How is Prostate Disease Diagnosed?
There are certain medical institutes that recommend regular screening of healthy men over the age of 50, or earlier for men with identified high-risk factors, as early prognosis is crucial in a more positive outcome.
- Digital Rectal Examination
- Prostate Specific Antigen Test
If these tests yield abnormal results, to confirm malignancy and its stage the doctor any of the tests listed below:
- Prostate MRI
- Prostate Biopsy
- Cystoscopy
- Urinary Flow or Urodynamic Testing
- Other Imaging Tests
Initial Consultation
Your doctor will review the history of yoursymptoms,family history, as well as other pre-existing disorders.
Digital Rectal Examination (DRE)
The bladder is the organ that stores urine and the urethra is the tube that drains urine out through the penis. The prostate lies immediately beneath the bladder and surrounds the urethra and lies immediately in front of the rectum (back passage).
Your doctor will perform a digital rectal examination (DRE) (examination via the back passage) of the prostate, an otherwise inaccessible internal organ.
During a digital rectal examination, your doctor inserts a gloved finger into the rectum to feel the condition of the prostate that lies close to the rectal wall. If your doctor feels something suspicious such as a lump or bump, further tests will be carried out.
Age-related enlargement is not a particular concern but if the gland feels abnormally firm or hard, it may sometimes be an indication of abnormal growth in the prostate gland.
Your doctor will discuss the test results with you. If anything suspicious is detected such as a lump or irregularity during the exam, further tests may be required.
After the test, you may continue your normal activities.
Prostate-Specific Antigen - PSA Test
Prostate specific antigen is a substance produced almost exclusively in the prostate and plays a role in fertility.
The vast majority is actually released into the ejaculate but tiny amounts are released into the bloodstream and can be detected by a simple blood test. Abnormally high levels of PSA can be an indication of disease of the prostate.
Common reasons for a high PSA level in the bloodstream may include
- Prostate cancer,
- Large prostates, and
- Age-related inflammation of the prostate or infection of the prostate.
Obviously, the first concern is to exclude prostate cancer.
If your PSA level is elevated, MRI or biopsy may be recommended.
Magnetic Resonance Imaging
Prostate MRI
Multi-parametric prostate MRI (mpMRI) is a new technique available to men.
The test assists in the diagnosis of prostate cancer. Read More
Abdominal/Pelvic MRI
Magnetic resonance imaging (MRI) is a non-invasive imaging technique. This test is similar to a CT scan but uses magnetism instead of X-rays to build up cross-sectional pictures of your body.
It is used to view organs, soft-tissue, bone, and other internal body structures.
In an abdominal MRI, the person's body is exposed to radio waves while in a magnetic field. Cross-sectional pictures of the abdomen are produced by energy emitted from hydrogen atoms in the body's cells.
MRI Fusion Biopsy
is a new technique that is also proving useful for accurate diagnosis.
An individual is not exposed to harmful radiation during this test.
Prostate Biopsy
This test is commonly performed because either a blood test called PSA is abnormally high or the Digital Rectal Examination (DRE) of the prostate is abnormal.
The test may also be performed to rule out prostate malignancy. Read More
Cystoscopy
Cystoscopy enables a urologist to directly view the inside of the urinary bladder and urethra in great detail using a "cystoscope" (the instrument used). There are two types of cystoscopes:
Rigid Cystoscope
This is a solid straight telescope and is used with a high-intensity light source. A separate channel allows other instruments to be attached.
Flexible Cystoscope
This is more commonly used, particularly for diagnosis and for post-op follow up examinations (e.g. bladder tumour removal). It is a fibre optic instrument that can bend easily and has a maneuverable tip that makes it easy to pass along the curves of the urethra.
This procedure may be carried out under general anaesthesia, although many doctors now use flexible instruments that allow the procedure to be done under a local anaesthetic on an outpatient basis.
Cystoscopy may be indicated for the following conditions:
- Frequent urinary tract infections
- Blood in your urine (haematuria)
- Loss of bladder control (incontinence) or overactive bladder
- Unusual cells found in a urine sample
- Need for a bladder catheter
- Painful urination, chronic pelvic pain, or interstitial cystitis
- Urinary blockages such as prostate enlargement, stricture, or narrowing of the urinary tract
- Stone in the urinary tract
- Unusual growth, polyp, tumour, or cancer
Urinary Flow Test
A urinary flow test also known as urinalysis is a test of your urine.
A urinalysis is used to detect and manage a wide range of disorders, such as:
- Urinary tract infections
- Prostatitis
- Kidney disease
A urinalysis involves checking:
- appearance,
- concentration and
- the content of urine
Urinalysis is used to determine the presence of leukocytes (white blood cells) in the urine. Leukocytes help the body to fight infection; a high number indicates a bacterial infection. A urine culture is used to analyse bacteria.
Urodynamic Testing
Urodynamics is a useful tool for determining if an enlarged prostate is to blame for lower urinary tract issues. Urodynamic assessment is a highly specialised and sophisticated method of making an accurate diagnosis of the cause of incontinence. Read More
Ultrasound
Ultrasound of the prostate uses sound waves to produce pictures of a man's prostate gland and to help diagnose symptoms such as difficulty urinating or an elevated blood test result.
Prostate ultrasound can also be used to:
- investigate a nodule found during a rectal exam
- detect abnormalities, and
- determine whether the gland is enlarged
Radiology
X-Rays
X-rays of the bones are often taken to check your general health and see if there has been any spread of cancer to other parts of the body.
Bone Scans
Your doctor may want to see if the disease or cancer has metastasised and has affected your bones.
A small amount of radioactive material is injected into your arm, abnormal bone absorbs more of the radioactive substance than normal bone and shows up on the scan as highlighted areas (known as 'hot spots').
You will then be scanned an hour later to view the activity of the bone and ascertain whether cancer has spread. The level of radioactivity that is used is very small and does not cause any harm.
This scan can also detect other conditions affecting the bones such as arthritis, so further tests such as an X-ray of the abnormal area may be necessary to confirm that it is cancer.
CT Scan
A CT Scan is an X-ray tube that rotates in a circle around the patient and takes a series of pictures as it rotates. The multiple X-ray pictures are reconstructed by a computer in axial slice images at different levels. Each level can be examined separately.
A CT scan may show if cancer has spread beyond the prostate to other parts of the body such as the lymph nodes.
The scan takes from 10-30 minutes. You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.
You will probably be able to go home as soon as the scan is over.
Nuclear Scans - Bone Scans / PSMA Scans
Your doctor may want to see if any cancer has metastasised and has affected your bones or other organs. A bone scan or a Gallium-68 PSMA scan may be ordered.
In these scans, a small amount of radioactive material is injected into your arm. The radioactive marker that binds to prostate cancer cells. It is combined with positron emission tomography (PET) and CT scanning technology
You will then be scanned an hour later to help identify areas where prostate cancer may have spread to.
Patients only need to present well hydrated and are not required to fast prior to the scan. They are given an injection approximately 45 minutes before the scan which then takes around 30 minutes.
Patients are generally in the radiology department for around 2½ hours in total.
This is a new scan and its accuracy is still being evaluated. As it is new, it is not yet covered by Medicare so patients should check the cost of the procedure with the radiology practice.
