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How to Detect Prostate Cancer?
What is PSA?
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Testing for prostate cancer

Your local or family doctor can test for prostate cancer with a blood test and a rectal (back passage) examination.

In a rectal examination, the doctor inserts a gloved finger into the rectum to feel the prostate gland and check if there is anything unusual.

The blood test checks your prostate-specific antigen (PSA) level. The higher the PSA level, the higher the likelihood of you having prostate cancer.

When prostate cancer is treated, the PSA level will decrease. During the course of treatment, your PSA level will be checked occasionally to see how the treatment is progressing.

Following your initial check-up, the doctor may refer you to a hospital for further tests. You may not need to undergo all of the following examinations. Your doctor will discuss the best option for your specific situation.

Trans-rectal Ultrasound Scan and Biopsy

An ultrasound probe called a trans-rectal ultrasound is passed into the rectum. The probe is the size of the thumb. It shows the shape and texture of the prostate on a screen. The ultrasound picture helps guide a small needle from the probe through the rectum into the prostate. Some samples of prostate tissue are taken from different parts of the prostate and checked under a microscope for signs of cancer.

The examination may be uncomfortable and there may be some bleeding, but it should take only a few minutes


Your chest and pelvic area may be x-rayed to check if any cancer cells have spread to other parts of your body.

Isotope Bone Scan

A bone scan is highly sensitive and allows cancer cells to be detected earlier than with x-rays.

A small amount of radioactive material (technetium) is injected into a vein, usually in your arm. This material is attracted to areas of bone where there are cancer cells.

After the injection, you will have to wait three hours before having the scan. Any area where there are cancer cells will be shown on a screen.

You may consider taking a book to read or listening to music while you wait for the scan.

A low dose of radioactive material is used. It will not make you radioactive or have any negative effects on your family or friends.

CT Scan

If the biopsy shows that you have prostate cancer you may have a blood test, bone scan, CT scan or MRI. You may have just one or a combination of these tests.

The tests will estimate the extent of the cancer in your body and find out whether it has spread to other parts of the body. This is called staging. Staging helps the doctor to recommend the best treatment for you.

MRI Scan

A magnetic resonance imaging (MRI) scan is similar to a CT scan. However, MRI uses a magnetic field rather than x-rays to produce a cross section of your body. Sometimes, a special dye is injected to give a clear image.

You will need to lie inside a metal cylinder – a large magnet – that is open at both ends, for about 30 minutes. If you feel uncomfortable in an enclosed environment, tell your doctor. The MRI machine makes a loud noise when operating and you will be given ear plugs during the test.

The metal cylinder has a strong magnetic field. You need to remove all metal objects before entering the room. If you have a heart rate monitor, a cardiac pacemaker or an implanted surgery clip implanted, an MRI scan is not suitable for you.

It may take a few days for the CT scan and MRI scan results to become available. Some people may worry during this period. Sharing your feelings with family members or friends may ease your concern.

What is prostate-specific antigen (PSA)?

PSA is a protein made by prostate cells. Its level is related to the size of the prostate gland. PSA is present in small quantities in semen. Usually, the level does not exceed 4 nanograms of PSA per millilitre. It is often higher when the prostate has cancer, is inflamed or is enlarged.

Your doctor will consider the following factors when considering your PSA level.

  • Your age
  • The size of your prostate gland
  • The rate at which your PSA level is increasing
  • Whether or not you are taking medicines such as Finasteride and Dutasteride or herbal supplements, as these may affect your PSA level

If you are diagnosed with prostate cancer, your PSA level can indicate whether or not the cancer cells have spread to other parts of the body. It also helps the doctor to decide if radiotherapy or surgery is a more suitable treatment. Generally, the higher the PSA level, and the faster the rate of increase, the greater the likelihood is that there are more prostate cancer cells in your body.

Remember, a high PSA level does not necessarily mean you have prostate cancer. Please consult your doctor for further check-up or other information.


Stages of Prostate Cancer

If biopsy and test results detect prostate cancer, one of the following groups of letters and numbers will be used to describe the stage of your prostate cancer.

The stage tells you how far the cancer has spread. The grade tells you how fast the cancer is growing.

The staging system used for prostate cancer is the TNM system; T=tumour, N=nodes and M=metastases.

  • T1 The tumour is found only in the prostate. It cannot be felt during a digital rectal examination.

  • T2 The tumour is located within the prostate only. It can be felt during a digital rectal examination.
  • T3 The tumour has spread from the prostate to nearby tissues such as the seminal vesicle glands, which produce semen.
  • T4 The tumour has spread beyond the prostate to the bones or lymph nodes.
  • N1-3 means the cancer has spread to the lymph nodes (glands) near the prostate. N0 means the cancer has not spread to any lymph nodes.
  • M followed by 1a, b or c shows that the cancer has spread to the bones or other organs of the body.
Grading of Prostate Cancer

How is prostate cancer graded?

Another step in the diagnostic process is grading the cancer cells - taking a measurement of how fast the tumour is likely to grow and spread. Grading is done in the laboratory with cells taken from the prostate gland during a biopsy. The cancer cells are measured by how closely they look like normal cells and reported in the Gleason scoring system.

