Prostate cancer diagnosis 

by Professor Caroline Moore Consultant Urologist

University College Hospital London, NHS Trust

 

The ‘gold standard’ for diagnosis is a 3T multiparametric MRI (mpMRI) and a Trans-Perineal Biopsy. In the past couple of years this has replaced the TRUS Biopsy.

 

The MRI scan

Non-invasive mpMRI scans and reports provide a picture of potential cancer lesions. For about a third of patients the mpMRI shows the chance of significant disease is so low that no further investigation is required.

Whilst 3T MRI provides the best quality image, only a few centres have these machines. A 1.5T MRI is acceptable as long as it conforms to the Consensus Paper standard, which covers the protocols and reporting of the mpMRI scan. Later sections provide more information on the mpMRI and Trans-Perineal biopsy as well as hospitals, clinics, and surgeons that use this standard.

 

Trans-Perineal Biopsy

If the scan indicates the specific areas of concern, then under the PROMIS standard, the consultant will proceed with a Trans-Perineal Biopsy (except in limited circumstances). The section on Trans- Perineal Biopsies explains the different techniques used. This biopsy technique normally involves a general anaesthetic (although some are done with local blocks), the legs are put in stirrups, and the biopsy is taken through the perineum (between the scrotum and the rectum). There are a number of benefits of this technique. The area is “clean” – which is not true of a Trans-Rectal Biopsy – so reducing the chances of infection; it allows for accurate testing of the anterior region of the prostate where 25-30% of tumours occur, (which can only be reached with the greatest difficulty through the rectum), and it allows the consultant to take as many or as few biopsy cores as they feel is necessary – which is not possible via the rectal approach.

 

Prostate Cancer Treatment options

For all patients diagnosed with prostate cancer there will be a multi-disciplinary team meeting (MDM). The Consultants (urology, radiology, pathology, and oncology) meet together to discuss and manage an individual patient’s diagnostic and treatment pathway so that the treatment options proposed are the most appropriate for that patient.

If cancer is detected by the biopsy, the severity can be accurately described. The detected cancer areas may be small and not that advanced and so don’t require treatment. In this case the best course of action is Active Surveillance, that is keeping an eye on the detected areas through repeating the mpMRI , as well as monitoring the PSA level.

If treatment is required there are a wide range of options – Focal Treatment which treats part of the prostate, by High Intensity Frequency Ultrasound (HIFU) or freezing the tumour via Cryotherapy.  Radical Treatment involves treating the whole gland and could involve removing the prostate surgically. Other radical treatments include irradiating the gland via External Beam Radiotherapy (EBRT) or by Brachytherapy, which uses radioactive seeds.

You may be recommended for a course of Hormone Treatment which is used to shrink the size of the prostate, prior to treatment.

 

If you have recently received a worrying PSA test result then the sections on where to access high quality diagnostics, and state of the art treatments should be consulted.

  • Watch a Video of Prostate Diagnostics
  • Watch a Video of MR Fusion
  • See example prostate cancer diagnosis reports using TGB

 

MR scan
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Mr Neil Barber 
Consultant Urological Surgeon 
Frimley Health NHS Foundation Trust

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