The following tests are used to detect prostate cancer
Prostate cancer is diagnosed with the help of a PSA blood test, a rectal examination, an ultrasound scan and a prostate biopsy. An MRI scan, a bone scan and an x-ray may also be necessary.
A PSA blood test is the first test that is carried out on all men with suspected prostate cancer. Important figures in the evaluation of cancer risk are the ratios of total PSA and free PSA.
The guideline levels increase with age. The guideline level of total PSA is 3.3 micrograms per litre for men under the age of 56 and goes up to 6.2 micrograms per litre for men over the age of 67.
The lower the ratio of free PSA the higher the risk of prostate cancer. In addition to a high PSA level, a rapid increase in the levels may also point to prostate cancer, even if they do not exceed the guideline levels.
In addition to a PSA test, a urologist will examine the prostate to feel for any lumps or hardenings and check whether the prostate is symmetrical.
A urologist will also carry our an ultrasound scan via the anus, and a biopsy. The biopsy is done under local anaesthetic and 12 tissue samples are usually taken. Larger samples are taken from abnormal areas.
An MRI scan might also be necessary. This is the case particularly when the PSA level is high, but no cancer cells have been found or if there is uncertainty as to whether the cancer has spread. MRI scans are rapidly becoming more common and they enhance diagnostics.
An isotope bone scan is carried out when metastatic prostate cancer is suspected. A bone scan is required when the PSA level is over 20 or with aggressive forms of prostate cancer. The bone scan is used to detect any bone metastases. This test can also be supplemented, if necessary, with an x-ray or MRI scan of the metastases.
Professor Teuvo Tammela from the University of Tampere was interviewed for this article.