Prostate Investigations

You are reading this information sheet because your General Practitioner is worried you may

have prostate cancer. This is either because you have worrying symptoms, an abnormal digital rectal examination, or a prostate blood test (PSA) above the normal range.

Yes.

If your PSA blood test is over 20, you may need to attend for a bone scan. 

A bone scan uses radioactivity to identify possible prostate cancer spread to the bones. The procedure takes up to 4 hours and involves an injection of a radioactive material into a vein. A scan is then performed to identify ‘hot spots’ in the skeleton which may indicate areas of metastases.

Following the bone scan, you will receive an outpatient appointment at Nottingham City Hospital, which will take place urgently . This appointment is the first in a sequence of appointments on an accelerated cancer diagnosis pathway. It is very important that you are available to attend appointments over the next 8 weeks as a failure to do so may lead to a delay in diagnosis and treatment. If you have holidays planned in the next 8 weeks you should discuss this with prostate assessment team on the numbers at the end of this information sheet.

You will be given the results of the bone scan by a member of our prostate cancer assessment team who will explain the results, and discuss the need for any further investigations or treatment. 

We aim to provide the best possible service and staff will be happy to answer any of the questions you may have. If you have any suggestions or comments about your visit, please either speak to a member of staff directly or contact the patient advice and liaison service.

(PALS) on 0800 183 0204 or 07812 270 003. You can also email PALS at pals@nuh.nhs.uk or write to NUH NHS Trust, C/O PALS, Freepost NEA 14614, Nottingham, NG7 1BR. The PALS team will listen to your concerns, suggestions or queries and are often able to help solve problems on your behalf.

Prostate Cancer UK

Provides support and information for men with prostate cancer.

0800 074 8383

www.prostatecanceruk.org

Macmillan Cancer Support

Provides specialist health care, information and financial support to people affected by

cancer.

0808 808 0000

www.macmillan.org.uk

 

Contact details:

Prostate Cancer Assessment Pathway Team

0115 9691169 ext. 79948/74082

Urgent Urology Advice Line (24 hours a day, 7 days a week)

0115 8404715

You are reading this information sheet because your General Practitioner is worried you may have prostate cancer. This is either because you have worrying symptoms, an abnormal digital rectal examination, or a prostate blood test (PSA) above the normal range. 

Yes. 

In most cases you will need to attend for an MRI scan, and you will be contacted directly by the X-Ray department with an appointment. A magnetic resonance imaging (MRI) scan uses magnetic waves to identify suspicious areas of the prostate that might be cancer. It does not use x-rays or radiation and takes approximately 30-45 minutes to perform.

To get the best possible MRI images you may receive an injection of a contrast agent into a vein, usually in the back of your hand. Please note that MRI scans cannot normally be performed if you have a cardiac pacemaker, a metal heart valve, a cochlear implant, a brain aneurysm clip, or have had surgery to implant metalwork in the last 3 months. If this is the case, or if you have an allergy to intravenous contrast agents, please contact the Prostate Cancer Assessment Pathway Team using the telephone number at the end of this information sheet. 

If your PSA blood test is very elevated you may need to attend for a bone scan. A bone scan uses radioactivity to identify possible prostate cancer spread to the bones. The procedure takes up to 4 hours and involves taking a small sample of blood which is mixed with a radioactive tracer and injected back into a vein. A scan is then performed to identify ‘hot spots’ in the skeleton which may indicate areas of prostate cancer. 

Following referral you will receive an outpatient appointment at Nottingham City Hospital, which will take place urgently and may be face to face or by telephone. This appointment is the first in a sequence of appointments on an accelerated cancer diagnosis pathway. It is very important that you are available to attend appointments over the next 8 weeks as a failure to do so may lead to a delay in diagnosis and treatment. If you have holidays planned in the next 8 weeks please contact the Prostate Cancer Assessment Pathway Team using the telephone number at the end of this information sheet.

