Prostate Cancer Risk Assessment

Prostate cancer is the most common internal cancer diagnosed in men. The risk of having prostate cancer increases with age, positive family history and other factors. 

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

Prostate Cancer Risk Assessment aims to: 
1. Find early Prostate cancer while 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 and your GP your own individual long-term risk assessment plan. This is particularly important if you have an elevated PSA or family history of Prostate cancer. 

How do we detect Prostate cancer? 

Prostate Specific Antigen (or PSA) is a blood test that can help us to assess your Prostate cancer risk. It is used in combination with your prostate examination findings, family history and MRI. An elevated PSA test does not necessarily mean that prostate cancer is present. 

PSA change over time (PSA Velocity) is also used to assess cancer risk. PSA normally takes more than 5 to 10 years to double. If the PSA rises more rapidly, (ie every 2-5 years) this suggests more active prostate growth and possibly an increased risk of Prostate cancer. 

Age “Age-specific” PSA
< 50 years< 2.5 ng/ml
50-60 years< 3.5 ng/ml
60-70 years< 4.5 ng/ml
> 70 years< 6.5 ng/ml

Prostate MRI (Magnetic Resonance Imaging) scans are now commonly used in Prostate cancer risk assessment. They 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 when ordered by a specialist. 

Prostate Biopsy 

Prostate biopsy is usually done under an anaesthetic using one of two techniques:  

• TRUS (Trans-rectal Ultrasound) Biopsy – an ultrasound probe is passed into the rectum, ultrasound images are used to guide needle biopsies through the back passage.  

• Trans-perineal (TP) MRI fusion biopsy – an ultrasound probe is passed into the rectum and ultrasound images are fused in a computer with your MRI images to guide needle biopsies through the perineum (the skin behind the scrotum). This is very accurate, and has no risk of infection.