Further tests

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Interactive illustration of the TRUS with biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. procedure

PCA3 test

Prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. geneThe basic unit of genetic material carried on chromosomes. 3 (PCA3) is a new geneThe basic unit of genetic material carried on chromosomes.-based test carried out on a urine sample produced immediately after massage of the prostate during a DREDigital rectal examination, physical examination that involves inserting a finger into the patient’s rectum, their back passage.. This process helps to release PCA3 into the urine.

PCA3 is highly specific to prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. and therefore not increased by conditions such as benign enlargement or inflammationThe body’s response to injury. of the prostate. This means that the PCA3 urine test could improve the diagnosisThe process of determining which condition a patient may have. of prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. by reducing the number of unnecessary biopsies.

The test is particularly useful in those men who experience repeated biopsies because their levels of PSA remain high but no clear results emerge from the biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself..

Prostatic massage is not painful though it may be physically and emotionally uncomfortable for the patient.

The PCA3 test is available in European countries such as Belgium, France, Germany and the Netherlands, where different laboratories are certified to perform the test. In the UK the test is not available from state-funded care but can be done privately. No PCA3 test has been approved by the US Food and Drug Administration.

The PCA3 test was first developed by the team of Professor Schalken at Radboud University in Nijmegen, the Netherlands. An interview with Professor Schalken is available at Urology Week's website here.

Transrectal ultrasound (TRUS) with biopsy

In this procedure, a small lubricated ultrasound probe is inserted into your rectum. This test is usually performed by your urologist or another specialist called a radiologist. A nurse will also be present.

The probe uses high-frequency sound waves to look at the prostate glandAn organ with the ability to make and secrete certain fluids. and can be used to measure its size and density.

The images of the prostate are shown on a television monitor. The operator can see if the prostate is blocking the bladderThe organ that stores urine. or the urethra. They also show whether you have any urine left in your bladderThe organ that stores urine. after you have urinated.

TRUS is also used to improve the accuracy of taking a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. of the prostate. This is normally done at the same time as having the TRUS scan.


Interactive illustration of the TRUS with biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. procedure

The urologist uses the ultrasound to guide the biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. needle through the probe and into the prostate glandAn organ with the ability to make and secrete certain fluids.. A number of samples will be taken (up to 12).

The samples are sent to a laboratory where they are checked by a pathologist who will send a report back to the urologist.

Things to know about a having a biopsy

  • This test is uncomfortable and can be painful
  • The probe is the size of a fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body. finger, and you may feel each biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. being taken as a sharp pressure
  • You can ask for an injection of local anaestheticA medication that reduces sensation in a part of the body. if you wish
  • The test should take about 30 minutes, and you can go home afterwards
  • You will be given antibioticsMedication to treat infections caused by microbes (organisms that can't be seen with the naked eye), such as bacteria. to take just before the biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself., either by injection or as tablets
  • After the biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself., you may be given a suppository antibiotic (inserted into your rectum) and tablets to take at home for a few days afterwards
  • This is to reduce the risk of infectionInvasion by organisms that may be harmful, for example bacteria or parasites.
  • It is normal to see a bit of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. in the urine after a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself.
  • You will be advised to rest after the test, and to drink a lot of fluids to help flush out the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. in the urine and any infectionInvasion by organisms that may be harmful, for example bacteria or parasites.
  • You should be told how long it will take to get the results back
  • You will have to give your written consent for this procedure.

After your biopsy

The hospital should give you information about what you need to look out for after a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself.. If you have any of the following problems, you should seek medical advice immediately:

  • Great difficulty in passing urine
  • A large amount of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. in the urine or bowel movements
  • The urge to pass urine very frequently
  • A high temperature
  • Pain when you urinate.

These types of problems affect around one per cent of men after a prostate biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself..

The biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. results showed a GleasonA system used to assess the extent of abnormality of prostate cancer cells. score of 6, indicating moderately aggressive cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. In some ways I was happy that a cause had been found - we knew what we were dealing with

Bryan

What do the biopsy results mean?

