link: British Association of Urological Surgeons TRUS patient leaflet
2. Trans perineal(TP) biopsies of prostate – This involves sitting in a reclined chair with legs up on stands. There is still an ultrasound probe in the back passage, but the biopsy is through the skin of the perineum (area between the back passage and scrotum). There is no need of antibiotics with this, but you will be advised to stop any blood thinners for a few days similar to the other type of biopsy. More information available in the following link: British Association of Urological Surgeons Trans perineal patient leaflet
Both types of biopsies are done under local anaesthesia. If a person wants the procedure under General anaesthesia, that will also be offered. After the biopsy you will be asked to stay in the clinic for a short while, observations will be done and asked to pass urine before going back home. You will be advised about the potential complications and where to come back if needed.
Around 10-14 days after the biopsy will be the results clinic (usually telephone clinic) where a cancer nurse specialist will go through the results of the biopsies and any future monitoring or treatment as necessary. Your symptoms will again be discussed in that clinic. If the biopsies show cancer, you will be advised if it is suitable for monitoring or needs any treatment. You will be advised if there is any more scans needed. Your biopsies and scan will be discussed in Multidisciplinary team meeting and you may be offered appointments with urology surgeons (for surgery) and/or the Oncology team for consideration of other options such as radiotherapy.
You will be kept informed throughout the journey and well supported in the decision making.
More information in the following links:
British Association of Urological Surgeons - Raised PSA
Transperineal prostate biopsy: discharge advice - Patient leaflet
Transrectal ultrasound scan and prostate biopsy: discharge advice - Patient leaflet