How do they identify prostate cancer? Pt 1

As per my previous post, I am NOT a medical doctor and the below is just the experiences and musings of a random punter. If you have any doubt go and see a professional! 

Because prostate cancer does not necessarily show any symptoms it can be hard to initially pick up without a blood test. In my case my Dad was diagnosed with prostate cancer a few years ago and so I requested the blood test every year afterwards. My GP actually suggested it wasn't worth it this year and that biannual checks would be enough, and at times I'm still a bit regretful that I insisted.

The primary blood test for prostate cancer is the PSA test (Prostate Specific Antigen). This essentially picks up a byproduct of the cancer that is in your bloodstream. But it is very imprecise. It can be affected by ejaculation within 48 hours of the test, by riding bikes, by phsyical exertion and a host of other things. So the first thing to do if you have a high PSA reading is to not panic! Give it a few weeks, book another test and be a bit careful of what you do for a few days beforehand. 

If you have a consistently elevated PSA level then your GP will call you in for a chat and probably get a urologist involved, particularly if you have experienced LUTS. They may also suggest an ultrasound first. 

The ultrasound is an uncomfortable appointment that you need to attend with a full bladder - always tricky if your urination is already disrupted! You have a scan with your bladder full, go to the toilet (sweet sweet blessed toilet) & empty your bladder as best you can and they rescan to assess how much fluid is left. In my case I needed to go twice because after my first return there was still about a quarter of the volume left, reducing to a fifth after the second time. This was a sign that something was up as I should have been able to empty the bladder in one go.    

The urologist is potentially the start of a longer journey so it's worth making sure you find a good one. It's like tattoo artists - get the best that you can afford, not the cheapest you can find. They will have a chat about symptoms, review your ultrasound and then carry out the dreaded Digitial Rectal Exam (DRE). This is initially a little unnerving but not too bad - and then they twitch their finger round. There are any number of jokes around this procedure but best to not tell them to your urologist as they will have heard them before, will be tired of hearing then and will have their finger up your bum. 

The DRE will generally pick up any cancers at the back of the prostate as the surface apparently feels different. But even if the DRE comes up clear (which was the case with me) you will probably be sent for a MRI (Magnetic Resonance Imaging)  scan just to be sure. The MRI scanner is a very cool piece of kit  - the whole room has a strong magnetic field which sets the spin of your atoms in a particular way, and then the MRI machine disrupts the spin of the atoms and records the energies that are put out when the spin returns to the pre-established norm. The energies put out are different for different types of matter and so by recording and aggregating the different energies out out by different regions they can stitch together an 'inside view' of the shape of your innards (in case you are wondering that only barely makes sense to me, but it is still very cool tech!). In reality the procedure is a little claustrophobic at first and suprisingly loud, but it only lasts for 30 mins or so and with some deep breathing I managed to doze off midway through. 

The output of the MRI scan will show the shape of your prostate. Any enlargements or irregularities can then be seen and if necessary followed up with a biopsy, which was necessary for me due to some enlargement in the anterior (front) region that couldn't have been detected by the DRE. I'll describe the biopsy in my next post. 


   


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