What is the Gleason system for grading cancer?

The Gleason grading system is based on a number range from 2 to 10. The lower the number, the lower the grade, and the slower the cancer is growing. The higher the number, the higher the grade of the tumour. High-grade tumours grow more quickly than low-grade tumours, and are more likely to spread to other parts of the body.

Grades under 4 mean that the cancer cells look similar to your normal cells, and the cancer is likely to be less aggressive.

Grades 5 to 7 are in the intermediate range. This means that the cancer cells do not look like normal cells, and are more likely to be aggressive and grow faster.

Grades 8 to 10 indicate that the cancer cells are more likely to grow aggressively.

Your urologist will advise you on the best treatment after considering your age, general health, how fast the prostate cancer is growing (the grade) and whether it has spread (the stage). Considering the side effects that you are prepared to accept is also important.

Some people may choose not to receive any treatment and undergo regular check-ups instead. The side effects from treating prostate cancer may make you feel worse than the illness itself. You should discuss with your doctor the best option for your individual case.

The treatments for localised prostate cancer include surgery and radiotherapy. If the cancer has spread beyond the prostate, hormone therapy may be used. Sometimes chemotherapy is also used. You may have one of these treatments or a combination.

Research into the best way to treat prostate cancer is ongoing.

It is possible that you will talk with other people in the hospital undergoing a treatment different to yours. This is due to different circumstances or the recommendations of different doctors. If you have questions regarding your treatment, talk with your doctor or a nurse. You may want to make a list of questions and invite a relative or a friend to go with you.

Some people prefer to get a second opinion to help them decide which treatment to take. Most doctors are willing to recommend another specialist to you. 

1. Surgery

Your doctor will discuss with you which surgery is the best for you based on the type of cancer, the size of the cancer cells and whether or not the cancer has spread to other areas.

Radical Prostatectomy

In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles (which make most of the content in semen). 
It can be undertaken as open or keyhole surgery with the help of a robot to remove the prostate gland. This procedure can be performed when the cancer cells have not yet spread. Usually, it is done under general anaesthetic, with the surgery taking about four hours.

This surgery can cause problems with achieving an erection and urinary incontinence. Given these and other potential side effects, it is important to learn more about the possible risks before undergoing surgery. Your doctor will discuss with you the surgery and other possible treatments.

After the surgery

After the prostate gland has been removed, you will receive an intravenous injection and have a thin tube (catheter) inserted into your bladder through which urine can be discharged. The catheter should only be removed by a medical professional. The areas around your lower abdomen and pelvis may feel painful in the first few days after surgery, especially when you walk, and you can consider taking pain-killers. If the dose is not sufficient, inform the medical professionals treating you.

You should be able to go home three or four days after the surgery. If you undergo laparoscopic surgery, it may be earlier. You may need to have the catheter for 1 to 2 weeks after you leave hospital.

Keyhole surgery

An alternative to open surgery for some men is to remove the prostate through keyhole surgery. This is called a laparoscopic prostatectomy. Five or six small cuts are made in the navel and the lower abdomen area. A small telescope with a camera attached and other medical instruments are passed through the holes to allow the surgeon to see inside the abdomen.

The doctor may need the help of a robotic arm during the surgery to enhance accuracy. Compared with open surgery, keyhole surgery leaves a smaller scar, enables faster healing, means there is less chance of infection and requires a shorter hospital stay.

Transurethral Resection (TURP)

If the prostate cannot be removed due to the extent of the cancer, symptoms such as the need to urinate often can be relieved by removing blockages in the urinary tract. This operation is called a transurethral resection of the prostate (TURP). It is often used for those with late-stage prostate cancer or those for whom the removal of the entire prostate gland is not an option.

It is usually done under general anesthetic or a spinal anesthetic.

A telescope-like instrument is passed through the opening in the penis and up the urethra to remove the blockage.

Always talk through the details of any surgery and raise any questions or concerns with your doctor. Your consent is required before any surgery or medical procedure can be performed.

After the surgery
After the surgery, the medical staff caring for you will encourage you to move about within 24 hours of the surgery. After a transurethral resection, you may need to take fluids intravenously until you are able to drink by yourself. A catheter will be inserted into your bladder for the removal of urine.

You should be able to return home three or four days after surgery. Before leaving hospital, a nurse may show you how to take care of the catheter. If needed, a community nurse can be arranged to visit your home. If you have any questions, talk with your doctor. In the first few days following surgery, you may feel somewhat uncomfortable or experience pain and so may consider taking pain-killers. If the dose is not sufficient, inform the medical professionals treating you.

A social worker can provide emotional support to you and your family. You can ask your doctor or nurse to meet for a referral to a social worker. Before leaving hospital,  a follow-up appointment will be arranged with you.

To slow the growth rate of cancer cells, the doctor may consider removing the testicles to reduce the levels of testosterone in your body. In this surgical procedure a small cut is made in the scrotum. Most men can return home on the same day as the surgery. 
The side effects of this surgery can include hot flushes or problems with achieving an erection. After removing the testicles, you may consider having artificial balls implanted to maintain the form of the scrotum. 
Hormone therapy can be used in place of surgery to remove the testicles however; it can have the same side effects as surgery.