The pathologist's report will tell your specialist the following:

  • If there are signs of prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • How many of the biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. samples include cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. cells
  • How many cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells are in each sample
  • How quickly the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. may be growing (slow, moderately aggressive or aggressive).

It is important that your doctor or specialist discusses the results with you in detail.

If there are no signs of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., this does not necessarily mean that there is no cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. in the prostate. A biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. can miss cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. in five to ten per cent of men tested. Your doctor will continue to monitor you using DREDigital rectal examination, physical examination that involves inserting a finger into the patient’s rectum, their back passage. and PSA tests and may decide to repeat a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. test if these still cause concern.

If there are signs of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., the cells in the biopsies will be graded and staged so that you and your doctors will be able to decide what to do next.

CT scan

Computerised tomography (CTA scan that generates a series of cross-sectional X-ray images.) takes X-rayA type of electromagnetic radiation used to produce images of the body. images of your body in thin sections, and creates a 3D image from them. These detailed pictures, often referred to as CAT scans, can create detailed pictures of the lymph nodesSmall swellings along the lymphatic system that filter lymph, a fluid derived from the blood, and produce antibodies and a type of white blood cells, lymphocytes. and the area around the prostate.

To prepare for a CTA scan that generates a series of cross-sectional X-ray images. scan, you will be asked not to eat or drink for a few hours before you are scanned.

When you arrive for the scan, you will be given a drink or injection of dye (this is called contrast mediumA substance taken (either by mouth or into a vein) by a person who is about to undergo an imaging investigation, to improve the visibility of the structures being imaged.). This is harmless, and helps the specialist to see the prostate on the scan.

For the scan, you will be asked to lie on a table that will then move through the scanner. You may have to lie still for 10-20 minutes because of the number of images being taken. If you have difficulty keeping still, feel claustrophobic inside the scanner or are in chronicA disease of long duration generally involving slow changes. pain, the technician can give you a mild sedative. You can talk to them at any time during the procedure.

MRI scan

Magnetic resonance imaging (MRIAn abbreviation for magnetic resonance imaging, a technique for imaging the body that uses electromagnetic waves and a strong magnetic field.) uses powerful magnets and radio waves to create an image of your organs. The magnetic field lines up hydrogen atomsThe smallest units of an element. in the body and the radio waves bounce off these atomsThe smallest units of an element. to create an image in the computer. It is much better than X-rays for examining soft tissue because it is able to distinguish healthy tissue from cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. tissue. Because MRIAn abbreviation for magnetic resonance imaging, a technique for imaging the body that uses electromagnetic waves and a strong magnetic field. uses magnets, the body is not exposed to radiation.

Although completely painless, an MRIAn abbreviation for magnetic resonance imaging, a technique for imaging the body that uses electromagnetic waves and a strong magnetic field. scan can be noisy or cause you to feel claustrophobic. As with the CTA scan that generates a series of cross-sectional X-ray images. scan, the technician will be in constant contact and monitoring your vital signs. The scan will last for about 30 minutes. During this time, you may be able to listen to music through headphones or even watch television.

X-rays

X-rays, which use radiation to look inside the body, are used to see if the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. has spread from your prostate.

Bone scan

Prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. can spread to other parts of the body (metastasise) although it is most likely to be found in the bones. You may therefore have another diagnostic test called a bone scanAn imaging test that uses radioactive substances to evaluate the whole musculoskeletal system..

A bone scanAn imaging test that uses radioactive substances to evaluate the whole musculoskeletal system. is carried out in a hospital and is safe and painless. You should be given plenty of information about what to expect before your appointment.

For prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., your whole body will be scanned. About four hours before the scan you will receive an injection of a harmless amount of radioactive substance. This will then have time to circulate in your bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. before you are asked to lie down on a scanning couch. You will then be scanned by a camera, called a gamma cameraA camera that detects gamma rays given off by some radioactive substances.. The camera will show hot spots or possible signs of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., although it will also show signs of other damage to bones, such as fractures and conditions such as arthritisInflammation of one or more joints of the body..

This should take about an hour, and you are free to go home afterwards.