Learn what to expect during prostate cancer diagnosis, including PSA tests, MRI scans, and biopsies. Specialist guidance from Mr Ammar Alanbuki, UK urologist.
Being referred for tests for prostate cancer can feel worrying, but knowing what happens at each stage can make the process easier. Prostate cancer diagnosis usually involves a PSA blood test, an examination, an MRI scan and, if needed, a biopsy. No single test confirms prostate cancer on its own, so your specialist uses the results together to decide on the next step.
Mr Ammar Alanbuki is a Consultant Urological Surgeon at University Hospitals Sussex NHS Foundation Trust, with specialist expertise in the diagnosis and surgical treatment of prostate cancer. He sees patients privately in Brighton, Hove, Haywards Heath, Gatwick and London.
Prostate cancer is the most common cancer in men in the UK, with more than 50,000 men diagnosed each year, according to Cancer Research UK. Many prostate cancers grow slowly and may never cause harm, while others are more aggressive and need treatment. An accurate diagnosis helps separate the two, so that men who need treatment get it, and men who do not can avoid unnecessary treatment.
The process usually starts when a man has symptoms, or when a PSA blood test is raised. Common reasons for investigation include:
These symptoms are more often caused by non-cancerous conditions, such as an enlarged prostate (benign prostatic hyperplasia, or BPH). A full assessment is always needed before any conclusions are drawn.
The PSA (prostate-specific antigen) test is a blood test that measures the level of a protein made by the prostate. A raised PSA level can be a sign of prostate cancer, but it can also be raised by an enlarged prostate, infection, inflammation, recent ejaculation or vigorous exercise. The NHS guide to prostate cancer diagnosis explains that a PSA test cannot diagnose prostate cancer on its own, but it is an important first step.
A digital rectal examination allows the clinician to feel the size, shape and texture of the prostate through the wall of the back passage. It takes less than a minute. An area that feels hard or irregular may prompt further tests, even if the PSA level is normal.
If the first tests suggest further investigation is needed, an MRI scan is usually the next step. Modern imaging has greatly improved how accurately prostate cancer is found and staged.
A multiparametric MRI (mpMRI) scan is now the recommended first scan in the UK for men with suspected prostate cancer. It produces detailed images of the prostate and shows any areas that look suspicious. This helps your specialist decide whether a biopsy is needed and, if so, exactly where to take samples from. An MRI scan does not use radiation.
If the MRI scan shows an area of concern, a biopsy is usually recommended. Small samples of tissue are taken from the prostate and examined under a microscope. A biopsy is the only way to confirm prostate cancer for certain.
If cancer is found, it is given a Gleason score and a grade group (from 1 to 5), which show how quickly the cancer is likely to grow. These are combined with your PSA level and the stage of the cancer to place it in a risk group, which guides treatment.
If prostate cancer is confirmed and there is a chance it has spread, further scans may be used to check the rest of the body. These can include a CT scan, a bone scan or a PSMA PET-CT scan. Staging scans are not needed for every patient, particularly those with low-risk cancer.
Once the diagnosis is confirmed, your specialist will go through the results with you in detail. Treatment depends on the stage and grade of the cancer, your age, your general health and your own preferences. Options range from active surveillance for low-risk cancer to surgery, radiotherapy or hormone therapy.
For men who need surgery, Mr Alanbuki performs robotic-assisted radical prostatectomy, an operation to remove the prostate gland. He discusses all suitable options with each patient, including non-surgical treatment and monitoring. You can read more about prostate cancer surgery.
Treatments for an enlarged prostate, such as Aquablation therapy, are not used to treat prostate cancer. They treat benign prostate enlargement (BPH) only.
If you are suddenly unable to pass urine, have blood in your urine, or have severe pain in your back, hips or pelvis, seek medical help promptly. These symptoms need urgent assessment.
Understanding how prostate cancer is diagnosed can help reduce uncertainty and help you make informed decisions. If you have a raised PSA result, symptoms that concern you, or have been referred for tests, speaking with a specialist is a sensible first step.
To arrange a prostate assessment, book a consultation with Mr Ammar Alanbuki in Brighton, Hove, Haywards Heath, Gatwick or London.
Consultant Urological Surgeon at University Hospitals Sussex NHS Foundation Trust. Specialist in robotic and minimally invasive urology, prostate surgery, kidney cancer and stone disease.
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