Prostate cancer tends to develop slowly, so its symptoms may not show for many years, and might never cause any problems in your lifetime.
But some men have cancer that is more aggressive. This will need treatment to stop the disease or at least delay the cancer spreading outside the prostate gland.
Prostate cancer can cause a range of symptoms, none of which are specific only to prostate cancer.
The signs of prostate cancer only become noticeable when the prostate is enlarged enough to affect the urethra – the tube carrying urine from the bladder to the penis. This means you might notice things like a greater need or effort to urinate, and then a feeling your bladder hasn’t properly emptied.
But these signs don’t mean you have prostate cancer. They could be caused by something else, like benign prostatic hyperplasia (BPH) – where your prostate is enlarged but not affected by cancer.
For some men the first symptoms of prostate cancer are when it has spread beyond the prostate gland to the bones. This may cause symptoms such as back, hip or pelvic pain – but again could be caused by benign conditions such as arthritis.
Whatever pain, discomfort or symptoms you feel, it is always best to discuss these with your GP.
Based on your symptoms, your GP can use one of the following tests to help reach the right diagnosis.
Prostate specific antigen (PSA) test
A PSA test is a blood test that measures the total amount of protein produced by the prostate.
All men have a small amount of the PSA protein in their blood, and the amount of this protein increases with age.
Raised levels of PSA can indicate a problem with the prostate, but this alone can’t diagnose prostate cancer. However, other test results, your family history and ethnicity can help assess your risk.
Digital rectal examination (DRE)
This is perhaps the most common way of diagnosing a problem with the prostate gland. The DRE should be done after a PSA test as this examination can raise your PSA levels and, therefore the result may be misleading.
To carry out the DRE your doctor or nurse uses their finger to feel the prostate gland through the wall of your back passage (rectum), feeling for any hard or irregular areas and to estimate the size of the gland.
Urine test for prostatitis
Your GP may also take a sample of your urine to test for prostatitis, which is an infection or inflammation of the prostate gland.
Prostatitis is a common condition that can affect men of any age, but is most common in men aged between 30 and 50. Prostatitis isn’t prostate cancer, nor is it related to an enlarged prostate.
It can however cause a number of symptoms that may be confused with prostate cancer, such as problems passing urine, and pain or discomfort around the testicles, back passage or lower abdomen.
Further hospital tests may include more advanced tests such as a prostate biopsy, MRI, CT or ultrasound scan, or prostate mapping.
To see if you need a prostate biopsy or not, you may need to have a multi parametric (MP) MRI scan. This is a high-definition MRI scan of your prostate.
A prostate biopsy is a procedure that takes a small piece of your prostate tissue to be examined under the microscope. It’s perhaps the most accurate way of finding out if you have prostate cancer. Your doctor will talk you through the advantages and disadvantages of a biopsy, and any concerns you might have before you decide upon this kind of test.
You may not need a biopsy if other tests (like an MRI, CT or bone scan) show that cancer has spread beyond the prostate.
An MRI scan may be carried out to look for primary disease and to see if any disease has spread beyond the prostate gland.
MRI scanning combines a powerful magnet with a very advanced computer to provide exact and detailed images without the use of x-rays.
Each scan or slice is like a single slice from a loaf of bread – when all the slices are put together a 3-D picture of the body can be obtained. The number of sequences or images depends on the area being scanned.
During the scan you will be asked to lie very still on the MRI table. A two-way intercom ensures that you may speak and listen to the MRI staff during your scan.
A radiographer will carry out the scan.
A CT scan can show whether the cancer has spread beyond the prostate to other organs.
A C.T. scan is a special type of x-ray test that takes ‘slice’ pictures of organs and structures in the body.
Each scan or slice is like a single slice from a loaf of bread – when all the slices are put together a 3-D picture of the body can be obtained. The number and width of the slices depends on the area being scanned.
During the scan you will be asked to lie very still on the C.T. table. No equipment will touch you and nothing will close in on you – the scanner is an open hole, rather like a polo mint – it is not a long or enclosed tube.
A radiographer will carry out the scan.
For some scans you will be given an injection, in your arm, of a contrast agent or ‘radio-opaque’ dye. This allows the scanned part of the body to be visualised more clearly.
A bone scan can detect if your cancer has spread outside the prostate to your bones.
This test involves administering a small amount of radioactive material into your body.
The radioactive materials used are normally injected into a vein in your arm, similar to a blood test. Depending upon the type of scan you are having you may have to wait before any imaging is carried out. The waiting time depends upon the type of scan you are having; it varies between a few minutes and a few hours. If the waiting time is more than an hour you may be able to leave the hospital during the interval.
During the scan you will have to lie still on a bed. In order to get good quality images the equipment, a Gamma camera will have to be close to you, you will not, however, have to go into a tunnel. Most investigations take approximately twenty minutes.
Prostate mapping uses state-of-the-art MRI imaging techniques with a biopsy under general anaesthetic to give information about the prostate to a high degree of accuracy.
Prostate mapping is a way of diagnosing prostate cancer that can enable a more accurate assessment of the risk of prostate cancer. This is because the test gives important information about the location of any cancer, the number of tumours and their grade. Most importantly, this information is more likely to be accurate when compared to standard diagnostic methods.
The stages of prostate cancer
When you’re diagnosed with prostate cancer, your consultant urologist will tell you the stage of your cancer. This tells you how far the cancer has developed, and if the cancer cells have spread to any other part of your body.
When your consultant urologist talks about the stage of your prostate cancer, they may refer to the TNM (Tumour Nodes Metastases) system.
This is one of the most common methods to label the stages, where each letter describes a feature of the tumour:
- T stage showshow far the tumour has spread in and around the prostate
- N stagemeasures if the cancer has spread to the lymph nodes
- M stagemeasures if the cancer has spread (metastasised) to other organs or partsof the body.
The T stage is usually determined by a digital rectal examination (DRE), but you might also have a magnetic resonance imaging (MRI) scan to see if the tumour has spread around the prostate.
At this first T stage, the cancer can’t be felt by a DRE or seen on scans, and may only be seen under a microscope – this would be localised prostate cancer.
At this second T stage the cancer can be felt by a DRE or seen on scans, but it’s contained within the prostate – this would be localised prostate cancer.
At the third T stage, the cancer can be felt by a DRE or seen in a scan breaking through the capsule of the prostate – this would now be described as locally advanced prostate cancer. There are two sub stages:
Where the cancer hasbroken through the capsule of the prostate, but not spread to the seminalvesicles, the small tubular glands that produce some of the fluid in semen.
The cancer has spread to the seminal vesicles.
At this fourth T stage, the tumour has spread to nearby organs, such as the bladder, back passage, or pelvic side wall– this is locally advanced prostate cancer.
The N stage describes whether the tumour has spread to the lymph nodes, which are a common place for cancer to spread, and can be seen with an MRI or CT scan. There are three N stages:
The state of the lymphnodes can’t be measured.
The lymph nodes do notlook like they contain cancer
The lymph nodescontain cancer – this may be treated as locally advanced or advancedprostate cancer.
The M stage shows whether the cancer has spread (metastasised) to other parts of the body, such as the bones, and may be measured with a bone scan. There are three M stages:
The spread of the cancer was not (or could not) be measured.
The cancer wasmeasured, and has not spread to other parts of the body.
The cancer has spread to other parts of the body – this will be diagnosed and treated as advanced prostate cancer.