2. Radiotherapy

Radiotherapy uses beams of radiation to kill cancer cells while at the same time aiming to leave normal cells unaffected. External beam radiotherapy is most commonly used to treat prostate cancer, although in some cases internal radiotherapy is used.

External beam radiotherapy

External beam radiotherapy is carried out in the radiotherapy department of a hospital. The course of treatment may last for a few weeks, with the length of the course dependent on:

  • The type of cancer
  • The size of the cancer cells
  • Whether or not it has spread

Before you undergo radiotherapy, the doctor will discuss a treatment plan with you.
When you arrive for treatment for the first time, x-rays will be taken of the area to be treated. Sometimes, a CT scan is also taken. More x-rays and scans may be taken as treatment progresses.

A medical professional will mark on your skin where the radiotherapy beam is to be targeted. During the course of treatment, you need to make sure the marks are clearly visible. After the treatment, you may wash them away.
Sometimes the doctor may ask you if a few permanent marks may be made on your skin. When your treatment begins, the medical staff will teach you how to take care of your skin.
Each time before undergoing radiotherapy, the technician will ensure you are placed correctly and comfortably. The radiotherapy process takes only a few minutes, during which you have to remain still, and is not painful.

Side effects

Radiotherapy can cause side effects such as nausea or fatigue. Most conditions are mild, depending on the strength of the radiotherapy and the area targeted. Radiotherapy for the prostate gland usually affects the bowel and bladder. You may feel a need to urinate more often than before. It may also be painful when urinating. When your course of radiotherapy is about to be completed, and for a few weeks after, you may suffer from diarrhoea. If this is the case, taking anti-diarrhoeal drugs, not eating too much at meal times, and avoiding high-fibre foods such as fruit and vegetables may help.

Before you use any skin-care products, seek advice from the radiotherapy technician. Avoid using creams or lotions. If necessary, the doctor will prescribe something to help moisturise your skin and to relieve pain. During treatment, you may get tired easily and go to the toilet frequently at night, so rest as much as you can.

Radiotherapy may cause urinary leakage or make it difficult to get an erection. However, the risks are not as high as from surgery. Before radiotherapy, your doctor will discuss the possible side effects with you. It is wise to prepare a list of questions before visiting the hospital. You may wish to ask a relative or a friend to go with you.

Most side effects will disappear after the treatment finishes. However, in some cases the side effects continue for a few months or even longer.

Radiotherapy does not make you radioactive, so your family and friends are not at risk.


Brachytherapy is not often used to treat prostate cancer. It is a type of internal radiotherapy in which the radiation source is placed directly within the tumour. This allows high doses of radiation to be given with minimal effect on nearby tissues.

Radiotherapy aimed at reducing bone pain

If prostate cancer cells have spread to the bones around the prostate, radiotherapy may be used around the area to help relieve the pain. Some people feel better after two or three days, while for others it takes three to four weeks. If necessary, you can consider taking pain-killers.

This can be a one-time, high-dose form of radiotherapy, or low dose with multiple sessions. The technician will discuss with you the possible side effects before treatment.

3. Hormone Treatment

The growth rate of prostate cancer cells is related to the levels of the male hormone testosterone. Reducing the amount of testosterone can help slow the growth rate of the cancer cells.

The two main ways of reducing testosterone are through surgery and medication. Hormone injections, or medication, are often used in place of surgery to remove the testicles.

A common form of treatment is an injection under the skin, usually in the tummy area, of drugs (such as leuprorelin, diphereline, degarelix) to block the production of testosterone in the testicles.

During the injection, the doctor may request you to take antiandrogens such as flutamide or bicalutamide.

The injections are usually given every one, three, or six months.
One of the side effects of hormone therapy is difficulty in getting an erection. This usually continues throughout the period of treatment and improves once it has been completed. Undergoing hormone therapy for a long period of time may increase your risk of osteoporosis. Your doctor can advise you about this if it is seen as an issue.


Chemotherapy uses drugs to destroy cancer cells. Although used widely to treat cancers, it is  usually only used to treat prostate cancer if the cancer has spread. Your doctor can advise you about using chemotherapy in your treatment.


  • After treatment, you will have to have regular check-ups at the hospital to monitor your blood, PSA level, and radiation levels.
  • Your PSA level should return to normal soon after your prostate gland has been removed.
  • After radiotherapy, your PSA level should decline gradually. It may take one or two years to return to a normal level.
  • Your doctor will recommend a check-up schedule for you based on the results of tests following your treatment.
  • If you experience any problems, always inform your doctor.

What if the prostate cancer comes back?

If your PSA level starts to rise after treatment, it may indicate that you still have cancer cells in that area. If this happens, you may be given more treatment.


If the cancer has spread beyond the prostate area, hormone treatment may be an option. Your doctor will take your previous treatment into consideration before deciding which treatment is best suited for you.