Modern prostate cancer diagnosis and treatment

We’ve become much more advanced in how we test for prostate cancer and make a decision on the right treatment to give. In this article we asked consultant urologist Mr Marc Laniado what patients can expect from the process and what your results mean.

How do doctors assess my risk of prostate cancer?

The main way is to have a blood test known as PSA. Your doctor may or may not combine it with an examination of the prostate using a finger inserted into the back passage.

PSA is a triage test – depending on the level, either no or more investigations are necessary. For example, if your PSA is high, you should confirm it is still high on a second PSA test a few weeks later, as often the first PSA result can be a false reading, and the PSA value can return to normal after a while.

To avoid false positives, you need to avoid exercise, ejaculation, or prostate stimulation for two days before, and the PSA should not be measured if a urinary tract infection is present.

What happens if my PSA results are high?

If you have two high PSA results or the prostate feels like it may have a cancer, then ideally you should have a multiparametric MRI performed on a high-quality MRI scanner and interpreted by radiologists with specific training.

If the mpMRI shows that significant prostate cancer is likely, a doctor should take a biopsy targeted to the abnormality seen on the MRI.

What happens if prostate cancer is found?

If prostate cancer is found, then the treatment plan needs to be personalised. That means either:

• active surveillance for slow-growing cancer, which is contained within the prostate.
• treating just part of the prostate with cancer - known as focal therapy or partial ablation
• surgical techniques with a high chance of success and fewer side effects than standard surgery, such as Retzius-sparing prostatectomy with NeuroSAFE, techniques involving radiotherapy such as brachytherapy, or some other advanced forms of radiotherapy.

Are there any alternatives to the PSA test?

Recently, a urine test called SelectMDx has become available in the UK, which appears to perform better than PSA. However, not so much is known about this test or how it fits into the current pathway to diagnose prostate cancer.

Occasionally, the SelectMDx test may have a help decide to have a prostate biopsy where other tests are unhelpful.