Further tests for prostate cancer
If the biopsy shows that a cancer is present, further tests may be needed to check whether the disease has spread beyond the prostate gland. These may include the following.
You might be offered a biopsy. This is when several small samples of tissue (usually around 10) are taken from the prostate to be looked at under a microscope.
However, some men with advanced prostate cancer may have a very high PSA or their scan results may show that the cancer has spread. In this case, they may start treatment without having a biopsy. Your doctor may also decide not to do a biopsy if you’re very ill or have certain other medical conditions.
During the procedure, a needle is passed through the wall of the back passage (rectum) and into the prostate. This test is often uncomfortable and can sometimes be painful. You may be given a local anaesthetic to reduce the discomfort. Antibiotics are also given to reduce the risk of infection.
It’s important to drink plenty of fluids for 24 hours after this test. For up to a few weeks afterwards, you may notice blood in your semen during sex. You may also experience a small amount of blood in your urine or when opening your bowels. If these symptoms persist, speak to your doctor.
The most common place for prostate cancer to spread to is to the bones. A bone scan can show abnormal areas of bone.
A very small amount of a mildly radioactive liquid is injected into a vein, usually in your arm. A scan is then taken of the whole body. Abnormal bone absorbs more of the radioactive substance than normal bone and shows up on the scan as highlighted areas called hot spots.
After the injection you’ll have to wait for up to three hours before the scan can be taken, so it’s a good idea to take a book or magazine with you.
The level of radioactivity that is used is very small and doesn’t cause any harm. However, you may be asked to avoid long periods of close contact with pregnant women or children for 2-3 days after the scan. The staff at the hospital will tell you more about this.
This scan can also detect other conditions affecting the bones such as arthritis. This means that further tests, such as an x-ray of the abnormal area, may be necessary to confirm that it is cancer.
X-rays of the chest and bones are sometimes taken to check your general health and to see if the cancer has spread to other parts of the body.
MRI (magnetic resonance imaging) scan
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This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it’s safe for you. The checklist asks about any metal implants you may have, for example a pacemaker, surgical clips or bone pins. You should also tell your doctor if you’ve ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, it’s likely that you won’t be able to have an MRI scan. In this situation, another type of scan can be used.
Before the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn’t usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly.
During the test you’ll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It’s also noisy, but you’ll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.
CT (computerised tomography) scan
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A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10-30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.
You’ll probably be able to go home as soon as the scan is over.
Waiting for your test results
It will probably take several days to a couple of weeks for the results of your tests to be ready. The results of the tests will show the grade and stage of the cancer. This information will be used by a team of doctors and nurses, known as the multidisciplinary team or MDT, to decide on the most appropriate treatment.
Waiting for results can be a difficult time. It may help to talk things over with a friend or relative. You can also contact one of our cancer support specialists.