Prostate cancer assessments step-by-step

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.

Step 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.

Step 2

What? Ultrasensitive PSA, urologist DRE and enhanced multi-parametric MRI scan.

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.


Step 3

What? Template-guided biopsy, either a whole prostate or targeted approach.

Where? Birmingham Prostate Clinic or other secondary care

At this stage, the results of your multi-parametric MRI will have provided a precise, reliable assessment that you have prostate cancer and where it is located. We may use a whole prostate template-guided biopsy, or if we may choose a focused approach, concentrated on specific parts of the prostate if this is most clinically appropriate.

“These steps 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