You will be given the results of the MRI or bone scan scan by a member of our prostate cancer assessment team who will explain the results and discuss the need for further investigations or treatment. On average approximately 6 out of 10 men will have reassuring findings on an MRI scan and can be safely discharged without further tests. However 4 out of 10 men will have an abnormal MRI scan and require prostate tissue sampling, known as a prostate biopsy. It is very important to appreciate that an abnormal MRI scan does not necessarily mean that prostate cancer is present. In fact there are many men with abnormal MRI scans who have negative biopsies.  

You will be given an appointment for a local anaesthetic transperineal (LATP) prostate biopsy. Transperineal biopsies take approximately 20-30 minutes and are usually performed as an outpatient procedure. Appointments are scheduled throughout the day however and you should expect to be in the department for several hours. You can eat and drink as normal on the day of the procedure and you should take your regular medication, including aspirin.

Please note that prostate biopsies cannot be taken if you are on other blood thinning agents such as warfarin, rivaroxaban, apixaban and clopidogrel.

If this is the case, or if you are not sure, please contact the Prostate Cancer Assessment Team using the telephone number at the end of this information sheet. 

On arrival in the department you will be given a single antibiotic tablet to take and a gown to change into. You will then be asked to lie on your back on an examination couch with your legs supported in stirrups. Antiseptic solution and numbing cold spray are then applied to the skin between your anus and scrotum (perineum) and local anaesthetic injected into the skin. An ultrasound probe is then inserted into your rectum and used to guide local anaesthetic deeper into the skin to numb the prostate.

The local anaesthetic stings during this stage and is the most uncomfortable part of the procedure.

After a few minutes the skin and prostate go completely numb and although you will feel pushing due to the probe, you should not feel any more pain. The local anaesthetic takes approximately 5 minutes to work, after which biopsies are taken through the perineal skin. The prostate biopsies are taken with a device that contains a spring-loaded needle which rapidly removes a tissue sample You will hear the click of the ‘gun’ each time a biopsy is taken. Normally 8-12 biopsies are taken, after which the procedure is over. Sealant spray will be applied to the perineum and you will be allowed to get up from the couch. Additional dressings are not necessary. Once you have passed urine and the nurses are happy with your observations you will be able to go home.

Most men tolerate the procedure without problems and with only minimal side effects. Common and occasional side effects include: 

• Discomfort passing urine (most men for one to two days)
• Blood in urine (most men for two to three days)
• Blood in semen (most men for two to three months)
• Bruising of the skin between the scrotum and anus (occasional)
• Retention of urine (1 in 200 men)
• Urine infection (1 in 500 men)

We will give you an antibiotic prior to the procedure to reduce your risk of urine infection, but you will not require further antibiotics after the procedure. If you get burning when passing urine that lasts for more than two days, or you get shakes, night sweats or a fever, or if you cannot pass urine at all, please contact our urgent 24 hour urology advice line on (0115) 8404715.

If you require any further x-rays these will be booked at the time of your prostate biopsy. An appointment will then be made for you to see your Consultant or one of their team to discuss the results.

We aim to provide the best possible service and staff will be happy to answer any of the questions you may have. If you have any suggestions or comments about your visit, please either speak to a member of staff directly or contact the patient advice and liaison service (PALS) on 0800 183 0204 or 07812 270 003. You can also email PALS at pals@nuh.nhs.uk or write to NUH NHS Trust, C/O PALS, Freepost NEA 14614, Nottingham, NG7 1BR. The PALS team will listen to your concerns, suggestions or queries and are often able to help solve problems on your behalf.

Prostate Cancer UK

Provides support and information for men with prostate cancer.

0800 074 8383

www.prostatecanceruk.org

 

Macmillan Cancer Support

Provides specialist health care, information and financial support to people affected by cancer.

0808 808 0000 

www.macmillan.org.uk

 

Contact details

Prostate Cancer Assessment Pathway Team

0115 9691169 ext. 79948/74082

Urgent Urology Advice Line (24 hours a day, 7 days a week)

0115 8404715