Diagnosing advanced prostate cancer

If you have previously 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.

Some men may have prostate cancer that is advanced when it is first diagnosed. 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.

Other tests you may have depend on your symptoms and whether you were previously diagnosed with early or locally advanced prostate cancer. The may include:

  • biopsy of the prostate gland
  • 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

How you are diagnosed with advanced prostate cancer will depend on your situation. It may be:

  • after previous treatment for early or locally advanced prostate cancer – possibly many years ago
  • after being diagnosed with cancer in the prostate, if further tests show the cancer is advanced
  • after tests to check symptoms of bone pain, with no previous diagnosis of prostate cancer.

The most common places for prostate cancer to spread to is to the bones and lymph nodes outside the pelvis. It rarely spreads to areas such as the lungs or liver.


Tests

Your doctor or specialist nurse will explain the tests that are best for your situation. You may not need all the tests we mention here. If you have had prostate cancer before and have symptoms, you will have tests to see if the cancer has spread. These usually include a PSA test and bone scan.

If you have just been diagnosed with prostate cancer, you will have further tests to see if the cancer is advanced. These include a bone scan, CT scan, or MRI scan.

If you were diagnosed with secondary cancer in the bones, you will need tests to find out if it started in the prostate. These include a PSA test.

PSA test

Your doctors will take a blood sample to check the level of PSA (prostate-specific antigen) in your blood. PSA is a protein produced by the prostate. There is normally a small amount of PSA in the blood. Men with prostate cancer tend to have a raised level of PSA. But the test is not always reliable. PSA levels get higher as men get older. Different things can raise PSA levels. But most men with advanced prostate cancer will have a very high PSA level.

If you have had prostate cancer before, you will have had regular blood tests to check your PSA levels.

Biopsy

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

If you have a very high PSA or scans show the cancer has spread, you may not need a biopsy.

Some men have a biopsy from the area of the secondary cancer. This is to find out if it is a cancer and what type it is. This is only usually if you have not been diagnosed with prostate cancer before.

X-rays

You may have x-rays of the bones in a painful area to find out if there are any abnormal areas.

Bone scan

This test can usually tell if the cancer has spread to the bones. The person doing the scan gives you a radioactive substance as an injection into a vein. After you have the injection, you will need to wait 2 to 3 hours before you have the scan. The person will then use a special camera to take a scan of your bones.

MRI (magnetic resonance imaging) scan

This scan uses magnetism to build up a detailed picture of areas of the body. You may have an injection of dye into a vein to improve the images from the scan. It can be used to look at the prostate and different parts of the body to see if the cancer has spread.

Some men may have an MRI scan before they have a biopsy. Specialised scans called multi-parametric MRI scans can give doctors more detailed images of the body. These images give more information about a suspected area of cancer. Depending on the results of the scan, your doctor may explain that you do not need a biopsy.

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.

Having tests for cancer

GP David Plume explains what to expect if you're referred by your GP for tests for cancer. He also talks about what happens if your results do show you have cancer.

About our cancer information videos

Having tests for cancer

GP David Plume explains what to expect if you're referred by your GP for tests for cancer. He also talks about what happens if your results do show you have cancer.

About our cancer information videos


Waiting for your 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. Your doctor will tell you the results and talk to you about the best treatment for your situation. Most prostate cancers grow very slowly. Even if it takes a couple of weeks to get your results, it is unlikely that the cancer will change during this time.

People have different support networks. Whether yours is your family, your partner, a friend, or a social group, try to talk to someone you trust about how you are feeling.

If you feel you have no one to talk to, you can call our cancer support specialists on 0808 808 00 00, or visit our Online Community, where you can speak to other people who understand.

My husband has advanced prostate cancer. Waiting for results can be horrible. But people in Macmillan's Online Community are wonderful. I had so much help from the Prostate Cancer group.

Carole

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