Being diagnosed with advanced prostate cancer

If you have been diagnosed with early or locally advanced prostate cancer you may be having regular blood tests and check-ups. If you have any new symptoms your doctor will suggest tests such as a PSA test and a bone scan. These are to see if the cancer has spread. You may have a biopsy of the prostate gland.

Sometimes advanced prostate cancer is found following tests to find a cause of bone pain. The bones are the most common place for prostate cancer to spread to. Your doctor may suggest you have a bone scan.

Depending on your symptoms, other tests you may have include:

  • x-ray
  • MRI (magnetic resonance imaging) scan – this uses magnetism to build up a picture of your body.
  • CT (computerised tomography) scan – this uses x-rays to build up a three-dimensional picture of the inside of your body.

Waiting for test results can be difficult. It helps to talk to someone close to you about your worries.

How advanced prostate cancer is diagnosed

If you have previously been diagnosed with early or locally advanced prostate cancer, you may be attending the hospital or your GP for regular check-ups and blood tests. If you develop new symptoms, you will have tests to see if the cancer has spread. These will usually include a PSA test and a bone scan. Other tests will depend on your symptoms.

Some men are found to have advanced prostate cancer after being investigated for bone pain. If you have bone pain, but no other symptoms, your GP may first arrange for you to have an x-ray or scan of the painful area. The scans you may have include a bone scan, CT scan or MRI scan.

If these suggest a secondary cancer in the bones, you will have further tests to find out where the cancer started.

You can read more about tests for early prostate cancer and locally-advanced prostate cancer.

The following tests may be done to help diagnose advanced prostate cancer:

PSA test

A sample of blood is taken to check for PSA (prostate-specific antigen). PSA is a protein produced by the prostate and a small amount is normally found in the blood. Men with cancer of the prostate tend to have more PSA in their blood.

In most men with advanced prostate cancer, the PSA level will usually be high, although this is not always the case. Once the cancer has been treated, the PSA level is likely to fall. Measuring the PSA levels can help to assess the cancer and see how well treatment is working.


Biopsy

Depending on your situation, you may be offered a biopsy. This is when several small samples of tissue (usually around 10–12) are taken from the prostate to be looked at under a microscope.

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, treatment may start without having a biopsy. Your doctor may also decide not to do a biopsy if you’re very ill or have certain medical conditions.

Sometimes the biopsy samples will be taken from an area that the prostate cancer has spread to, rather than from the prostate gland itself. If this is the case, your doctor will explain this to you.

Having a prostate biopsy

To take a biopsy, the doctor will pass a needle through the wall of the back passage (rectum) into the prostate. They will use an ultrasound scan to guide them to the exact area where the biopsies will be taken.

Ultrasound scans use sound waves to build up pictures of inside the body. To scan the prostate gland, the doctor passes a small probe into the back passage and an image of the prostate appears on a screen. Sometimes, an MRI scan is used instead of an ultrasound.

Having a biopsy is often uncomfortable and can sometimes be painful. Your doctor will give you a local anaesthetic to numb the area and reduce any discomfort. You may also be given antibiotics to reduce the risk of infection.

It’s important to drink plenty of fluids (about two litres, or three and a half pints) for 24 hours after this test. For a few weeks afterwards, you may notice blood in your semen, urine and after opening your bowels. If these symptoms persist, speak to your doctor or specialist nurse.


Bone scan

The bone is the most common place for prostate cancer to spread to. A bone scan can show abnormal areas of bone.


X-rays

You may have a chest x-ray and x-rays of the bones to check your general health. You may also have x-rays to see if the cancer has spread to other parts of the body.


MRI scan

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, such as a pacemaker, surgical clips, bone pins, etc. 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

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.

CT scan
CT scan

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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 test results

Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready. You may find it helpful to talk with your partner, family or a close friend. Your specialist nurse or one of the organisations listed on our database, can also provide support. You can also talk things over with one of our cancer support specialists on 0808 808 00 00.