The Prostate is a small gland below the urinary bladder and around the urethra. The prostate grows as men age, which can cause problems with lower urinary tract symptoms (poor stream, bladder over-activity, urinary retention).
Prostate cancer is increasingly common as men get older, and there are a number of factors which can increase a mans risk including; a family history of prostate cancer, breast cancer, BRAC2 and other genetic conditions.
The aim of Prostate Cancer Risk Assessment is to:
- Detect prostate cancer early, while it is still localised to the prostate (and potentially curable with treatment).
- Determine whether your prostate cancer needs active treatment or whether it can be watched, commonly known as ‘Active Surveillance’.
- Reassure. A large number of men can be tested and reassured of a low risk of Prostate Cancer.
If you are concerned about your risk of prostate cancer, particularly if you have a family history of Prostate cancer, are a carrier of the BRAC2 gene or have had an elevated PSA before, regular PSA testing can be very reassuring.
How do we find Prostate Cancer?
A simple bloods test which includes the Prostate Specific Antigen (or PSA) can be requested by your GP and can provide a measure to appropriately assess your Prostate Cancer risk.
In Australia, it is recommended that you have a PSA blood test every 2 years if you are over 50 years of age, or if you have a family history (father, brother or son) from the age of 40 years. If you have any symptoms suggesting a problem with your prostate, you should also have a PSA as part of a prostate health check.
It is important that if your GP does not request this test, you ask.
A digital rectal examination (DRE) by your GP is not recommended as part of the initial assessment unless your GP is experienced in doing this test. A Urologist will perfor, a digital rectal examination as part of your specialist assessment.
The PSA change over time (PSA Velocity) and a PSA Free/Total ratio can also help to assess your risk.
| Your Age | Normal “Age-specific” PSA |
| < 50 years | < 2.5ng/ml |
| 50-60 years | < 3.5ng/ml |
| 60-70 years | < 4.5ng/ml |
| > 70 years | < 6.5ng/ml |
Referral to a Urological Surgeon
If your GP is concerned about your risk of prostate cancer or your urinary symptoms, they may recommend that you see a Urological Surgeon.
A full medical history will be conducted at your initial consultation, which includes, family history and urinary symptoms. On most occasions, an examination including digital rectal examination (DRE) of your prostate and an abdominal ultrasound will be performed. Depending on your medical history and examination, a recommendation of ongoing PSA testing or MRI of the prostate will be advised.
Prostate MRI (multi-parametric MRI) scans uses 3 scanning techniques to locate abnormal areas in your prostate which may indicate a risk of cancer. Radiologist will specify a PIRADS score of 1-5, indicating the level of concern about cancer.
Larger and more aggressive cancers appear more distinct on MRI scans. These images can be used in the operating theatre to help your Urologist to accurately target the abnormal area with prostate biopsies (see below).
Small prostate cancers may look like benign prostate tissue on MRI and are not always represented clearly.
Prostate Biopsy
A prosate biopsy is performed to provide a definitive diagnosis on patients who are a “high-risk” or if there is apprehension of prosate cancer. This is done under a general anaesthetic using one of two techniques:
• Trans-rectal Ultrasound (or TRUS) Biopsy – an ultrasound probe is passed into the rectum, ultrasound images are used to guide needle biopsies through the back passage.
• Trans-perineal (TP) template or MRI fusion-guided biopsy – an ultrasound probe is passed into the rectum and the ultrasound images and your MRI images are fused together in a computer. The needle biopsies are taken through the perineum (the skin behind the scrotum). An MRI fusion biopsy is the most accurate way to guide needle biopsies to the target area. Template biopsies are also taken of the rest of the prostate.
After your biopsy, you will have a followup appointment to discuss the biopsy result and plan the next steps in your care. If there is cancer detected, you will need staging tests to see if the cancer has spread from the prostate.
For further reading about Prostate cancer, we recommend these Australian websites:
