Stages of prostate cancer risk

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Mr Alan Doherty
“These stages set out clearly the principles behind the way we manage prostate cancer at BPC. We want the most accurate picture possible to avoid unnecessary treatment. We need to act quickly for some patients. We want to know as much as possible about what sort of prostate cancer we are dealing with before surgery, so you are informed of all relevant options and can make meaningful decisions about treatment.”
Mr Alan Doherty, consultant urologist, Birmingham Prostate Clinic

The way we assess prostate cancer risk has been transformed by advanced new tests. This means we can build a more accurate picture of your individual prostate cancer risk, but avoid invasive tests such as a biopsy unless absolutely necessary. At BPC, we use clearly graded stages of assessments, so it is clear what tests are required at each level of the assessment pathway.

Stage 1

What? PSA test, Digital Rectal Examination (DRE) and discussion about whether there is a history of prostate cancer in your family.

Where? GP surgery.

  • If your PSA is above the threshold for your age.
  • If your PSA is rapidly rising, even if within threshold.
  • If your prostate feels hard or is difficult to assess during a digital rectal examination.
  • If you have troublesome urinary symptoms – having to get up to go to the toilet a lot at night or urgency.
  • If your father or brother has been diagnosed with prostate cancer, particularly if he was under the age of 60 at diagnosis.

Stage 2

What? The genetics based PCA3 test, DRE, transrectal ultrasound, ultrasensitive PSA and pre-biopsy MRI.

Where? Birmingham Prostate Clinic offers these extensive and advanced second stage tests.

All of these results together build the picture of your overall prostate cancer risk – not only whether cancer is likely to be present, but the likelihood of the cancer being clinically significant, with the age of the patient considered.


Stage 3

What? Biopsy.

Where? Birmingham Prostate Clinic or other secondary care

For about 80 per cent of patients, the standard TRUS biopsy, combined with all the other assessments, provides a clear picture of prostate cancer risk and informs treatment. However, a significant number of patients will have inconclusive biopsies, usually false negatives, when their assessments suggest moderate to high risk of cancer but the biopsy fails to find cancer. If this is the case for you, we would recommend a new type of biopsy undertaken at the next stage.


Stage 4

What? Mapping biopsy.

Where? Birmingham Prostate Clinic and a small number of specialist urology centres in the UK.

Mapping biopsies are based on a MRI-guided template of the prostate (using the same principles as the template which is used to plan and treat men using brachytherapy). This approach provides a much higher degree of accuracy and assurance that if cancer is present, it will be found. It is particularly helpful for men with cancer on the anterior of their prostate. Studies also suggest that template biopsies provide greater accuracy of staging the prostate cancer.