Prostate Cancer

Prostate cancer is the most common cancer diagnosed in men, apart from skin cancer. The risk increases with age.

Many prostate cancers grow very slowly and may not cause problems for many years, but many are more agressive and can become life threatening.

Prostate Cancer Risk Assessment aims to:

1. Find Prostate cancer at a stage when it is potentially curable, in men who will benefit from treatment
2. Reassure men who do not have an increased risk of Prostate cancer, and
   
3. Give you an individual long-term risk assessment plan. This is particularly important if you have an elevated PSA or family history of Prostate cancer.

What is PSA?

Prostate Specific Antigen (or PSA) is a blood test that can be used (in combination with family history, examination and sometimes MRI) to assess Prostate cancer risk. Men with Prostate cancer can have an elevated PSA test, but an elevated test does not necessarily mean prostate cancer is present.

"Age-specific" PSA reference ranges are useful as the prostate grows with age, and PSA increases (see table).

PSA change over time (PSA Velocity) is also used to assess cancer risk: 

• PSA normally doubling every 5 to 10 years. More rapid rise in PSA (doubling every 2-5 years) suggests more active prostate growth and suggests an increased risk of Prostate cancer
• but PSA levels can change from day to day with physical and sexual activity
• PSA Velocity should be assessed on 3 or more PSA tests over 12 months to reduce the effect of day-to-day variation

Digital Rectal Examination (or DRE) performed by your GP, a Specialist Nurse or Urologist is important in the diagnosis and staging of Prostate cancer. Prostate cancer can be felt on DRE in around 60% of men with Prostate cancer.

Magnetic Resonance Imaging (or MRI) scans are very good at detecting larger or more aggressive Prostate cancers (small cancers look just like normal prostate tissue on MRI and are not seen very well). Prostate MRI scans are now reimbursed by Medicare, and have an established place in Prostate cancer risk assessment.

Prostate Biopsy

Prostate biopsy can be performed in several different ways. 

• Trans-rectal Ultrasound (TRUS) Biopsy - under a light anaesthetic, an ultrasound probe is passed into the rectum. Ultrasound images are used to target areas of the prostate that are more likely to have cancer. Needle biopsies are taken through the back passage. 
• Trans-perineal biopsy (TPBx) - under a light anaesthetic, an ultrasound probe is passed into the rectum. Ultrasound images of the prostate may be fused with the MRI images (a fusion biopsy) to target areas of the prostate that are more likely to have cancer. Needle biopsies are taken through the skin of the perineum (behind the scrotum).

Calculate Your Prostate Cancer Risk

You can use the Prostate Cancer Risk calculator from the Prostate Cancer Prevention Trial to give you an idea of your risk of having cancer on prostatic biopsy.

The Prostate Cancer Risk Calculator will give:

1. Your Overall risk of Prostate cancer
2. Your risk of high grade (aggressive or "life threatening") Prostate cancer
   

The results of this Risk Assessment calculator should be interpreted with the help of your Urologist or GP.